Maternal and Child Health Services Block Grant: Overview and Issues for Congress

Maternal and Child Health Services Block Grant: Overview and Issues for Congress

Maternal and Child Health Services Block
August 5, 2024
Grant: Overview and Issues for Congress
Alexandria K. Mickler
The Maternal and Child Health (MCH) Services Block Grant program aims to support and
Analyst in Health Policy
improve the health and well-being of mothers, children, and families, particularly those with low

income or limited access to health services. The program consists of three separate activities: (1)
the State MCH Block Grant program, (2) Special Projects of Regional and National Significance

(SPRANS), and (3) Community Integrated Service Systems (CISS). These activities are
permanently authorized under Title V, Section 501, of the Social Security Act (SSA). The program is administered by the
Maternal and Child Health Bureau (MCHB) in the Health Resources and Services Administration (HRSA), an agency of the
U.S. Department of Health and Human Services (HHS).
State MCH Block Grant
The State MCH Block Grant program is the nation’s oldest federal-state partnership and receives the largest proportion of
MCH Services Block Grant funding. States and jurisdictions (collectively referred to as states in this report) must match $3
for every $4 in federal funding allotted to the state; federal allotments are determined based on prior federal funding levels
and state-specific child poverty data. State MCH Block Grant funds aim to provide each state the flexibility to meet the
unique needs of its population of pregnant women, infants, and children, including children and youth with special health
care needs (CYSHCNs). State MCH Block Grant funds can be used to provide a variety of MCH services, including direct
health care services (e.g., preventive and primary care services), enabling services (e.g., case management and care
coordination services), and public health services and systems (e.g., workforce training and quality improvement activities).
Special Projects of Regional and National Significance
SPRANS funding provides grants for projects that aim to address national or regional needs, priorities, or emerging MCH
issues. SPRANS funding is intended to complement other MCH Block Grant activities and related federal programs by
building capacity through pilot programs, research, training, data, quality improvement, and workforce development. Specific
set-asides, such as for sickle cell disease research, and directives toward priority areas, such as reducing maternal morbidity
and mortality, are typically established through annual appropriations acts. The remaining funding supports additional
activities authorized by statute. Funding is open to a variety of entities, including institutions of higher learning, nonprofit
organizations, and community organizations.
Community Integrated Service Systems
CISS funding provides grants for projects aimed at increasing local service delivery capacity and fostering comprehensive
and integrated community services for MCH populations. CISS authorizing legislation specifically mentions the following
topics: MCH home visiting and case management, health education and social support services, health workforce
participation under Medicaid and the Title X Family Planning Program, integrated MCH delivery systems, and programs that
focus on rural populations and CYSHCNs. CISS funding is preferentially awarded to projects implemented in an area with a
high infant mortality rate.
Appropriations
Funding for the MCH Services Block Grant is discretionary and determined through the federal annual appropriations
process. Current law permanently authorizes $850 million across all three components from FY2001 onwards. In FY2024,
the program received an appropriation of $815.7 million. Of this amount, $593.3 million was allotted to the State MCH
Block Grant component (73%), $210.1 million to SPRANS (26%), and $10.3 million to CISS (1%). The President’s FY2025
budget request is $831.7 million.
Topics Covered in This Report
This report provides background, funding, and program information for each of the three program activities authorized in
Title V, Section 501. Additionally, it identifies selected MCH policy issues for Congress’s consideration. Other programs
authorized under SSA Title V are briefly summarized in Appendix L.
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Contents
Introduction ..................................................................................................................................... 1
History ....................................................................................................................................... 1
Funding ..................................................................................................................................... 3
State MCH Block Grant Program .................................................................................................... 4
Purpose ...................................................................................................................................... 4
Funding ..................................................................................................................................... 5
Nonuse and Redistribution .................................................................................................. 8
Services Provided ...................................................................................................................... 9
Service Requirements for Federal Funds ........................................................................... 11
Prohibited Services ............................................................................................................ 11
Expenditures by Service Category .................................................................................... 12
Populations Served .................................................................................................................. 13
Populations Reached ......................................................................................................... 14
Expenditures by Population Group ................................................................................... 15
Application and Reporting Requirements ............................................................................... 17
Needs Assessment and State Action Plan ......................................................................... 17
Relationship with Medicaid .............................................................................................. 18
Relationship with Other Programs .................................................................................... 19
Performance Measurement Framework ............................................................................ 19
Additional Reporting Requirements ................................................................................. 23
Special Projects of Regional and National Significance (SPRANS)............................................. 23
Grant Recipients ...................................................................................................................... 24
Funding and Program Topics .................................................................................................. 24
Community Integrated Service Systems (CISS) ........................................................................... 27
Grant Recipients ...................................................................................................................... 27
Funding and Program Topics .................................................................................................. 28
Issues for Congress ........................................................................................................................ 29
Funding ................................................................................................................................... 29
State MCH Block Grant: Relationships with Related Programs ............................................. 31
Oversight and Accountability .................................................................................................. 32

Figures
Figure 1. MCH Services Block Grant Funding, by Component ..................................................... 4
Figure 2. State MCH Block Grant: Federal Allotments .................................................................. 7
Figure 3. State MCH Block Grant Funding, by Source ................................................................... 8
Figure 4. MCH Pyramid of Services and Illustrative Examples ................................................... 10
Figure 5. State MCH Block Grant Expenditures, by Service Category ........................................ 12
Figure 6. State MCH Block Grant Expenditures, by Service Category, FY2018-FY2022 ........... 13
Figure 7. State MCH Block Grant Distribution of Populations Reached, by Service
Category ..................................................................................................................................... 15
Figure 8. State MCH Block Grant Distribution of Expenditures, by Population Group ............... 16
Figure 9. State MCH Block Grant Expenditures, by Population Group, FY2018-FY2022 .......... 16
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Figure 10. State MCH Block Grant Application/Annual Report Timeline ................................... 18

Figure E-1. State MCH Block Grant Expenditures, by Service Category and
Funding Source .......................................................................................................................... 39
Figure G-1. State MCH Block Grant Expenditures, by Population Group and
Funding Source .......................................................................................................................... 41

Tables
Table 1. Performance Measurement Framework ........................................................................... 20
Table 2. Special Projects of Regional and National Significance (SPRANS) ............................... 25

Table A-1. MCH Services Block Grant Federal Funding History ................................................. 33
Table B-1. State MCH Block Grant Funding, by State ................................................................. 34
Table D-1. State MCH Block Grant Funds, by Funding Source ................................................... 38
Table F-1. State MCH Block Grant Expenditures, by Service Category ...................................... 40
Table H-1. State MCH Block Grant Expenditures, by Population Group ..................................... 42
Table I-1. List of National Performance Measures (NPM) ........................................................... 43
Table J-1. List of National Outcome Measures (NOM) ................................................................ 46
Table K-1. F2F HIC Legislation and Appropriation History ......................................................... 48

Appendixes
Appendix A. MCH Services Block Grant Federal Funding History ............................................. 33
Appendix B. State MCH Block Grant Funding, by State .............................................................. 34
Appendix C. Essential Public Health Services for MCH Populations .......................................... 37
Appendix D. State MCH Block Grant Funds, by Source (FY2018-FY2022) ............................... 38
Appendix E. State MCH Block Grant Expenditures, by Service Category and Funding
Source ......................................................................................................................................... 39
Appendix F. State MCH Block Grant Expenditures, by Service Category (FY2018-
FY2022) ..................................................................................................................................... 40
Appendix G. State MCH Block Grant Expenditures, by Population Group and Funding
Source ......................................................................................................................................... 41
Appendix H. State MCH Block Grant Expenditures, by Population Group (FY2018-
FY2022) ..................................................................................................................................... 42
Appendix I. State MCH Block Grant National Performance Measures ........................................ 43
Appendix J. State MCH Block Grant National Outcome Measures ............................................. 46
Appendix K. Family-to-Family Health Information Centers (F2F HIC): Legislation and
Appropriation History ................................................................................................................ 48
Appendix L. Other Title V Programs ............................................................................................ 49
Appendix M. Abbreviations Used in This Report ......................................................................... 51

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Contacts
Author Information ........................................................................................................................ 51

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Introduction
Title V of the Social Security Act (SSA; P.L. 74-271, as amended; 42 U.S.C. §§701-709)
permanently authorizes the Maternal and Child Health (MCH) Services Block Grant, which aims
to support and improve the health and well-being of mothers, children, and families, particularly
those with low income or with limited access to health care services. The program provides
services to pregnant women, infants, children, and children and youth with special health care
needs (CYSHCNs), though other individuals may also benefit from block grant-funded
activities.1 The MCH Services Block Grant is administered by the Maternal and Child Health
Bureau (MCHB) in the Health Resources and Services Administration (HRSA), an agency within
the U.S. Department of Health and Human Services (HHS).
SSA Section 501 permanently authorizes three activities within the MCH Services Block Grant
program (hereinafter referred to as components):
1. State MCH Block Grants (§501(a)(1)).2
2. Special Projects of Regional and National Significance (SPRANS; §501(a)(2)).
3. Community Integrated Service Systems (CISS; §501(a)(3)).
The first and largest component is awarded directly to states and other jurisdictions (referred to
hereinafter as states)3 through a formula-based, federal-state partnership. The State MCH Block
Grant program aims to provide states the flexibility to meet the unique needs of its population of
pregnant women, infants, and children. The remaining two components provide competitive grant
funding to projects that intend to complement state efforts to improve access to quality MCH
services. SPRANS projects focus on national or regional needs and priorities, including specific
set-asides or directives that are typically established through annual appropriations acts. CISS
projects aim to build comprehensive, integrated systems of care to improve access and outcomes
for all children, including CYSHCNs.
History
Title V of the Social Security Act (SSA), enacted by Congress in 1935, authorizes funding for
services and projects that are intended to improve the health of mothers and children. Originally,

