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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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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