Maternal and Child Health (MCH) Services Block Grant
Updated March 7, 2018
Maternal and Child Health (MCH) Services Block Grant
The Maternal and Child Health (MCH) Services Block
each state who are at or below 100% of the federal poverty
Grant is a federal-state partnership program that aims to
level (FPL) as a proportion of the total number of children
improve the health of low-income pregnant women,
at or below 100% of the FPL for all states. The 2018 FPL
mothers, and children. In addition, the program aims to
for a family of four is $25,100.
connect low-income families with other services and
programs, such as Medicaid and the State Children’s Health
States are required to use at least 30% of their block grant
Insurance Program (CHIP). The MCH Services Block
allocations for the population of children with special health
Grant program is administered by the Maternal and Child
care needs (CSHCNS), 30% for services for preventive and
Health Bureau (MCHB) of the Health Resources and
primary care services for children, and 40% for services for
Services Administration (HRSA) in the Department of
either of these groups or for other appropriate maternal and
Health and Human Services (HHS). The program is
child health activities (SSA, §504(d)). However, states may
authorized under Title V of the Social Security Act of 1935
use no more than 10% of their federal allocations for
(SSA; P.L. 74-121).
administrative costs. CSHCNs are infants and children who
have or are at risk of having a disability, chronic
The MCH Services Block Grant program has three
illness/condition, or educational/behavioral issue.
components: (1) block grants to states, (2) the Special
Projects of Regional and National Significance (SPRANS)
Special Projects of Regional and National
program, and (3) the Community Integrated Service
Significance (SPRANS)
Systems (CISS) program.
The SPRANS program is a set-aside that provides
competitive grants for research and training programs and
Block Grants to States
services related to maternal and child health, and CSHCNS.
The block grants to states program is a block grant within
SPRANS grants are awarded to (1) public or nonprofit
the MCH Services Block Grant that provides formula-based
private institutions of higher learning that train health care
grants to enable states to undertake a number of activities
and maternal and child health personnel, and (2) public or
that, among other things, aim to ensure that quality health
nonprofit private organizations or institutions of higher
care is provided to mothers and children, particularly to
learning that conduct maternal and child health research.
those with low incomes or limited availability of care.
Block grants to states are awarded to all 50 states, the
Use of SPRANS Funds
District of Columbia, and eight jurisdictions (referred to
SPRANS funds may be used for genetic disease testing,
collectively as states). The eight jurisdictions are American
counseling, and information development and
Samoa, Federated States of Micronesia, Guam, Marshall
dissemination programs; for grants relating to hemophilia
Islands, Northern Mariana Islands, Palau, Puerto Rico, and
without regard to age; for the screening of newborns for
the U.S Virgin Islands.
sickle cell anemia and other genetic disorders; and for
follow-up services. Generally, the priority for funding
Use of Block Grants by States
SPRANS projects is determined by HRSA; however,
Block grants may be used by states “to provide and to
Congress has sometimes provided specific directives for
assure [that] mothers and children (in particular those with
certain programs, including set-asides. For example,
low income or with limited availability of health services)
Congress provided SPRANS set-aside funds for oral health
[have] access to quality maternal and child health services”
($5.24 million), epilepsy ($3.63 million), sickle cell ($2.99
(SSA, §501(a)(1)(A)). States determine the actual services
million), and fetal alcohol syndrome ($0.48 million) in
provided under the block grant. For example, a state may
FY2017.
provide medical services in sectors where public and
private health insurers offer limited coverage options, such
Community Integrated Service Systems
as coverage for dental and durable medical equipment (e.g.,
(CISS)
wheelchairs and oxygen equipment).
The CISS program is a set-aside that provides competitive
grants to support development and expansion of a variety of
Individual State Allocation
service delivery strategies. CISS grants are awarded to
Individual state allocations are determined by a formula that
public and private organizations or institutions.
compares the proportion of low-income children in a state
with the total number of low-income children within all
Use of CISS Funds
states. Specifically, the first $422 million of the amount
CISS funds may be used for home visitation, integrated
appropriated is distributed to each state based on the
service delivery systems, services to rural populations,
amount the state received under the consolidated maternal
outpatient and community-based services for CSHCNs, and
and child health programs in 1983. Any funds above that
increased participation of obstetricians and pediatricians
amount are distributed based on the number of children in
under Medicaid and the Title X Family Planning program.
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Maternal and Child Health (MCH) Services Block Grant
Appropriation
Figure 2. Percentage of Individuals Served Under the
The MCH Services Block Grant was funded at $640.2
MCH Services Block Grant Program, by Classification,
million in FY2017. Of the FY2017 amount, an estimated
FY2016
$10.3 million (1.6%) was for CISS, $80.4 million (12.6%)
was for SPRANS, and $549.5 million (85.8%) was for
block grants to states. See Figure 1 for the past six years of
appropriations.
Figure 1. Appropriations to the MCH Services Block
Grant, FY2012-2017
($ in millions)
Source: Figure prepared by CRS using data from HRSA, “Explore
the Title V Federal-Partnership,” https://mchb.tvisdata.hrsa.gov/.
Notes: “Others” includes women of childbearing age and any others
who are not classified by the state.
State and National Reporting
Requirements
Source: Figure was prepared by CRS using annual HRSA budget
Each state must prepare and submit an annual report to the
justifications and appropriations legislation for the relevant years.
Secretary of HHS on all MCH Services Block Grant
Note: Funding levels are not adjusted for inflation.
activities. Specifically, these reports must include
information on program participation, standardized
Allocation of Funding by Formula
measures of maternal and child health, and data on maternal
The MCH Services Block Grant is allocated by formula.
and child health systems, including measures of the
The allocation requirements are as follows (42 U.S. Code
pediatric and family practice workforce. HRSA must
§702(a)):
annually compile the information reported by states and
present the data to the House Committee on Energy and
For an appropriation that is above $600 million.
Commerce and the Senate Committee on Finance in a
report to Congress.
Part 1. The CISS program receives 12.75% of the amount
that exceeds $600 million. Of the remaining exceeding
Discussion
amount, SPRANS receives 15% of it. Block grants to states
According to HRSA’s FY2017 Annual Performance
receive the remainder.
Report, “The MCH Services Block Grant program also
serves as the payer of last resort. In cases where no
Part 2. The SPRANS program receives 15% of the amount
resources or services are available, states use their block
that is at or below $600 million. Block grants to states
grants to fund direct care services, such as prenatal care,
receive the remainder.
pediatric specialty care, or services for children with special
health care needs.” See HRSA, FY2017 Annual
For an appropriation that is at or below $600 million.
Performance Report, p. 34, https://www.hrsa.gov/sites/
default/files/hrsa/about/budget/fy17annualperformancerepo
The SPRANS program receives 15% of the total
rt.pdf. Therefore, any change in current state funding levels
appropriation. Block grants to states receive the remainder.
under programs such as Medicaid and the Title X Family
The CISS program is not funded.
Planning program may cause states to change the amount of
funding they request through the MCH Services Block
Population Served
Grant program.
In FY2016 (the most recent available data), 76,405,066
individuals were served (see Figure 2). Of the total served,
Victoria L. Elliott, Analyst in Health Policy
46,862,500 were children aged 1 up to 22 years; 15,046,754
were others; 7,373,507 were CSHCNs; 3,789,175 were
IF10777
infants; and 3,333,130 were pregnant women.
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Maternal and Child Health (MCH) Services Block Grant
Disclaimer
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