1 This report uses “pregnant women” to refer to pregnant individuals who have the capacity to give birth to be
consistent with terms used in both Title V legislation and in the Health Resources and Services Administration’s
(HRSA’s) current Title V MCH Block Grant guidance documents, available at https://mchb.tvisdata.hrsa.gov/Home/
Resources. According to the MCHB, children and youth with special health care needs (CYSHCN) “have or are at
increased risk for having chronic physical, developmental, behavioral, or emotional conditions. They have conditions
such as asthma, sickle cell disease, epilepsy, anxiety, autism, and learning disorders. They may require more
specialized health and educational services to thrive, even though each child’s needs may vary.” For more information,
see https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn.
2 The State MCH Block Grant program is often referred to as “Title V MCH Services Block Grant to States Program,”
“MCH Block Grant,” “State Formula Grants,” or colloquially and simply as “Title V.” This report uses “State MCH
Block Grant” and “State MCH Block Grant Program” to avoid confusion with the overarching program and legislative
title (Title V—MCH Services Block Grant) and to align with the terms used in HRSA’s FY2024 and FY2025
Congressional Budget Justifications. This terminology also allows for nuanced descriptions of the three program
components authorized under Section 501 of Title V (State MCH Block Grants, SPRANS, and CISS). This report
focuses exclusively on the three programs authorized and described in SSA §§501-509. Additional information on
other Title V programs is available in Appendix L.
3 Referred to collectively as “states” in this report, all 50 states and nine jurisdictions are eligible to apply for the State
MCH Block Grant program. The nine jurisdictions consist of (1) American Samoa, (2) District of Columbia, (3)
Federated States of Micronesia, (4) Guam, (5) Marshall Islands, (6) Northern Mariana Islands, (7) Palau, (8) Puerto
Rico, and (9) U.S. Virgin Islands.
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four separate grant programs were created under the previous SSA statutory heading, “Title V–
Grants to States for Maternal and Child Welfare,” two of which related to MCH. These programs
aimed to (1) provide and improve health services for mothers and children, particularly those with
low-income or who live in rural settings, and (2) provide and improve health care services for
“children who are crippled or who are suffering from conditions which lead to crippling,”
respectively.4 Over time, additional categorical programs for low-income women and children
were added to both the SSA and the Public Health Service Act (PHSA).
In 1981, seven of the aforementioned programs were combined with Title V through the Omnibus
Budget Reconciliation Act of 1981 (OBRA 1981; P.L. 97-35).5 This consolidated and renamed
statute, “Title V–Maternal and Child Health Services Block Grant,” was intended to provide
states additional flexibility in determining how to use federal funds to address state-specific MCH
needs. It required each state to receive, at a minimum, the combined funding of the programs
consolidated under OBRA 1981 and authorized a federal set-aside for discretionary grants—
thereby establishing the SPRANS program.
The Omnibus Budget Reconciliation Act of 1989 (OBRA 1989; P.L. 101-239) made additional
changes to the MCH Services Block Grant. These changes increased the amount of federal
funding authorized, called for greater accountability, and created stricter application and reporting
requirements for states, including the requirement for a statewide needs assessment to be
conducted every five years in order to receive State MCH Block Grant Program funds. OBRA
1989 also introduced the requirement for states to maintain a level of state contributions equal to
or greater than that of the state contributions in 1989, known today as the Maintenance of Effort
level. Additionally, OBRA 1989 added Section 501(a)(3), which authorized federal funding to
develop and expand a variety of community-based care coordination services to “promote the
effective and efficient organization and utilization of resources to assure access to necessary
comprehensive services for children with special health care needs and their families.” This new
authorization designated funding to such services when the amount appropriated to the MCH
Services Block Grant exceeds $600 million; this component is now known as the CISS program.6
Most recently, the Maternal and Child Health Stillbirth Prevention Act of 2024 (P.L. 118-69)
amended the State MCH Block Grant and SPRANS programs by clarifying that federal funds
may be used toward programs or activities that aim to reduce the incidence of stillbirth, including
research, screening and surveillance programs, and other evidence-based programs.
In addition to the three components of the MCH Services Block Grant, current Title V legislation
authorizes funding for additional services and projects aimed to improve the health of mothers
and children, many of which were added or amended by the Patient Protection and Affordable
Care Act (ACA, P.L. 111-148, as amended). These include the Maternal, Infant, and Early
Childhood Home Visiting Program (MIECHV) and other categorical grant programs such as

4 The other two grant programs under the previous SSA statutory heading were related to child welfare services and
vocational rehabilitation for physically disabled individuals. For more information on programs contained in the
original statute, see https://www.ssa.gov/history/35actv.html#Part3.
5 The programs that were consolidated by P.L. 97-35 were maternal and child health and services for children with
special health needs; supplemental security income for children with disabilities; lead-based paint poisoning prevention
programs; genetic disease programs; sudden infant death syndrome programs; hemophilia treatment centers; and
adolescent pregnancy prevention grants.
6 Section 501(a)(3) authorized funds in FY1989, but the CISS program did not receive funds until FY1992. FY1992
was the first fiscal year since 1989 that appropriations for the Title V MCH Services Block Grant exceeded $600
million. Note that CISS is not explicitly mentioned by name in the SSA; however, the program is operationalized as
such by MCHB in alignment with the authorizing legislation.
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those focused on personal responsibility and abstinence education.7 A brief discussion of these
programs is available in Appendix J. This report focuses exclusively on the MCH Services Block
Grant program (authorized in SSA §501 and referred to in SSA §§501-509), which receives the
largest single federal appropriation of all programs authorized under Title V.8 Current law
permanently authorizes $850 million across all three components of the MCH Service Block
Grant program.9
Funding
Figure 1 displays the MCH Services Block Grant federal appropriation history by program
component from FY2020 through FY2024. Additional federal appropriation history appears in
Table A-1 in Appendix A.
SSA Section 502 mandates the following annual allocation formula (per fiscal year) for federal
funds across each of the MCH Services Block Grant components:
• SPRANS: 15% of the appropriation that does not exceed $600 million, and 15%
of funds remaining above $600 million after CISS funds are set aside.
• CISS: 12.75% of the appropriation that is above $600 million.
• State MCH Block Grants: remainder of the total federal appropriation.
Annual appropriations acts have frequently deviated from this formula. For example, the
Consolidated Appropriations Act, 2023 (CAA 2023; P.L. 117-328), mandated that no more than
$219.116 million of FY2023 funds would be made available to SPRANS and that $10.276
million would be made available for CISS, “notwithstanding sections 502(a)(1) and 502(b)(1) of
the Social Security Act.”10 Through this approach, Congress effectively increased the proportion
and amount of FY2023 funds allocated to SPRANS ($219.116 million, compared with $119.5
million per the §502 formula) and decreased the amount appropriated to CISS ($10.276 million,
compared with $28.394 million that would have been available under the §502 formula).
Conversely, Congress has used this approach to decrease the proportion of funds for SPRANS
and increase the proportion for CISS, such as in FY2014.11

7 Also authorized under SSA Title V, these programs are not part of the Title V MCH Services Block Grant programs
authorized under Section 501. To learn more about the Maternal, Infant, and Early Childhood Home Visiting
(MIECHV) program, see CRS In Focus IF10595, Maternal, Infant, and Early Childhood Home Visiting Program. To
learn more about the Personal Responsibility Education Program (PREP) and the Title V Sexual Risk Avoidance
Education Program (Title V SRAE), see CRS In Focus IF10877, Federal Teen Pregnancy Prevention Programs.
8 As of FY2024, the MCH Services Block Grant received $816.2 million. See Figure 1 and Table A-1 for additional
funding history.
9 P.L. 106-554 substituted “$850,000,000 for fiscal year 2001” for “$705,000,000 for fiscal year 1994” in introductory
provisions.
10 Consolidated Appropriations Act, 2023 (CAA 2023; P.L. 117-328), 136 STAT. 4856
11 The Consolidated Appropriations Act, 2014 (CAA 2014; P.L. 113-76), 128 STAT.364, designated not more than
$77.1 million to SPRANS (compared with $94.3 million per the §502 formula) and $10.3 million to CISS (compared
with $9.7 million under the §502 formula).
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Figure 1. MCH Services Block Grant Funding, by Component
FY2020–FY2024

Source: Figure created by CRS using final funding levels as reported in annual Department of Health and Human
Services, Health Resources and Services Administration (HRSA) Congressional Budget Justifications for FY2020-
2023. FY2024 figures reflect enacted totals, rather than final numbers, based on P.L. 118-47 and Congressional
Record, vol. 170, no. 51, book II, March 22, 2024, p. H1887.
Notes: MCH = Maternal and Child Health; FY = Fiscal Year. Amounts not adjusted for inflation.
State MCH Block Grant Program
The majority of MCH Services Block Grant funding is allotted to states through the formula-
based, State MCH Block Grant program. The State MCH Block Grant program is the oldest
federal-state partnership program and aims to “create partnerships that enable each
state/jurisdiction to address the health service needs of its mothers, infants, and children, which
includes children with special health care needs and their families.”12 State health agencies are
typically responsible for the overall administration and supervision of activities implemented
under the program.13
Purpose
Section 501(a)(1) of Title V establishes the purpose of the State MCH Block Grant program as
aiming to enable each state to
• ensure access to quality health care services for mothers and children,
particularly to those with low income or limited availability of care;
• reduce the number of infant deaths, preventable diseases, and children with
disabilities;
• reduce the incidence of stillbirth;
• reduce the need for inpatient and long-term care services;
• increase the number of children receiving immunizations, health assessments,
and follow-up diagnostic and treatment services;

12 HRSA, Explore the Title V Federal-State Partnership, https://grants6.tvisdata.hrsa.gov/Home.
13 SSA §509(b).
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• provide prenatal, delivery, and postpartum care for low-income, at risk-women;
• provide preventive and primary care services for low-income children;
• provide rehabilitation services for blind and disabled individuals under the age of
16 receiving benefits under Social Security Insurance (SSI) (Title XVI of the
SSA),14 if the services are not provided under Medicaid (SSA Title XIX);15
• promote and provide family-centered, community-based coordinated care
services for CYSHCNs; and
• facilitate the development of community-based systems of services for
CYSHCNs and their families.
According to HRSA, all State MCH Block Grant programs are guided by four key principles that
support the delivery of public health services and systems to address the needs of MCH
populations.16 These principles are as follows:
1. Delivery of MCH services within a public health service model.17
2. Data-driven programming and performance accountability.18
3. Partnerships with individuals, families, and family-led organizations to ensure
systems and services that support the interests of all MCH populations.
4. Health equity and assurance that all MCH populations achieve their full health
potential.
Funding
The State MCH Block Grant program receives the remaining federal appropriation after federal
funds for both SPRANS and CISS are allocated (see the “Funding” section above). All 50 states
and nine jurisdictions may apply for State MCH Block Grant funds. Historically, all 59 have
applied for and been awarded State MCH Block Grant funds since HRSA began administering the
program in 1981.19 Each state is responsible for using block grant funds to meet the unique needs
of its MCH populations in alignment with federal requirements.20
Federal funds are annually allotted to individual state recipients using a formula-based approach
that considers (1) the amount of federal funds historically allotted to each state, and (2) the
proportion of low-income children in each state relative to the total number of low-income
children nationwide. Specifically, the first $422 million of the annual federal appropriation is
distributed to each state based on the amount it received under the consolidated maternal and
child health program in FY1983.21 Remaining federal appropriations are distributed to each state

14 Title XVI of the SSA refers to Supplemental Security Income for the Aged, Blind, and Disabled.
15 Title XIX of the SSA refers to Grants to States for Medical Assistance Programs (Medicaid).
16 HRSA, Title V Maternal and Child Health Services Block Grant to State Program. Guidance and Forms for the Title
V Application/Annual Report, p. 2., OMB No: 0915-0172, https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/
DownloadContent?fileName=BlockGrantGuidance.pdf&isForDownload=False. Hereinafter HRSA, Title V Maternal
and Child Health Services Block Grant to State Program: Guidance and Forms for the Title V Application/Annual
Report.
17 See “Services Provided” for more information on HRSA’s suggested public health service model.
18 See “Application and Reporting Requirements” for more information on performance accountability.
19 Email correspondence with HRSA staff, February 16, 2024.
20 This report generally uses “states” to refer to both states and jurisdictions, except as noted.
21 This amount ($422 million) is the sum of the funding for the individual programs that were consolidated into the
Title V MCH Services Block Grant under OBRA 1981 (P.L. 97-35).
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using child poverty-based allotments.22 Historically, poverty allotments were calculated based on
data reported in the U.S. Census Bureau’s long-form decennial census. The annual American
Community Survey (ACS) replaced the decennial census as the block grant’s source for child
poverty data in FY2013.23 Historically, the U.S. Territories (American Samoa, Northern Mariana
Islands, Guam, U.S. Virgin Islands, and Puerto Rico) and the Freely Associated States (Federated
States of Micronesia, Marshall Islands, and Palau) have not been included in the ACS. For these
jurisdictions, HRSA distributes funds in excess of the 1983 level in a manner proportionate to
each jurisdiction’s share of overall State MCH Block Grant funding in 1983.24 This approach does
not incorporate poverty-based allotments.
In FY2022, the year for which the most recent federal data are available, final federal allotments
to individual states ranged from $150,340 (Palau) to $39.6 million (California).25 The distribution
of State MCH Block Grant federal funds by state in FY2022 is displayed in Figure 2 and is listed
in Table B-1 in Appendix B.

