Updated March 7, 2018
Maternal and Child Health (MCH) Services Block Grant
The Maternal and Child Health (MCH) Services Block
Grant is a federal-state partnership program that aims to
improve the health of low-income pregnant women,
mothers, and children. In addition, the program aims to
connect low-income families with other services and
programs, such as Medicaid and the State Children’s Health
Insurance Program (CHIP). The MCH Services Block
Grant program is administered by the Maternal and Child
Health Bureau (MCHB) of the Health Resources and
Services Administration (HRSA) in the Department of
Health and Human Services (HHS). The program is
authorized under Title V of the Social Security Act of 1935
(SSA; P.L. 74-121).
The MCH Services Block Grant program has three
components: (1) block grants to states, (2) the Special
Projects of Regional and National Significance (SPRANS)
program, and (3) the Community Integrated Service
Systems (CISS) program.
Block Grants to States
The block grants to states program is a block grant within
the MCH Services Block Grant that provides formula-based
grants to enable states to undertake a number of activities
that, among other things, aim to ensure that quality health
care is provided to mothers and children, particularly to
those with low incomes or limited availability of care.
Block grants to states are awarded to all 50 states, the
District of Columbia, and eight jurisdictions (referred to
collectively as states). The eight jurisdictions are American
Samoa, Federated States of Micronesia, Guam, Marshall
Islands, Northern Mariana Islands, Palau, Puerto Rico, and
the U.S Virgin Islands.
Use of Block Grants by States
Block grants may be used by states “to provide and to
assure [that] mothers and children (in particular those with
low income or with limited availability of health services)
[have] access to quality maternal and child health services”
(SSA, §501(a)(1)(A)). States determine the actual services
provided under the block grant. For example, a state may
provide medical services in sectors where public and
private health insurers offer limited coverage options, such
as coverage for dental and durable medical equipment (e.g.,
wheelchairs and oxygen equipment).
Individual State Allocation
Individual state allocations are determined by a formula that
compares the proportion of low-income children in a state
with the total number of low-income children within all
states. Specifically, the first $422 million of the amount
appropriated is distributed to each state based on the
amount the state received under the consolidated maternal
and child health programs in 1983. Any funds above that
amount are distributed based on the number of children in
each state who are at or below 100% of the federal poverty
level (FPL) as a proportion of the total number of children
at or below 100% of the FPL for all states. The 2018 FPL
for a family of four is $25,100.
States are required to use at least 30% of their block grant
allocations for the population of children with special health
care needs (CSHCNS), 30% for services for preventive and
primary care services for children, and 40% for services for
either of these groups or for other appropriate maternal and
child health activities (SSA, §504(d)). However, states may
use no more than 10% of their federal allocations for
administrative costs. CSHCNs are infants and children who
have or are at risk of having a disability, chronic
illness/condition, or educational/behavioral issue.
Special Projects of Regional and National
Significance (SPRANS)
The SPRANS program is a set-aside that provides
competitive grants for research and training programs and
services related to maternal and child health, and CSHCNS.
SPRANS grants are awarded to (1) public or nonprofit
private institutions of higher learning that train health care
and maternal and child health personnel, and (2) public or
nonprofit private organizations or institutions of higher
learning that conduct maternal and child health research.
Use of SPRANS Funds
SPRANS funds may be used for genetic disease testing,
counseling, and information development and
dissemination programs; for grants relating to hemophilia
without regard to age; for the screening of newborns for
sickle cell anemia and other genetic disorders; and for
follow-up services. Generally, the priority for funding
SPRANS projects is determined by HRSA; however,
Congress has sometimes provided specific directives for
certain programs, including set-asides. For example,
Congress provided SPRANS set-aside funds for oral health
($5.24 million), epilepsy ($3.63 million), sickle cell ($2.99
million), and fetal alcohol syndrome ($0.48 million) in
FY2017.
Community Integrated Service Systems
(CISS)
The CISS program is a set-aside that provides competitive
grants to support development and expansion of a variety of
service delivery strategies. CISS grants are awarded to
public and private organizations or institutions.
Use of CISS Funds
CISS funds may be used for home visitation, integrated
service delivery systems, services to rural populations,
outpatient and community-based services for CSHCNs, and
increased participation of obstetricians and pediatricians
under Medicaid and the Title X Family Planning program.
https://crsreports.congress.gov
Maternal and Child Health (MCH) Services Block Grant
Appropriation
The MCH Services Block Grant was funded at $640.2
million in FY2017. Of the FY2017 amount, an estimated
$10.3 million (1.6%) was for CISS, $80.4 million (12.6%)
was for SPRANS, and $549.5 million (85.8%) was for
block grants to states. See Figure 1 for the past six years of
appropriations.
Figure 2. Percentage of Individuals Served Under the
MCH Services Block Grant Program, by Classification,
FY2016
Figure 1. Appropriations to the MCH Services Block
Grant, FY2012-2017
($ 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
justifications and appropriations legislation for the relevant years.
Note: Funding levels are not adjusted for inflation.
Allocation of Funding by Formula
The MCH Services Block Grant is allocated by formula.
The allocation requirements are as follows (42 U.S. Code
§702(a)):
For an appropriation that is above $600 million.
Part 1. The CISS program receives 12.75% of the amount
that exceeds $600 million. Of the remaining exceeding
amount, SPRANS receives 15% of it. Block grants to states
receive the remainder.
Part 2. The SPRANS program receives 15% of the amount
that is at or below $600 million. Block grants to states
receive the remainder.
For an appropriation that is at or below $600 million.
The SPRANS program receives 15% of the total
appropriation. Block grants to states receive the remainder.
The CISS program is not funded.
Population Served
In FY2016 (the most recent available data), 76,405,066
individuals were served (see Figure 2). Of the total served,
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
infants; and 3,333,130 were pregnant women.
Each state must prepare and submit an annual report to the
Secretary of HHS on all MCH Services Block Grant
activities. Specifically, these reports must include
information on program participation, standardized
measures of maternal and child health, and data on maternal
and child health systems, including measures of the
pediatric and family practice workforce. HRSA must
annually compile the information reported by states and
present the data to the House Committee on Energy and
Commerce and the Senate Committee on Finance in a
report to Congress.
Discussion
According to HRSA’s FY2017 Annual Performance
Report, “The MCH Services Block Grant program also
serves as the payer of last resort. In cases where no
resources or services are available, states use their block
grants to fund direct care services, such as prenatal care,
pediatric specialty care, or services for children with special
health care needs.” See HRSA, FY2017 Annual
Performance Report, p. 34, https://www.hrsa.gov/sites/
default/files/hrsa/about/budget/fy17annualperformancerepo
rt.pdf. Therefore, any change in current state funding levels
under programs such as Medicaid and the Title X Family
Planning program may cause states to change the amount of
funding they request through the MCH Services Block
Grant program.
Victoria L. Elliott, Analyst in Health Policy
https://crsreports.congress.gov
IF10777
Maternal and Child Health (MCH) Services Block Grant
Disclaimer
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https://crsreports.congress.gov | IF10777 · VERSION 5 · UPDATED