MATERNAL AND CHILD HEALTH

Maternal and Child Health Block Grant

Authorizing Legislation - Title V of the Social Security Act.

FY 2008 Authorization................................................................................................$850,000,000

Statement of the Budget Request - The FY 2008 Budget is equal to the FY 2007 Continuing Resolution (CR).

Program Description - The mission of the Maternal and Child Health (MCH) Block Grant Program, as authorized under Title V of the Social Security Act, is to improve the health of all mothers, children, and their families. Specifically the program seeks to: (1) assure access to quality care, especially for those with low-incomes or limited availability of care; (2) reduce infant mortality; (3) provide and ensure access to comprehensive prenatal and postnatal care to women (especially low-income and at risk pregnant women); (4) increase the number of children receiving health assessments and follow-up diagnostic and treatment services; (5) provide and ensure access to preventive and child care services as well as rehabilitative services for certain children; (6) implement family-centered, community-based, systems of coordinated care for children with special health care needs (CSHCN); and (7) provide toll free hotlines and assistance in applying for services to pregnant women with infants and children who are eligible for Title XIX (Medicaid).

These legislated responsibilities are consistent with the Department’s current emphasis on reducing racial differences, building capacity and infrastructure for child health, and ensuring quality care. They are also consistent with the President’s New Freedom Initiative which states that “the Health and Human Services (HHS) Health Resources and Services Administration, will take the lead in partnership with States, tribes and other organizations, in developing and implementing a plan to achieve appropriate community-based service systems for children and youth with special health care needs and their families.” (Reference: Delivering on the Promise: Preliminary Report of Federal Agencies’ Actions to Eliminate Barriers and Promote Community Integration. Presented to the President of the United States December 21, 2001.)

Section 502 of the Social Security Act states that of the amounts appropriated, up to $600,000,000, 85% is for allocation to the States, and 15 % is for Special Projects of Regional and National Significance (SPRANS) activities. Any amount appropriated in excess of $600,000,000 is distributed as follows: 12.75% is for Community Integrated Service Systems (CISS) activities; of the remaining amount, 85% is for allocation to the States, and 15% is for SPRANS activities.

The MCH Block Grant is at its core a public health program that reaches across economic lines to improve the health of all mothers and children. Created as a partnership with State MCH programs and with broad State discretion, State Title V programs use appropriated formula grant funds for: capacity and systems building, public information and education, knowledge development, outreach and program linkage, technical assistance, provider training, evaluation, support for newborn screening, and genetic services, lead poisoning and injury prevention, additional support services for children with special health care needs, and promotion of health and safety in child care settings.

Special efforts are made to build community capacity to deliver such enabling services as care coordination, transportation, home visiting, and nutrition counseling. Where no services are available, States also use Title V to provide categorical direct care such as prenatal care or services for children with special health care needs.

The accompanying pyramid graphically shows the Title V MCH approach to, and resources for providing comprehensive services for mothers and children. It also displays the uniqueness of the MCH Block Grant, the only Federal program that consistently supports services and activities at all levels of the pyramid. Functions related to infrastructure building are at the base of the pyramid and form its foundation.

Additional activities that support the improved health care of mothers and children are SPRANS and CISS. SPRANS funds support projects (through grants, contracts, and other mechanisms) in research, training, genetic services and newborn screening and follow-up, hemophilia, and maternal and child health improvement. SPRANS projects must:

· Support national needs and priorities or emerging issues.

• Have regional or national significance.
• Demonstrate ways to improve State systems of care for mothers and children.

CISS projects (through grants, contracts, and other mechanisms) seek to increase the capacity for service delivery at the local level and to foster formation of comprehensive, integrated, community level service systems for mothers and children using six specified strategies:

• Provide maternal and infant home health visiting, health education, and related support services for pregnant women and infants up to one year old.
• Increase participation of obstetricians and pediatricians under Titles V and XIX.
• Integrate MCH service delivery systems.
• Operate MCH centers under the direction of not-for-profit hospitals.
• Increase MCH projects in rural areas.
• Provide outpatient and community-based services for children with special health care needs.