22 SSA §502(c).
23 From FY2013 to FY2016, block grant poverty allocations were based on three-year rolling ACS estimates. The
Census Bureau discontinued three-year ACS estimates for FY2017, prompting HRSA to use pooled data across three
one-year estimates. HRSA implemented a temporary change in this method due to ACS 2020 survey disruptions and
data quality issues resulting from the COVID-19 pandemic. Under this change, FY2020 ACS data were to be excluded
from poverty calculations for FY2023-FY2025. HRSA will resume three consecutive one-year estimates for FY2026
calculations. See https://www.federalregister.gov/documents/2022/09/09/2022-19477/notice-of-intent-to-make-
temporary-changes-in-the-state-title-v-maternal-and-child-health-block.
24 Email correspondence with MCHB staff, June 7, 2024.
25 Final state allocations for FY2023 were reported in HRSA’s FY2025 Congressional Budget Justification. However,
at the time of this report, the most recent data for all other metrics published on the Title V Information System (TVIS)
are from FY2022. As such, this report uses FY2022 figures for consistency. Full data for FY2023 is expected to be
available on the Title V Information System (TVIS) between November-December 2024; see
https://mchb.tvisdata.hrsa.gov/Home/StateApplicationOrAnnualReport.
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Figure 2. State MCH Block Grant: Federal Allotments
FY2022

Source: Figure created by CRS using final FY2022 federal funding allotments as reported in HRSA’s FY2024
Congressional Budget Justification, pp. 198-200.
As part of a federal-state partnership program, each state is required to match at least $3 for every
$4 of federal block grant funds allotted to the state.26 States must also maintain a level of state
contribution that is at or above the state’s total contribution from FY1989, known as the
Maintenance of Effort.27 States are allowed to exceed the match requirement; this is called an
overmatch.
HRSA categorizes the total funding for the State MCH Block Grant program as coming from five
sources:28
1. Federal Allocation: Federal funding provided to states under the MCH Services
Block Grant.
2. State MCH funds: Nonfederal funds derived from the state that are used for
program activities and meet the legislatively mandated match requirements.
3. Local MCH funds: MCH-dedicated funds from local governments or
jurisdictions within the state.
4. Program Income: Funds collected by state MCH agencies from insurance
payments, Medicaid, health maintenance organization (HMO) payments, private
grants/entities, etc.
5. Other federal funds: Monies other than Title V funds that are under control of
the person responsible for administering the Title V program (e.g., funds from
Centers for Disease Control and Prevention [CDC]; Healthy Start; and the

26 SSA §503(a).
27 SSA §504(a)(4). Each state’s FY1989 Maintenance of Effort total is documented by the state in the combined
Application/Annual Report, which are publicly available on the Title V Information System (TVIS).
28 HRSA, Title V Information System, Glossary, https://mchb.tvisdata.hrsa.gov/Glossary/Glossary.
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Supplemental Special Nutrition Program for Women, Infants, and Children
[WIC]).
States are allowed to put all nonfederal funding sources toward meeting the state match
requirement; that is, state MCH funds, local MCH funds, and program income may contribute to
the required maintenance of effort total (items 2-4 above).
In FY2022, state MCH funds constituted the largest proportion of total State MCH Block Grant
program funding (41.0%), whereas federal allocations accounted for 21.0% (see Figure 3).
Combining all five funding sources, the State MCH Block Grant program totaled an estimated
$2.65 billion in FY2022. Individual state totals across each of these five funding sources are
presented in Table B-1 in Appendix B. Trends in program expenditures by service category and
population group are discussed below (see “Expenditures by Service Category” and
“Expenditures by Population Group,” respectively). Unless otherwise noted, all expenditure data
hereinafter are inclusive of all funding sources.
Figure 3. State MCH Block Grant Funding, by Source
FY2022

Source: Figure created by CRS using final federal allocation data reported in HRSA’s FY2024 Congressional
Budget Justification, pp. 198-200. State funds, other local funds, and program income totals were extracted from
individual state Application/Annual Reports, Form 2, FY2022 Expenditures column. Each state Application/Annual
Report is located on HRSA’s Title V Information System (TVIS); https://mchb.tvisdata.hrsa.gov/Home/
StateApplicationOrAnnualReport.
Notes: TVIS funding data are estimates/projections that are collected once each year at the time of application
and are not meant to be the final fiscal record of note. The FY2022 expenditures presented above were
reported in July 2023 and thus may not reflect final state, local, or program income expenditures. Not all states
submit data on the “other funds” or “program income” categories.
Nonuse and Redistribution
According to SSA Section 502(d), if a state chooses not to apply for funds, is not qualified for
such funds, or indicates that it does not plan to use its full allotment, that state’s federal allotment
is redistributed among the remaining states in the proportion otherwise allotted to the state.29 All
states have applied for and been awarded funds since HRSA began administering the program in

29 SSA §502(d).
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1981.30 Each state has 24 months to expend its full federal allotment. MCHB staff monitor
expenditure drawdown and identify expenditure plans with any states that have more than one-
quarter of funds remaining at the 18-month mark. Any funds not expended at the end of the 24-
month period are returned to the U.S. Treasury Department.31
Services Provided
States are required to use State MCH Block Grant funds “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.”32 Specifically, states may use block
grant funds for the provision of health services and related activities, which may include
“planning, administration, education, and evaluation, including payment of salaries and other
related expenses of National Health Service Corps personnel.”33 According to MCHB, State
MCH Block Grant Programs are encouraged to incorporate the four key principles discussed in
the “Purpose” section above and to ensure that MCH systems are family centered, community
based, and culturally competent.34
The MCHB provides a guiding framework, known as the MCH Pyramid of Services, to support
states in identifying which MCH services and activities to fund with block grant resources.
Broadly, pyramid structures are used in various public health capacities to visually communicate
the potential impact of certain public health interventions, with the base of the pyramid reflecting
interventions that reach larger populations at once. Interventions that aim to change individual
contexts are presented in ascending order. The MCH Pyramid of Services is also referenced in
states’ Application/Annual Reports to measure program participation, reach, and expenditures
across three service categories: (1) direct health care services, (2) enabling services, and (3)
public health services and systems. Figure 4 contains definitions of each service category and an
illustrative, nonexhaustive list of examples by service category.

30 Email correspondence with HRSA staff, February 16, 2024.
31 Email correspondence with HRSA staff, April 29, 2024.
32 SSA §501(a)(1)(A).
33 SSA §504(a). For more information on the National Health Corps, see CRS Report R44970, The National Health
Service Corps.
34 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 82.
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Figure 4. MCH Pyramid of Services and Illustrative Examples

Direct Health Care Services
•
Primary care or emergency department visits
•
Inpatient services for CYSHCN
•
Occupational, physical, and/or speech therapy
•
Prescription drugs
•
Mental and behavioral health services
•
Durable medical equipment or medical supplies
•
Dental and/or vision care
Enabling Services
•
Translation and/or interpretation services
•
Case management and/or care coordination
•
Environmental health risk reduction activities
•
Health education for individuals and/or families
•
Outreach and/or eligibility assistance
•
Salary or operational support to health facilities that provide access to MCH care
Public Health Services and Systems
•
Development of policies, standards, and/or guidelines
•
Health promotion campaigns for MCH services (e.g., newborn screening, safe-sleep education)
•
Implementing MCH programs and/or evaluations
•
Health workforce development activities, such as training on MCH core competencies
•
Quality assurance and improvement activities
Source: Figure created by CRS using HRSA’s Title V Maternal and Child Health Services Block Grant to State
Program. Guidance and Forms for the Title V Application/Annual Report. pp. 82-83. OMB No: 0915-0172, illustrative
examples.
In addition to the MCH Pyramid of Services, the MCHB provides an illustrative list of 11
strategies for states to use in their program planning. This list draws upon (1) the three core
functions of public health, as defined by the Institute of Medicine; (2) the revised Ten Essential
Public Health Services; and (3) legislative requirements for Title V services.35 The full list of
strategies is presented in Appendix C. States also have the flexibility to implement additional

35 A 1988 Institute of Medicine (IOM) report defined the core functions of public health as assessment, policy
development, and assurance. For more information, see Institute of Medicine, The Future of Public Health, National
Academy Press, 1988. To ensure that the IOM functions were operationalized and supported the unique needs of
women and children, the MCH community worked with the Public Health Service and the IOM to further identify 10
Essential Public Health Services in 1994. For more information, see Public Health in America (1994), Washington,
DC: US Public Health Service, Essential Public Health Services Working Group of the Core Public Health Functions
Steering Committee. The IOM is now known as the National Academy of Medicine.
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frameworks or health service models to better understand how various factors influence the health
and well-being of a state’s unique MCH population.
Service Requirements for Federal Funds
States are required to use at least 30% of federal allocations for preventive and primary care
services for children and 30% for CYSHCNs.36 These requirements may be waived by the HHS
Secretary if the state (1) demonstrates “extraordinary unmet need” for either of the required
populations, and (2) provides assurances that some funds will be allocated toward each required
population by specifying the substitute percentages.37 This waiver may be requested in the state’s
annual application.38 Additionally, no more than 10% of federal allocations may be used for
administrative costs.39
Prohibited Services
Section 504 of the SSA prohibits the use of State MCH Block Grant funds for the following
activities:40
• inpatient services, other than for children with special health care needs, high-
risk pregnant women, and infants, unless otherwise approved by the Secretary of
HHS;
• cash payments to intended recipients of health services;
• purchase or improvement of land, buildings, or facilities (other than minor
remodeling), or the purchase of major medical equipment;41
• to satisfy any requirement for the expenditure of nonfederal funds as a condition
for the receipt of federal funds;42
• research or training at a private, for-profit entity,43 and
• payment for any item or service (other than an emergency item or service)
furnished by an individual, entity, or physician excluded under Titles V, XVIII,
XIX, or XX of the SSA.44

