Maternal and Child Health Block Grant

NC Division of Public Health Women’s and Children’s Health Section

Kelly Kimple, MD, MPH, FAAP September 26, 2017

Title V - Maternal and Child Health Block Grant Program • Nation’s oldest federal-state partnership

• Aims to improve health and well-being of all mothers and children by − investing in the health of mothers, children & families − improving accountability of performance and impact − demonstrating returns on investment while

maintaining state flexibility

Title V Goals – MCHB/ HRSA • Access to quality care, especially for people with low-incomes

or limited availability of care • Assistance in reduction of infant mortality • Access to comprehensive prenatal and postnatal care for

women, especially low-income and at-risk pregnant women • An increase in health assessments and follow-up diagnostic

and treatment services • Access to preventive and child care services as well as

rehabilitative services for certain children • Family-centered, community-based systems of coordinated

care for children with special health care needs • Toll-free hotlines and assistance in applying for services to

pregnant women with infants and children who are eligible for Title XIX (Medicaid)

Maternal and Child Health Block Grant • First award in 1980

• Annually awarded for the federal fiscal year (October 1 – September 30)

• 2 years to spend the award

• Funds awarded by formula–on the basis of the number of children in poverty in a state in relation to the total number of such children nationally

MCHBG Requirements • Requirements for use of federal MCHBG funds:

• ≥30% preventive and primary care services for children • ≥30% services for children with special health care

needs • ≤10 percent may be used for administering funds

• States must provide a three dollar match for every four Federal dollars allocated

• Maintenance of effort requirement • State will maintain level of funds being provided for

MCH programs at least equal to the level provided in FY 1989

Federal funding for MCHBG

• Decreased by $92 million since FY 2003

Association of Maternal and Child Health Programs, February 2016

Overall buying power has decreased

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6000000

8000000

10000000

12000000

14000000

16000000

18000000

20000000

Impact of Inflation on MCHBG for North Carolina* *difference between data points for each year is the actual award less the CPI

rate adjusted award using the 1981 award as the standard

Annual Award Inflation Adjusted Award

MCHBG – State Side

• Block Grant Plans approved on a state fiscal year (July 1 – June 30) basis through the Budget Act

• An annual plan is proposed by DHHS and certified with legislative approval

• Funding must adhere to federal requirements

• General Assembly may designate funding for particular activities and/or organizations

MCHBG – State Side

• Designated set-aside amounts must come from available funds in category assigned − Therefore, existing allocations in those categories must be reduced − Designated allocations mostly are in the local services categories

MCHBG – State Side • Since 2011, # of programs and amount of money set

aside by the NC General Assembly has increased to 39% of entire MCHBG in 2017

7.65% 6.73%

11.70%

15.72%

23.06% 22.26%

38.73%

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

FY 11-12 FY 12-13 FY 13-14 FY 14-15 FY 15-16 FY 16-17 FY 17-18

Per

cent

of t

otal

pla

n

Legislated set-asides in the Maternal and Child Health Block Grant state plan

MCHBG – Local Public Health • As a result, “Healthy Mothers, Healthy Children” funding to local health departments has declined

$12,000,000

$12,500,000

$13,000,000

$13,500,000

$14,000,000

$14,500,000

$15,000,000

$15,500,000

$16,000,000

$16,500,000

$17,000,000

SFY 10-11 SFY 11-12 SFY 12-13 SFY 13-14 SFY 14-15 SFY 15-16 SFY 16-17 SFY 17-18**

Healthy Mothers Healthy Children Funding Trends

MCHBG – Local Public Health • Money to fund MCHBG legislated set-asides mostly comes

from local health department (LHD) funding (i.e., no new resources provided) − This in part has been to maintain compliance with Title V statute

• Even with the attempt to minimize impact, LHDs absorb largest share of reductions

• LHDs are critical, especially in rural areas with limited resources and health care access issues

• LHDs have experienced cumulative reductions, now concern for damaging infrastructure to provide safety net services and programs for pregnant women, infants/children and women

•  Impacts LHDs ability to offer medical services as a safety net provider and evidence-based programs for maternal and child health

MCHBG Local Public Health • LHDs may receive: − State and Federal funding − County appropriations − Local revenues (i.e. grants) − Medicaid revenues

• Some counties are dependent on state and federal funding for maternal and/or child health services − 22.5% of LHD expenditures (SFY 15-16) overall came from

state/federal funding, but significant range by county − Some counties receive up to 92% of all maternal health

funding from state/federal sources and up to 100% of all child health funding from state/federal funding sources

MCHBG Local Program Expenditures

•  Child Health preventive/clinical services

•  Maternal Health/ Prenatal services •  Reproductive Life Planning •  Coordinated Care for Children (CC4C) •  Innovative Approaches for Children

with Special Health Care Needs •  Strengthening Families/Triple P •  Local Child Fatality Prevention Teams •  Medical genetics •  Newborn metabolic testing/ follow up •  Speech and Hearing •  Pregnancy Care Management •  Healthy Beginnings projects •  Oral Health •  Preconception Care

•  Nurse Family Partnership* •  Safe Sleep* •  Teen Pregnancy Prevention* •  March of Dimes* •  17 P* •  Carolina Pregnancy Care Fellowship* •  Prevent Blindness* •  Sickle Cell Centers* •  Perinatal Quality Collaborative •  Perinatal & Neonatal Outreach

Coordinator Contracts* •  Evidence-Based Programs in Counties

with Highest Infant Mortality Rates* •  Every Week Counts Demonstration

Project*

Programs reduced to support designated funding Legislated designated funding (*currently designated)

Questions