D-link

Resources actually expended in FY 2005, including Federal, State and local MCH funds were distributed along the pyramid as follows: Direct Health Care Services, 58.6%; Enabling Services, 21%; Population-Based Services, 11.1%; and Infrastructure Building Services, 9.3%.

Rationale for the Budget Request - The FY 2008 Budget of $693,000,000 is the equal to the FY 2007 CR.

Of the total amount requested, $573,957,768 is for State Block Grant awards and $119,042,232 is available for the SPRANS and CISS set-asides.

Title V is the only Federal program that focuses solely on improving the health of all mothers, adolescents and children, whether insured or not, through a broad array of public health and community-based programs that are designed and carried out through well-established Federal/State partnerships. State Title V programs support capacity and infrastructure building, population-based and enabling services, as well as direct health care services where no services are available. In these latter roles, Title V programs serve as a safety net for uninsured and underinsured children, including CSHCN. Title V continues to play a valuable, complementary role to SCHIP and Medicaid programs. States will also be able to continue using MCH Block grant funds for newborn hearing screening activities.

SPRANS and CISS funds support innovative projects in the area of: applied MCH research; MCH Leadership training in areas such as neurodevelopmental disabilities, developmental behavioral pediatrics, pediatric pulmonary centers, pediatric dentistry, nursing, nutrition, schools of public health, adolescent health; expansion of genetics services capacity, hemophilia treatment centers; and a variety of MCH Improvement Projects (MCHIP) including, adolescent health, SIDS, “Bright Futures” guidelines for practitioners; medical homes; and child care health and safety. SPRANS and CISS both complement and help ensure the success of State Title V, Medicaid, and SCHIP programs, building community capacity to create family-centered, integrated systems of care for mothers and children, including children with special health care needs.

Funding levels for the Maternal and Child Health Block Grant during the last five years reflect this effort and are as follows:

Outputs

* MCH Improvement Projects

Performance Analysis - The Title V Block grant program provides support to all 59 States and Territories to address three overarching goals: 1) improving access to health care; 2) eliminating health disparities; and 3) improving the quality of health care. In addressing the improvement of access to health care, the program has been able to increase both the number of children served by the States under Title V (to 27.8 million in FY 2005) and the number of children receiving Title V services who have Medicaid and State Child Health Insurance Program (SCHIP) coverage (10.1 million in FY 2005). Increased coverage under Medicaid and SCHIP for children receiving Title V services assures access, availability, and continuity of care to a wide range of preventive and acute care services. These increases are significant as they occurred in a period of severe financial constraints at the State and local levels. The 10.1 million is a significant increase over the FY 2002 baseline.

Title V programs work towards the elimination of health disparities in health outcomes through the removal of economic, social, and cultural barriers to receiving comprehensive, timely, and appropriate health care. In the effort to eliminate health disparities, progress toward reducing the infant mortality rate continued and the FY04 rate of 6.8 infant deaths per 1,000 live births was lower than the target. The ratio of the black infant mortality rate to the white infant mortality rate decreased from 2.48:1 to 2.44:1 from FY 2002 to FY 2004 (National Vital Statistics Reports). While progress in the timely initiation of prenatal care for all population groups has been made over the past decade, the rate of increase has been slow in recent years. Further information on this program’s performance is presented in “Details of Performance Analysis.”

The Title V Block grant was reviewed by OMB for the FY 2004 Budget using the Program Assessment Rating Tool (PART) and received a rating of Moderately Effective. To further identify performance issues, the program is conducting an evaluation of the results of the States’ investment in health systems infrastructure.

In FY 2004, the Title V Block Grant program initiated a customer satisfaction survey utilizing the American Customer Satisfaction Index (a standardized methodology used by both public and private sectors). Recipients of the Title V Block grantees’ services were surveyed. As a result, the program received a score of 91 out of a possible 100, the second highest score ever recorded for a government program.