36 SSA §505(a)(3).
37 SSA §505(b)(1-2).
38 Based on a February 2024 CRS review of all FY2024 state applications, no states have requested this waiver.
39 SSA §504(d).
40 SSA §405(a-c).
41 Per SSA §504(b), “The Secretary may waive the limitation ... upon the request of a State if the Secretary finds that
there are extraordinary circumstances to justify the waiver and that granting the waiver will assist in carrying out this
title.”
42 For example, this requirement would seem to prohibit states from using federal allotments from the State MCH
Block Grant to satisfy a state match or maintenance of effort (MOE) requirement for other federal programs.
43 Per §504(c), “A State may use a portion of the amounts described in subsection (a) for the purpose of purchasing
technical assistance from public or private entities if the State determines that such assistance is required in developing,
implementing, and administering programs funded under this title.”
44 Title XVIII of the SSA refers to Health Insurance for the Aged and Disabled. Title XX of the SSA refers to Block
Grants and Programs for Social Services and Elder Justice, which includes the Social Services Block Grant (SSBG).
For more information on SSBG, see CRS Report 94-953, Social Services Block Grant: Background and Funding.
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Expenditures by Service Category
States are required to provide budgeted and actual program expenditure data as part of the
Application/Annual Report.45 This includes detail on all expenditures by service category (see
Figure 4), in addition to other requirements. Across all states and all five funding sources, the
largest proportion of FY2022 funds were expended on enabling services (40.7%), followed by
public health services and systems (31.2%), and direct health care services (28.1%) (see Figure
5).
Figure 5. State MCH Block Grant Expenditures, by Service Category
FY2022

Source: Figure created by CRS using data from HRSA’s Title V Information System (TVIS);
https://mchb.tvisdata.hrsa.gov/Financial/FundingByServiceLevel.
Notes: TVIS funding data are estimates/projections that are collected once each year at the time of application
and are not meant to be the final fiscal record of note. The FY2022 expenditures presented above were
reported in July 2023 and thus may not reflect final expenditures.
Within the category of direct health care services, states report on the types of direct services
provided using predefined categories; however, over half of direct services funds are allocated to
the category of other services. For example, in Texas, other direct services included home health
services, whereas Washington, DC, included adolescent mental health services under this
category. Conversely, California did not fund any direct services with State MCH Block Grant
program funding in FY2022. Additional detail on what other direct services include is available
in FY2024 Application/FY2022 Annual Reports among those states that provide direct services
with State MCH Block Grant funds. Figure E-1 in Appendix E displays FY2022 expenditures
by service category with an additional disaggregation of expenditures by federal and all
nonfederal funding sources.
From FY2018 to FY2019, direct services accounted for over 60% of total program expenditures;
more recently, expenditures have increasingly shifted toward enabling and public health services
and systems (see Figure 6). In FY2022, these two respective categories constituted over 85% of
total expenditures. Additional information on program expenditures, including changes in specific
dollar amounts, is available in Table F-1 in Appendix E.

45 Detailed section-by-section requirements are available on HRSA’s “Guidance and Documents” page, available at
https://mchb.tvisdata.hrsa.gov/Home/Resources.
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Figure 6. State MCH Block Grant Expenditures, by Service Category,
FY2018-FY2022

Source: Figure created by CRS using data from HRSA’s Title V Information System (TVIS);
https://mchb.tvisdata.hrsa.gov/Financial/FundingByServiceLevel.
Notes: TVIS data are estimates/projections that are collected once each year at the time of application and are
not meant to be the final fiscal record of note. State reporting on direct and enabling services does not include
services that are reimbursed by Medicaid, CHIP, or other public or private payers. Figure reflects total program
expenditures, inclusive of federal and nonfederal funds.
Populations Served
The populations served by the State MCH Block Grant include pregnant women, infants,
children, CYSHCN, and others. HRSA defines these five population groups as follows:
• Pregnant Women. A female from the date of conception to 60 days after
childbirth, delivery, or expulsion of the fetus.46
• Infants. Children less than one year old.
• Children. Children from age 1 through 21 years old.47
• Children and Youth with Special Health Care Needs (CYSHCN). CYSHCN
are infants and children who have or are at risk of having a disability, chronic
illness/condition, or educational/behavioral issue.48
• Others. This category consists of women and men who are over 21 years of
age.49

46 Maternal and Child Health Bureau, Glossary, Appendix K of the MCH Block Grant - Application/annual Report
Guidance, Appendix of Supporting Documents, https://mchb.tvisdata.hrsa.gov/Glossary/Glossary. Although not
defined in HRSA’s guidance documents, “expulsion of the fetus” may refer to birth and pregnancy outcomes that do
not result in a live birth, such as miscarriage, stillbirth, or abortion.
47 A pregnant female child is classified by HRSA as a pregnant woman.
48 Children who “have or are at risk of having chronic physical, development, behavioral, or emotional conditions” and
who generally require more intensive types or an increased volume of services than other children are considered as
children or youth with special health care needs. HRSA classifies infants (0-12 months) with special health care needs
as a child with special health care needs. See HRSA, Glossary, https://mchb.tvisdata.hrsa.gov/Glossary/Glossary.
49 Services for this group may include well-woman visits or other education and family-centered care provided to
parents/guardians.
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Populations Reached
Using annual state-reported data, the MCHB publishes estimates of the number of individuals
reached across each of the five population groups described above. These estimates are developed
by (1) quantifying the number of individuals who received direct and enabling services (i.e., the
top two categories in the MCH Services Pyramid; see Figure 4), and (2) estimating the
proportion of each population group who were reached by State MCH Block Grant-funded
services across all three service categories (i.e., direct, enabling, and public health services and
systems).
States typically derive estimates of the number of individuals reached by direct and enabling
services from reimbursement data or individual client service records. As part of the estimate,
states outline the total number of individuals served, by population group, and indicate the types
of health insurance coverage to ensure that only services funded by the State MCH Block Grant
without full reimbursement from another source (e.g., Medicaid, private health insurance) are
included in the final estimate.
Estimating the number of individuals reached through public health services and systems can be
challenging. For instance, quantifying the number of individuals who were exposed to a mass
media campaign, such as those promoting safe newborn sleep practices, can be difficult since
public health promotion activities do not typically measure the discrete number of individuals
who heard, saw, or were otherwise influenced by the message. With the design of public health
campaigns in mind, HRSA’s reporting forms guide recipients through the development of these
estimates using various denominators and data sources.50 To avoid double-counting, states are
encouraged to focus on the programs and services that have the largest reach for a given
population and approximate percentages for each numerator. States describe their methods, data
sources, and the specific programs or services that were included in the estimate as part of the
Application/Annual Report.
Across all three MCH service categories—direct, enabling, and public health services and
systems—over 108 million individuals were estimated to have been reached by State MCH Block
Grant activities in FY2022 (see Figure 7). The majority of recipients across the three service
categories were children aged 1-21 years (51%), followed by “others,” which includes men and
women over age 21 (34%). When examining population groups reached by direct and enabling
services only (11.9 million individuals), children continued to make up the majority of individuals
reached (51%). Combined, pregnant women, infants, children, and CYSHCN made up a larger
share of the population reached by both direct and enabling services (81%) compared with their
share across all three service categories (65%). This demonstrates that State MCH Block Grant-
funded direct and enabling services tend to focus primarily on pregnant women, infant, and child
populations (81%); however, a relatively larger proportion of other groups (34%) and a larger
overall population (108 million individuals compared with 11.9 million) is reached when
examining block grant activities across all three types of services, particularly since public health
services and systems aim to reach a broader population than that of direct and enabling services.

50 States are able to provide their own denominators; however, population denominators are generally derived from the
National Vital Statistics System, U.S. Census Bureau Population Estimates, and the National Survey of Children’s
Health. See https://mchb.tvisdata.hrsa.gov/Home, “Data Notes.”
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Figure 7. State MCH Block Grant Distribution of Populations Reached,
by Service Category
FY2022

Source: Figure created by CRS using data from HRSA’s Title V Information System (TVIS);
https://mchb.tvisdata.hrsa.gov/, see “Reporting Domains.”
Notes: TVIS data are estimates/projections that are collected once each year at the time of application and are
not meant to be the final fiscal record of note. For example, FY2022 data were reported in July 2023 and may
not reflect final totals of individuals reached. TVIS provides estimates only across these two aggregated
categories; separate totals by individual service category are not available. State reporting on direct and enabling
services does not include services that are reimbursed by Medicaid, CHIP, or other public or private payers. The
figure reflects individuals reached across all program activities, inclusive of those funded by federal and
nonfederal funds. “Others” include men and women over age 21.
Both of these estimates can be found in TVIS; however, TVIS does not provide individual
estimates for each of the three service categories. Rather, estimates are totaled across (1) direct
and enabling services, and (2) direct, enabling, and public health services and systems.
Considerable variation exists across individual states.
Expenditures by Population Group
In addition to annually reporting on expenditures by service category, states are also required to
report on program expenditures by each population group. In FY2022, children composed the
largest proportion of total expenditures (36.3%; see Figure 8). Notably, CYSHCN accounted for
nearly one-third (29.6%) of all program expenditures, yet this group accounted for 8.3% of the
total individuals served across all service categories (see “Populations Reached”). Conversely,
others accounted for the lowest proportion of expenditures (7.3%) despite representing over one-
third (34.5%) of individuals reached. Considerable variation in program expenditures by
population group exists across all states.
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Figure 8. State MCH Block Grant Distribution of Expenditures, by Population Group
FY2022

Source: Figure created by CRS using data from HRSA’s Title V Information System (TVIS);
https://mchb.tvisdata.hrsa.gov/Financial/FundingByIndividualsReached.
Notes: TVIS funding data are estimates/projections that are collected once each year at the time of application
and are not meant to be the final fiscal record of note. The FY2022 expenditures presented above were
reported in July 2023 and thus may not reflect final expenditures. “Others” include men and women over age 21.
CYSHCN refers to children and youth with special health care needs.
Figure G-1 in Appendix G displays FY2022 expenditures by population group with an
additional disaggregation of expenditures by federal and all nonfederal funding sources.
From FY2018 to FY2019, CYSHCNs accounted for approximately 70% of total program
expenditures; more recently, expenditures have increasingly shifted towards children, with
smaller increases towards pregnant women and infants (see Figure 9). Additional information on
expenditures by population group, including changes in specific dollar amounts, is available in
Table H-1 in Appendix H.
Figure 9. State MCH Block Grant Expenditures, by Population Group,
FY2018-FY2022

Source: Figure created by CRS using data from HRSA’s Title V Information System (TVIS); see
https://mchb.tvisdata.hrsa.gov/Financial/FundingByIndividualsServed.
Notes: TVIS data are estimates/projections that are collected once each year at the time of application and are
not meant to be the final fiscal record of note. For example, FY2022 data were reported in July 2023 and may
not reflect final expenditures. The figure reflects individuals reached across all program activities, inclusive of
those funded by federal and nonfederal funds.
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Application and Reporting Requirements
All block grant recipients must annually submit a combined application for the forthcoming fiscal
year along with an annual report for the prior fiscal year (hereinafter referred to as the
Application/Annual Report). This section provides a brief overview of some of the
Application/Annual Report requirements, including information on the program’s national
performance measurement framework.51
Section 505(b) of the SSA requires the Application/Annual Report to be developed by, or in
consultation with, the state MCH agency, and SSA Section 506(a) requires the standardized report
to be submitted to the Secretary of HHS. States must solicit public comments (including from
community members and other federal or public agencies) throughout the Application/Annual
Report development process. A description of this process, including how public comments were
addressed, must be discussed in the Application/Annual Report.52 In addition, state MCH and
CYSHCN Directors attend an annual Application/Annual Report review meeting, which provides
an opportunity for HRSA staff to assess each state’s progress relative to its selected performance
measures and to discuss the state’s plan for the coming year. Reviewers also include information
on former state and federal MCH leaders, MCH experts and academics, and family/parent
reviewers. During the review process, states can request additional technical assistance from
HRSA to support activity planning and implementation; however, HRSA does not provide
additional funding to support technical assistance.53
As part of the Application/Annual Report, states must submit standardized information including
an overview of all funding sources, program participation and reach, program expenditures and
other budget data, standardized MCH measures, and a narrative update on state MCH data
systems and infrastructure. States must also perform a biennial independent audit of all program
expenditures.54 Specific requirements, templates, and additional guidance are published on
HRSA’s TVIS, which also publishes each state’s final Applications/Annual Reports.55
Needs Assessment and State Action Plan
Each state is required to conduct and submit a comprehensive statewide needs assessment once
every five years.56 The needs assessment must identify statewide goals that align with national
health objectives, including the need for preventive and primary care services for pregnant
women, mothers, infants, and children, and services for CYSHCN.57 This process includes data
collection and analysis regarding a state’s MCH capacity and infrastructure, needs and desired
outcomes, and relevant legislative mandates, among other topics. The needs assessment process is
intended to be a systematic and collaborative process that includes MCHB, a state’s department

51 Detailed section-by-section requirements documents are available on HRSA’s “Guidance and Documents” page,
available at https://mchb.tvisdata.hrsa.gov/Home/Resources.
52 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 39.
53 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 11 and email correspondence with HRSA staff, April 2024.
54 SSA §506(b).
55 To view a state’s application, see HRSA, State Application/Annual Report, https://grants6.tvisdata.hrsa.gov/Home/
StateApplicationOrAnnualReport. To view a state action plan table, see HRSA, State Action Plan Table,
https://grants6.tvisdata.hrsa.gov/Home/StateActionPlan.
56 SSA §505(a)(1).
57 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 25
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of health, families, health care practitioners, and other agencies, organizations, and state MCH
stakeholders.
Findings from the needs assessment are submitted in the form of a Needs Assessment Summary,
which drives the development of a state’s annual application for block grant funds. These needs
assessment results also inform the development of a five-year State Action Plan, which outlines
7-10 priority needs and statewide objectives and strategies, typically compiled in a table format.58
The plan must also convey areas of alignment between the priority needs, objectives, and
strategies and performance measures (see “Performance Measurement Framework”).
In each of the four interim years following the needs assessment, states must include Needs
Assessment Interim Updates as part of the Application/Annual Report process. These updates
may reflect changes to program strategies, demographics, and/or other emerging MCH issues.
Figure 10 summarizes the annual reporting cycle based on the five-year needs assessment.
Figure 10. State MCH Block Grant Application/Annual Report Timeline

Source: Figure created by CRS using example deadlines provided in HRSA’s Title V Maternal and Child Health
Services Block Grant to State Program. Guidance and Forms for the Title V Application/Annual Report.
Relationship with Medicaid
The State MCH Block Grant program and the Medicaid program (SSA Title XIX) share a
common goal of improving health for the MCH population through the provision of affordable
health care delivery systems and adequate coverage. Section 509(a)(2) of the SSA cites the need
to promote “coordination at the Federal level of activities authorized under this title [Title V] and
under title XIX.” Further, SSA Section 1902(a)(11) requires state Medicaid agencies to enter into
Inter-Agency Agreements (IAAs) with agencies administering programs authorized under SSA
Title V, including those agencies that receive State MCH Block Grant funding.
Medicaid law further clarifies that the Medicaid program should serve as the payor of first resort
for services covered under both Title V and Medicaid. This means that State MCH Block Grants
cannot be used to reimburse a claim for a service otherwise covered under Medicaid. HRSA’s
MCHB encourages robust IAAs that outline specific areas of program collaboration. The goal of
this partnership and collaboration is to allow for the effective leveraging of federal and state

58 State Action Plans are available at https://mchb.tvisdata.hrsa.gov/Home/StateActionPlan.
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resources to help ensure that MCH populations receive necessary preventive services, health
examinations, treatments, and follow-up care. IAAs are publicly available in the TVIS.
As part of the Application/Annual Report, states are required to provide a detailed description of
the existing relationship between the State MCH Block Grant program and the Medicaid program
to build upon the IAA. This includes information on program outreach and enrollment, health
care financing, waivers or state-specific amendments that affect the MCH population, joint
policy-level decision-making, and Medicaid Core Set measures.59
Relationship with Other Programs
States are required to describe partnerships with other federal, state, and local entities and how
such collaboration may address priorities identified in the Needs Assessment (see the “Needs
Assessment and State Action Plan” section). Every five years (at minimum), states must describe
the relationship between the State MCH Block Grant program and other programs, including (1)
other MCHB investments (e.g., Maternal Health Innovation Grants); (2) other HRSA investments
(e.g., HIV/AIDS programs); (3) other federal investments (e.g., CDC-funded programs); (4) local
programs and organizations (e.g., local health departments); (5) other State Department of Health
programs (e.g., health promotion activities); (6) other governmental agencies (e.g., the State
Children’s Health Insurance Program (CHIP);60 (7) tribes, tribal, and urban Indian organizations;
(8) related public health universities and educational programs; and (9) relevant nongovernmental
organizations.
Performance Measurement Framework
The State MCH Block Grant program uses a three-tiered performance measurement framework to
track annual progress toward MCH goals. The framework consists of Evidence-based or -
informed Strategy Measures (ESMs), National Performance Measures (NPMs), and National
Outcome Measures (NOMs). According to the program guidance, ESMs are structural and
process measures that influence the NPMs, which are short- and medium-term indicators. NPMs
are hypothesized to influence NOMs, the longer-term, population-level MCH indicators. Table 1
displays the relationship of these measures as identified in the performance measurement
framework; each measure category is further described below.

59 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 23.
60 The State Children’s Health Insurance Program (CHIP) is a federal-state program that provides health coverage to
certain uninsured, low-income children and pregnant women in families that have annual incomes above Medicaid
eligibility thresholds but do not have health insurance. CHIP is jointly financed by the federal government and the
states and is administered by the states. States may design their CHIP programs in three ways. They may cover eligible
children under their Medicaid programs (i.e., CHIP Medicaid expansion), create a separate CHIP program, or adopt a
combination approach where the state operates a CHIP Medicaid expansion and one or more separate CHIP programs
concurrently. When states provide Medicaid coverage to CHIP children (i.e., CHIP Medicaid expansion), Medicaid
rules (Title XIX of SSA) typically apply. When states provide coverage to CHIP children through separate CHIP
programs, Title XXI of SSA rules typically apply. In all cases, federal CHIP funding is available to pay for the costs for
services provided to CHIP children.
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Table 1. Performance Measurement Framework

ESMs
NPMs
NOMs
Quantify short-term
Assess short- or medium-term
Measure trends in longer-term

se
outcomes and assess
outcomes related to clinical health
indicators to understand MCH
o
p
progress of specific
systems, health behaviors, and social
population health, and inform
evidence-based or
determinants of health.
future needs assessments and
Pur
evidence-informed
program strategies.
strategies.
States must develop at
Selected NPMs must represent state
HRSA collects and reports data
s
least one ESM for every
priorities and activities, directly link to
on NOMs using a variety of
t
n
strategy in the State
at least one NOM, and represent
federal data sources. States may,
me
Action Plan. Each ESM
health areas with significant disparities. but are not required to, report
eri
must be clearly aligned to
States must report on a minimum of
on NOMs as part of the
u
q
a state priority.
five NPMs, with at least one NPM for
Application/Annual Report.
e
each of the five population domains.
R
Two of the five NPMs are Universal
NPMs and reported by each state.
20 NPMs, including two Universal
33 NOMs.
s
States develop unique
n
ESMs and provide detail
NPMs (Postpartum Visit; Medical
o
States may also develop their
it
on each measure in the
Home).
own unique State Outcome
p
Application/Annual
O
States may also develop their own
Measure (SOM) if existing NOMs
e
Report. HRSA does not
r
unique State Performance Measure
do not appropriately reflect an
provide a required list.
(SPM) or use standardized measures
activity or state priority.
asue
provided by HRSA if existing NPMs do
M
not appropriately reflect an activity or
state priority.
Source: Table developed by CRS using information from HRSA’s Title V Maternal and Child Health Services Block
Grant to State Program. Guidance and Forms for the Title V Application/Annual Report and HRSA’s Title V Maternal and
Child Health Services Block Grant to State Program. Technical Assistance Resources.
Notes: The full list of NPMs is available in Appendix I. The full list of NOMs is available in Appendix J.
Evidence-Based or Informed Strategy Measures
ESMs quantify and assess outputs related to NPMs and support states in setting improvement
objectives across the five-year reporting cycle. States are required to develop and report on at
least one ESM for each NPM. States must detail the ESM’s relationship to state priorities,
describe of the scientific evidence informing the measure and its significance, and present
additional considerations about data availability and measure definition.61

61 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report. Technical Assistance Resources, p. 15. Available at https://mchb.tvisdata.hrsa.gov/
Home/Resources. Hereinafter, HRSA, Title V Maternal and Child Health Services Block Grant to State Program:
Guidance and Forms for the Title V Application/Annual Report. Technical Assistance Resources.
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National Performance Measures
NPMs are short- and medium-term measures that are intended to improve NOMs. NPMs are
considered to be more directly modifiable by the specific activities that states implement with
block grant funds.62
The 20 NPMs are organized across five MCH
Universal National Performance
population domains—(1) Women/Maternal
Measures (NPMs)
Health, (2) Perinatal/Infant Health, (3) Child
Universal NPMs were recently introduced in the 10th
Health, (4) Children with Special Health Care
version of the State MCH Block Grant program
Needs, and (5) Adolescent Health—as well as
guidance. To accelerate progress toward national and
across three measure domains. Measure
state priorities, HRSA designated Postpartum Visit and
domains were introduced in the most recent
Medical Home as NPMs that all states must report on
beginning in FY2025. These measures are briefly
guidance and reflect different ways in which a
highlighted below; see Appendix I for more
health strategy or activity may improve
information.
NOMs. These include (1) clinical health
Postpartum Visit measures the percentage of
systems, (2) health behaviors, and (3) social
women who attend a timely and thorough postpartum
determinants of health. The full list of
checkup. Evidence indicates that a comprehensive
measures, including each measure’s
postpartum visit is an opportunity to identify, prevent,
and treat adverse maternal health outcomes. According
population and measure domain, is available
to HRSA, this measure was chosen to drive
in Appendix I. States must report on a
improvements in maternal mortality rates nationwide.
minimum of five NPMs, with at least one
Medical Home refers to a health care approach that
NPM for each of the five MCH population
is accessible, family centered, stable, and
domains. Two of the mandatory five NPMs
comprehensive, among other elements. Evidence
are “Universal NPMs,” which all states are
suggests that children with a medical home are more
likely to receive appropriate preventive measures and
required to report on.63 The Universal NPMs,
treatment, and are less likely to be hospitalized.
Postpartum Visit and Medical Home, were
According to HRSA, this measure was selected to drive
introduced in the 10th version of the guidance
improvements in the health of CYSHCN and improve
in January 2024 (see Appendix I and text box,
quality health care for infants, children, and adolescents.
right). According to MCHB, these NPMs were
selected for their ability to measure access and quality of primary and preventive care specific to
maternal health and improving care networks for CYSHCN.64
National Outcome Measures
NOMs are longer-term measures of health status that the block grant program aims to improve
overall. For instance, NOMs can reflect measures about quality of life at the population level,
such as preventable morbidity and mortality, emerging health priorities, and health across the life
course.65 States do not individually report on NOMs; rather, MCHB prepopulates NOM data
across all states using a variety of federal and state data sources (see the “Selected Federally
Available Data Sources” text box below) to better monitor the impact of the State MCH Block

62 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 25.
63 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 6.
64 Ibid.
65 The life course approach, also referred to as life course theory, identifies critical life stages that can influence lifelong
health and well-being. For more information, see HRSA, Title V Maternal and Child Health Services Block Grant to
State Program. Guidance and Forms for the Title V Application/Annual Report, p. 5.
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Grant without duplicating federal data collection efforts. The full list of 33 NOMs is available in
Appendix J.
If state priorities are not adequately reflected by NOMs or NPMs, states may use unique State
Outcome Measures (SOMs) or State Performance Measures (SPMs). States may develop these
measures independently or use a list of Standardized Measures provided by HRSA. States provide
a detailed overview of unique measure definitions, data sources, and multiyear data points in the
Application/Annual Report.
Performance Measurement Considerations
The 10th version of the Application/Annual Report Guidance notes that the performance
measurement framework underwent a revision to better address the social determinants of
health,66 provide more choices for NPMs across population domains, and introduce optional
standardized SPMs.67 In addition to the new Universal NPM requirement, the revised guidance
allows states to select priority populations for each NPM and includes NOMs to reflect emerging
priorities such as stillbirth rates, among other changes.68 MCHB notes the revised guidance puts a
greater emphasis on health equity as a guiding principle.69 MCHB updated the guidance
following consultation with state MCH agencies, MCH leaders and stakeholders, and the
public—a process implemented in past iterations.70
While the measures are designed to standardize reporting across states and capture progress
toward state and national health objectives, variation exists among states in terms of capacity for
collecting and reporting data. MCHB and individual states may use federally available data
sources, in addition to state-collected data, to track NOMs, NPMs, and ESMs. A selection of
MCH data sources is presented in the text box below. States are required to provide an update on
data capacity and enhancement activities every five years.71

66 The Social Determinants of Health (SDOH) are “the conditions in the environments where people are born, live,
learn, work, play, worship, and age that affect a wide variety of health, functioning, and quality-of-life outcomes and
risks.” For more information on the five SDOH domains, see https://health.gov/healthypeople/priority-areas/social-
determinants-health.
67 Since the program became a block grant in 1981, the application and reporting guidance has undergone multiple
changes. According to Michael C. Lu et al., one of the largest transformations occurred with the introduction of the
three-tiered measurement framework. For more information, see Lu et al., “Transformation of the Maternal and Child
Health Services Block Grant,” Maternal and Child Health Journal, vol. 19, issue 2 (May 2015), pp. 927-931.
68 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 17.
69 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. iv.
70 Michael C. Lu et al., and Health Resources and Services Administration, “Agency Information Collection Activities:
Submission to OMB for Review and Approval; Public Comment Request; Title V Maternal and Child Health Services
Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, OMB No. 0915-0172-
Revision,” 88 Federal Register 63963-63965, 2023.
71 HRSA, Title V Maternal and Child Health Services Block Grant to State Program: Guidance and Forms for the Title
V Application/Annual Report, p. 31.
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Selected Federally Available MCH Data Sources
National Vital Statistics System (NVSS): Coordinated by the CDC National Center for Health Statistics,
NVSS collects and disseminates data from states on vital events, which include births, deaths, marriages, divorces,
and fetal deaths, to calculate statistics on maternal and perinatal mortality rates, among others.
Pregnancy Risk Assessment Monitoring System (PRAMS): PRAMS is a joint research project between the
CDC Division of Reproductive Health and state, territorial, or local health departments. PRAMS collects data on
high-risk MCH populations. It is the only surveillance system that provides data through pregnancy and the early
postpartum period.
National Survey of Child Health (NSCH): Led by HRSA’s MCHB, the NSCH produces state and national-
level data on the physical and emotional health of children aged 0-17. Topics include physical and mental health,
access to health care, and children’s social and familial environments.
State Inpatient Databases (SID): Developed for the Healthcare Cost and Utilization Project (HCUP), led by
the Agency for Healthcare Research and Quality (AHRQ), SID contains discharge data from inpatient stays in
community hospitals. Data can be used to identify preventable hospitalizations, estimate costs, assess access to
quality care, and categorize diagnoses, among other things.
Sources: Centers for Disease Control and Prevention, About the National Vital Statistics System,
https://www.cdc.gov/nchs/nvss/about_nvss.htm; Centers for Disease Control and Prevention, What is PRAMS?,
https://www.cdc.gov/prams/index.htm; United States Census Bureau, National Survey of Children's Health (NSCH),
https://www.census.gov/programs-surveys/nsch.html; Agency for Healthcare Research and Quality, Overview of the
State Inpatient Database, https://hcup-us.ahrq.gov/sidoverview.jsp.
Additional Reporting Requirements
In addition to the components discussed above, states must submit standardized information
including an overview of all relevant funding sources, program participation and reach, program
expenditures and other budget data, standardized MCH measures, and a narrative update on state
MCH data systems and infrastructure. This also includes reporting on an annual “MCH Success
Story,” which highlights the contributions of the State MCH Block Grant, as well as narratives on
the broader health of MCH populations in each state and the context of the state’s health care
system. States must also perform a biennial independent audit of all program expenditures.72
Reports to Congress
Section 506(a)(3) requires HRSA to annually compile the information reported by states and to
present reports to the House Committee on Energy and Commerce and the Senate Committee on
Finance. This report must include a summary of the information reported to the Secretary of HHS
by the states and a compilation of specified maternal and child health indicators at both the
national and state levels. All information included in this requirement can be found in the publicly
accessible TVIS.73
Special Projects of Regional and National
Significance (SPRANS)
The SPRANS component of the MCH Services Block Grant competitively provides federal funds
to projects aimed at driving innovation, improving systems of care for MCH populations, and
addressing emerging needs, priorities, or issues.74 SPRANS funding complements other Title V

72 SSA §506(b).
73 HRSA, Title V Information System, https://mchb.tvisdata.hrsa.gov/Home.
74 HRSA, FY2025 Justification of Estimates for Appropriations Committees, pp. 183-184.
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MCH Services Block Grant components, as well as other federal and state efforts, by building
capacity through pilot programs, research, training, data collection, quality improvement, and
workforce development.75
SPRANS authorizing legislation specifically mentions the following focus areas: (1) MCH
research and training; (2) genetic disease testing, counseling, and information dissemination; (3)
comprehensive hemophilia diagnostic and treatment centers; (4) newborn screening and follow-
up services, including sickle cell and other genetic disorders; (5) evidence-based programs,
activities, and research to reduce the incidence of stillbirth.76
Grant Recipients
Unlike the State MCH Block Grant program, SPRANS funding can be competitively awarded to
and administered by other entities beyond state health agencies. Typically, projects funded
through the SPRANS component are open to public or nonprofit private institutions of higher
learning that train health care personnel (particularly those focused on MCH populations), or
public or private nonprofit organizations or institutions of higher learning that conduct MCH
research. Community-based organizations, tribal organizations, and faith-based organizations
may also be eligible to receive SPRANS funding. Since SPRANS funding is competitively
awarded into discrete projects, eligibility requirements, application timeframes, and reporting
requirements may vary by project.77
Funding and Program Topics
The total amount of MCH Services Block Grant funding for SPRANS (per fiscal year) is made
available under the following formula:
• SPRANS: 15% of the annual federal appropriation that does not exceed $600
million, and 15% of funds remaining above $600 million after CISS funds are set
aside.78
Annual appropriations acts have frequently deviated from this formula. For example, the
Consolidated Appropriations Act, 2023 (CAA 2023; P.L. 117-328), mandated that no more than
$219.116 million of FY2023 funds would be made available to SPRANS and that $10.276
million would be made available for CISS, “notwithstanding sections 502(a)(1) and 502(b)(1) of
the Social Security Act.”79 Through this approach, Congress effectively increased the proportion
and amount of FY2023 funds allocated to SPRANS ($219.116 million, compared with $119.5
million per the §502 formula) and decreased the amount appropriated to CISS ($10.276 million,
compared with $28.394 million that would have been available under the §502 formula).
Historically, parameters for SPRANS funding have been outlined through authorizations and
appropriations for specific programs or activities, including funding set-asides for particular
priority issues. Table 2 outlines specific SPRANS set-asides and directives from FY2022 to

75 Ibid.
76 SSA §501(a)(2). Item (5) was added in July 2024 through the Maternal and Child Health Stillbirth Prevention Act of
2024 (P.L. 118-69).
77 Specific eligibility details, application timeframes, and reporting requirements are typically included as part of
HRSA’s funding announcements on grants.gov.
78 Unlike the State MCH Block Grant program, which is a federal-state partnership program, SPRANS activities are
funded with federal appropriations.
79 Consolidated Appropriations Act, 2023 (CAA 2023; P.L. 117-328), 136 STAT. 4856.
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FY2024. Appropriations have historically been provided for oral health, epilepsy, sickle cell, and
fetal alcohol spectrum-related projects; in FY2024, these accounted for 8% of total SPRANS
funding. Other SPRANS set-asides may reflect areas of interest identified by HRSA in the annual
budget justification process or other areas of congressional interest laid out in appropriations
reports. In FY2024, Congress directed approximately 59% of total SPRANS funding to address
specific priority issues in appropriations report language.
Other priority areas for SPRANS funding may be highlighted by Congress in committee reports.
For example, the FY2023 House Committee on Appropriations highlighted concerns with the
rising prevalence of congenital syphilis and encouraged HRSA to expand prenatal screening and
testing opportunities with SPRANS funding.80 Remaining SPRANS funds support additional
activities as authorized by statute.
Table 2. Special Projects of Regional and National Significance (SPRANS)
FY2022–FY2024 ($ in Millions)
Set-Asides
Focus Area
Purpose
FY2022
FY2023
FY2024
Oral Health
Improve perinatal and infant oral health.
$5.2
$5.2
$5.2
Epilepsy
Improve access to quality health care services for
$3.6
$3.6
$3.6
children and youth with epilepsy or seizure
disorders.
Sickle Cell Disease
Improve care coordination for children and families
$5.9
$7.0
$7.0
with sickle cell diseases.
Fetal Alcohol
Decrease incidents of alcohol use during pregnancy
$1.0
$1.0
$1.0
Syndrome
through the dissemination of provider and
consumer information.
Directives and Other Programs Authorized by Statute
Focus Area
Purpose
FY2022
FY2023
FY2024
Children’s Health and
Study ways to improve child health through a
$3.5
N/A
N/A
Development
statewide system of early childhood developmental
screenings and interventions.
Infant-Toddler Court
Provide ongoing training and technical assistance,
$12.8
$18.0
$18.0
Teams
implementation support, and evaluation research
to support research-based Infant-Toddler Court
Teams, which aim to improve child welfare
practices and the early developmental health and
well-being of infants, toddlers, and families.
Maternal Mortality
Support state-led demonstrations to implement
$28.8
$55.0
$55.0
(State Maternal Health
evidence-based interventions to address critical
Innovation Grants)
gaps in maternity care service delivery and reduce
maternal mortality.
Maternal Mental Health Support state-specific actions that address
$4.0
$7.0
N/A
Hotlinea
disparities in maternal health and improve maternal
health outcomes, including the prevention and
reduction of maternal mortality and severe
maternal morbidity.

80 H.Rept. 117-403, p. 56.
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Minority Serving
Establish a research network that is composed of
N/A
$10.0
$10.0
Institutions
and supports minority-serving institutions to study
health disparities in maternal health outcomes.
Early Childhood
Place early childhood development experts in
$4.9
$10.0
$10.0
Education Expert
pediatrician offices that serve a population with a
Grants
high percentage of Medicaid and CHIP patients.
Regional Pediatric
Coordinate among the nation’s pediatric hospitals
$17.9
$25.0
$25.0
Pandemic Network
and their communities to prepare for and
coordinate research-informed responses to future
pandemics.
Hereditary
Support coordination and expansion of care for
$2.0
$2.0
$2.0
Hemorrhagic
HHT patients and participation in a prospective,
Telangiectasia Centers
longitudinal registry of HHT patients to better
for Excellence (HHT)
understand this rare disease and accelerate the
development of new diagnostic and treatment
options.
National Fetal Infant
Expand support and technical assistance to states
$2.1
$5.0
$5.0
and Child Death
and tribal communities and improve the availability
Review (FICDR)
of data on sudden unexpected infant deaths and
child mortality.
Source: Data from FY2022 and FY2023 was compiled by CRS from HRSA’s FY2023 Operating Plan and
Committee Reports from the Consolidated Appropriations Acts of 2022 and 2023. FY2024 data was compiled
by CRS from data contained in the explanatory statement accompanying P.L. 118-47, available in the Congressional
Record, vol. 170, no. 51, book II, March 22, 2024, pp. H1887-H1888.
Notes: This table focuses on discretionary uses of SPRANS funding. Detail on Family-to-Family Health
Information Centers (F2F HICs), a mandatory SPRANS program, is provided in Appendix K.
N/A = Not applicable.
a. Division FF of P.L. 117-328 amended the Public Health Service Act (PHSA) to establish a new authority for
the Maternal Mental Hotline. Previously, funding for this hotline had been provided within the MCH
SPRANS, but starting in FY2024, funding was shifted from SPRANS to a separate budget line item,
consistent with the hotline’s new statutory authority within the PHSA. The Alliance for Maternal Safety
Bundles received SPRANS project funding in FY2022. Starting in FY2023, however, this project was funded
under the newly authorized Section 330O of the Public Health Service Act, as established by Division P of
P.L. 117-103. This section authorizes HHS to support grants for Innovation in Maternal Health.
SPRANS authority has been used to mandate the development and funding of separate programs.
For example, the Family-to-Family Health Information Centers (F2F HIC) program was
established through the Deficit Reduction Act of 2005 (DRA; P.L. 109-171). The DRA amended
Title V to authorize and appropriate mandatory funding for F2F HIC in all states through
FY2009.81 Subsequent laws have provided mandatory appropriations for this program in each
year since. Most recently, the Consolidated Appropriations Act, 2024 (CAA 2024; P.L. 118-42),
appropriated funds through the first quarter of FY2025. According to SSA Section 501(c)(2),
funds are required to be appropriated to F2F HICs to provide information, education, technical
assistance, and peer support to families of CYSHCN and health professionals who serve such
families. For additional funding history, see Table K-1 in Appendix J; for more information
about this program, see CRS Insight IN12317, Family-to-Family Health Information Centers:
Current Status and Policy Considerations.

81 The F2F HIC were established in the Deficit Reduction Act of 2005 (DRA; P.L. 109-171). However, from FY2002
through FY2006, HHS funded F2F HIC in 36 states using a combination of various program authorities and direct
appropriations.
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SPRANS Spotlight: Minority-Serving Institutions (MSI) Research Collaborative
Over the past several decades, maternal mortality and pregnancy-related morbidity have risen across the United
States. Underlying health disparities can further exacerbate differences in maternal health across ethnic and racial
groups. In particular, non-Hispanic Black women and American Indian/Alaska Native women are two to three
times more likely to die from pregnancy-related causes than are White, Hispanic, and Asian Pacific Islander
women.
In alignment with the 2022 White House Blueprint for Addressing the Maternal Health Crisis, HRSA’s MCHB
established a new $10 million minority-serving institutions (MSI) research collaborative. This SPRANS-funded
project aims to build the capacity of MSIs to study maternal health disparities, research and address root causes of
maternal mortality, develop curricula to train MCH professionals, and examine the impact of climate change on
maternal health disparities. Identifying community-based solutions to addressing maternal health disparities and
advancing health equity is also a key focus. As of April 2024, 17 MSI awardees received SPRANS funding to
coordinate and collaborate on maternal health research.
Sources: Donna L. Hoyert, Maternal Mortality Rates in the United States, 2022, National Center for Health
Statistics, Health E-Stats, May 2024, https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-
mortality-rates-2022.htm; HRSA, FY2024 Justification of Estimates for Appropriations Committees, p. 185; Health
Resources and Services Administration, Maternal Health Research Collaborative for Minority Serving Institutions (MSIs),
April 2024, https://mchb.hrsa.gov/data-research/research-investments/maternal-health-research-colloborative-
minority-serving-institutions.
Community Integrated Service Systems (CISS)
The CISS component of the MCH Services Block Grant provides federal funds to projects that
seek to increase local service delivery capacity and build comprehensive and integrated
community service systems for mothers and children. In particular, CISS funding supports the
development, innovation, and expansion of services in rural areas or for MCH populations with
special health care needs.82
CISS authorizing legislation mentions the following topic areas: MCH home visiting and case
management, health education and social support services, health workforce participation under
Medicaid and Title X, integrated MCH delivery systems, and programs focusing on rural
populations and CYSHCN. SSA Section 502 also requires HRSA to give preference to applicants
that demonstrate that a CISS project will be carried out in an area with a high infant mortality
rate.83
Grant Recipients
Similar to the SPRANS component, CISS funding can be awarded to and administered by other
entities beyond state health agencies. Public and private entities, including faith-based and
community-based organizations, may be eligible to receive CISS funding. Since CISS funding is
typically partitioned into discrete projects, eligibility requirements, application timeframes, and
reporting requirements may vary by project.84 According to HRSA, there were 26 CISS awards as
of FY2024.85

82 HRSA, FY2024 Justification of Estimates for Appropriations Committees, pp. 191-192.
83 SSA 502(b)(2)(A).
84 Specific eligibility details, application timeframes, and reporting requirements are typically included as part of the
HRSA’s funding announcements on grants.gov.
85 HRSA, FY2025 Justification of Estimates for Appropriations Committees, p. 190.
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Funding and Program Topics
The total amount of federal MCH Services Block Grant funding for CISS (per fiscal year) is
made available under the following formula:
• CISS: 12.75% of the annual federal appropriation that is above $600 million.86
The first tranche of CISS funding was allocated in FY1993 ($6.4 million). Since then, Congress
has not appropriated less than $600 million to the Title V MCH Services Block Grant. Since
FY2006, CISS levels have remained relatively consistent (see Table A-1 in Appendix A) with
appropriations acts often deviating from the above formula. For example, the Consolidated
Appropriations Act, 2023 (CAA 2023; P.L. 117-328), mandated that no more than $219.116
million of FY2023 funds would be made available to SPRANS and that $10.276 million would
be made available for CISS, “notwithstanding sections 502(a)(1) and 502(b)(1) of the Social
Security Act.”87 Through this approach, Congress effectively increased the proportion and amount
of FY2023 funds allocated to SPRANS ($219.116 million, compared with $119.5 million per the
§502 formula) and decreased the amount appropriated to CISS ($10.276 million, compared with
$28.394 million that would have been available under the §502 formula). Conversely, Congress
has used this approach to decrease the proportion of funds for SPRANS and increase the
proportion for CISS, such as in FY2014.88
One of HRSA’s longest-standing CISS projects is the Early Childhood Comprehensive Systems
(ECCS) program. Since 2002, ECCS have helped states improve access to and the quality of
preventive health services for young children and families. The current iteration, ECCS: Health
Integration Prenatal-to-Three, focuses on promoting early developmental health and well-being,
increasing family-centered access to care, and building MCH systems that are equitable,
sustainable, comprehensive, and inclusive.89 HRSA currently awards $5.1 million annually
(FY2021-FY2026) to 20 state-level ECCS entities.90
CISS Spotlight: Enhancing Systems of Care for Children with Medical Complexity
Nationwide, there are approximately 3 million children with medical complexity (CMC), many of whom have co-
occurring behavioral health diagnoses. In FY2022, HRSA announced the Enhancing Systems of Care for Children
with Medical Complexity Program. The purpose of this program is to optimize the health, quality of life, and well-
being of CMC and their families. Within the program, HRSA defines CMC as a subset of CYSHCN who have
family-identified service needs, severe chronic clinical conditions, functional limitations, and a high utilization of
health resources. HRSA funded five demonstration sites and one coordinating center to implement, evaluate, and
support evidence-informed, patient/family-centered models of care delivery. These five-year demonstration
projects are intended to develop and disseminate innovative and evidence-based care models for CMC and their
families. According to HRSA, over $5.1 million has been awarded across all six grantees as of FY2023.
Sources: HRSA funding announcement, https://www.hrsa.gov/grants/find-funding/HRSA-22-088; AcademyHealth,
https://academyhealth.org/about/programs/enhancing-systems-care-children-medical-complexity-cmc-coordinating-
center.

86 Unlike the State MCH Block Grant program, which is a federal-state partnership program, CISS activities are funded
with federal appropriations.
87 Consolidated Appropriations Act, 2023 (CAA 2023; P.L. 117-328), 136 STAT. 4856.
88 The Consolidated Appropriations Act, 2014 (CAA 2014; P.L. 113-76), 128 STAT.364, designated not more than
$77.1 million to SPRANS (compared with $94.3 million per the §502 formula) and $10.3 million to CISS (compared
with $9.7 million under the §502 formula).
89 HRSA Early Childhood Comprehensive Systems (ECCS), https://mchb.hrsa.gov/programs-impact/early-childhood-
systems/early-childhood-comprehensive-systems
90 Ibid.
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Issues for Congress
Recent congressional attention has increasingly been directed toward maternal, infant, and child
health topics, particularly as the number of maternal deaths in the United States remains higher
than comparable high-income countries and amid recent increases in infant mortality.91 Current
executive branch initiatives, such as the Biden Administration’s White House Blueprint for
Addressing the Maternal Health Crisis, highlight rising maternal morbidity and mortality rates
and ongoing racial disparities across both measures. Moreover, the improvement of various
maternal, infant, and child health indicators is considered among the high-priority objectives in
the Healthy People 2030 framework, which aims to “promote, strengthen, and evaluate the
nation’s efforts to improve the health and well-being of all people.”92
The MCH Services Block Grant can support a variety of services, activities, and public health
efforts to prevent maternal and child mortality and improve the overall health and well-being of
MCH populations. This section outlines selected policy issues Congress may consider in the
current MCH landscape relevant to the MCH Services Block Grant, should Congress wish to
explore changes to the MCH Services Block Grant or maintain the status quo.
Funding
Allocation Trends. The State MCH Block Grant program has historically received the largest
proportion of federal MCH Services Block Grant funds (see Table A-1 in Appendix A). This
proportion has decreased since FY2017 as increasingly larger amounts are reserved for SPRANS
activities. For example, in FY2013, State MCH Block Grant funds accounted for 86.1% of total
program funding and SPRANS accounted for 12.3%; in FY2024, the State MCH Block Grant and
SPRANS components accounted for 72.9% and 25.8%, respectively. Similarly, the FY2025
HRSA Budget Justification reflects a $16 million increase to SPRANS, while State MCH Block
Grant levels remain consistent with FY2024.93 Congress may consider whether this shift in the
proportion of funds across components aligns with national MCH priorities.
Allocation Formulas and Set-Asides. Congress may wish to examine the relevance of the
federally defined allocation formula across all three programs in the MCH Services Block Grant,
given that appropriation laws frequently deviate from these requirements (see “Funding”). For
example, a CRS analysis of final MCH Services Block Grant funding levels from FY2013 to
FY2024 revealed that across this 12-year period, there were seven years where the CISS program
received an allocation greater than that specified by the formula and six years where SPRANS
received an allocation greater than that specified by the formula.94 Congress may also consider
whether the federal allotment formula for the State MCH Block Grant adequately allots federal
funds to individual states. The formula directs the first proportion of funds based on historical
individual state allotments in 1983 and directs remaining funds based on child poverty statistics.
However, U.S. Territories and Freely Associated States do not receive child poverty-based

91 Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and
UNDESA/Population Division. Geneva: World Health Organization, 2023. Ely DM, Driscoll AK, “Infant mortality in
the United States: Provisional data from the 2022 period linked birth/infant death file,” National Center for Health
Statistics, Vital Statistics Rapid Release, no 33, Hyattsville, MD: National Center for Health Statistics, 2023.
92 U.S. Department of Health and Human Services, Healthy People 2030, Building a healthier future for all,
https://health.gov/healthypeople.
93 HRSA, FY2025 Justification of Estimates for Appropriations Committees, p. 185.
94 In FY2019, both CISS and SPRANS received final federal funding levels that were higher than the amount specified
by formula.
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allotments due to a historical lack of ACS data in these jurisdictions – instead receiving a second
proportion of funds that is proportionate to each jurisdiction’s share of overall State MCH Block
Grant funding in 1983. Congress may examine whether these formulas and approaches
adequately achieve program goals and if other MCH-related disparities, measures, data sources,
or factors should be taken into consideration.
The State MCH Block Grant program is distinct from various other federal health and human
services block grants, in that there is no mandate or set-aside to fund services specifically for
tribal populations. Whereas some federal block grant programs reserve a proportion of funds for
tribal entities (e.g. MIECHV, Tribal Opioid Response Grants), and may also allow federally
recognized tribes to operate such programs (e.g. Temporary Assistance for Needy Families), the
State MCH Block Grant does not specify, nor request states to report on, the extent to which
funds are specifically used to support tribal populations.95 In addition, tribes cannot specifically
operate their own State MCH Block Grant program, but must instead coordinate with states for
funding. Congress may examine the extent to which tribal populations are reached by State MCH
Block Grant services, or assess the degree to which these populations face gaps in MCH services
that could be fulfilled by the State MCH Block Grant program. Such considerations may also be
framed within the program’s overarching goal of improving the health and well-being of MCH
populations, particularly those with low income or limited access to health services.
State Contributions. State contributions to the State MCH Block Grant program have decreased
following the COVID-19 pandemic (see Table D-1 in Appendix D). In FY2019, nonfederal,
state-matched and overmatched funds totaled over $5 billion, representing nearly 91% of program
funds totaled across all sources. In FY2020, state contributions decreased by 63.3% to $2 billion.
Although there is no evidence to suggest that any states did not fulfill the required match of $3 for
every $4 in federal funds, this decrease drove the total program funding from over $6 billion in
FY2019 to $2.5 billion in FY2020. As of FY2022, State MCH funds, local MCH funds, and
program income contributions have not returned to prepandemic levels, and federal contributions
have remained relatively flat. Congress may choose to examine barriers or facilitators that have
affected nonfederal funding sources following the COVID-19 pandemic. Congress may also
consider examining trends in nonfederal contributions to the State MCH Block Grant across the
near future to assess whether funding and/or spending patterns eventually reflect pre-pandemic
totals. Congress may also consider whether supplemental federal funds are needed to support
states that face ongoing or acute MCH issues.96

95 Currently, the F2F HIC program (established under SPRANS authority) is the only program within the overarching
MCH Services Block Grant where funding shall be used to fund program activities for Indian tribes. According to SSA
Section 501(c)(5), the term “Indian tribe” refers to the definition provided in section 4 of the Indian Health Care
Improvement Act (25 U.S.C 1603).
For more information on the MIECHV program, see CRS In Focus IF10595, Maternal, Infant, and Early Childhood
Home Visiting Program. For more information on Tribal Opioid Response Grants, see CRS In Focus IF12116, Opioid
Block Grants. More information on tribal TANF programs can be found in CRS Report RL32748, The Temporary
Assistance for Needy Families (TANF) Block Grant: A Primer on TANF Financing and Federal Requirements.
Some states may indicate the proportion of their total State MCH Block Grant funds that are reserved for tribal
populations. For instance, Nebraska specifies that 5 percent of State MCH Block Grant funds are annually set-aside for
four recognized tribes headquartered in Nebraska. However, this is not a requirement across all State MCH Block
Grant programs. For more information, see Nebraska Dept. of Health and Human Services, Title V - Maternal & Child
Health Block Grant, https://dhhs.ne.gov/Pages/Title-V.aspx.
96 For example, such funding was provided during the Zika virus in 2017 (P.L. 114-223).
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State MCH Block Grant: Relationships with Related Programs
Coordination and Monitoring. State MCH Block Grant programs must coordinate with other
programs and stakeholders through both formal and informal partnerships. These partnerships
may include other MCHB investments (e.g., Healthy Start grants), other HRSA programs (e.g.,
community health centers), and other federal investments (e.g., Maternal Mortality Review
Committees), among others. Congress may consider examining how federally funded programs
coordinate and avoid duplication of MCH-related efforts, including the degree to which existing
programs address MCH needs in various settings or contexts.
Financing and Implementation. Congress could also examine how changes to other federal
programs potentially affect how State MCH Block Grant programs are financed or implemented.
For example, as discussed in the “Relationship with Medicaid” section, State MCH Block Grant
funds should be used as a “payor of last resort” for direct health care expenditures and
specifically cannot be used to reimburse a claim for a service covered under Medicaid.97 Recent
changes to Medicaid policy may affect how State MCH Block Grant programs utilize their
funding. For instance, under the Families First Coronavirus Response Act (FFCRA; P.L. 116-
127), as amended by the CARES Act (P.L. 116-136), states were required to implement
continuous Medicaid enrollment during the COVID-19 public health emergency as a condition of
receipt of enhanced Medicaid funds. This, along with other related federal and state policies (as
well as economic and social factors), led to substantial increases in Medicaid enrollment.98
From FY2019 to FY2022, the proportion of State MCH Block Grant funds used toward direct
services substantially decreased, from over 60% to less than one-third of the total program
funding (see Table F-1 in Appendix F). While the overall use of preventive and primary direct
health care services declined as some individuals delayed or missed medical care during the acute
phases of the pandemic, this shift in the types of services funded with State MCH Block Grant
Funds may also reflect increased Medicaid enrollment. From FY2020 to FY2022, State MCH
Block Grant Funds were increasingly used toward enabling and public health services and
systems.
The Consolidated Appropriations Act of 2023 (CAA 2023; P.L. 117-328) ended the continuous
Medicaid enrollment condition on March 31, 2023. The law specified a process for redetermining
eligibility for all Medicaid enrollees and terminating coverage for individuals who are no longer
eligible. Congress may consider how State MCH Block Grant funds could be leveraged to
address potential gaps in coverage following the redetermination process, and to assess whether
current federal funding levels adequately meet the needs of MCH populations. Congress may also
consider closely examining current and future State MCH Block Grant spending patterns. For
instance, if State MCH Block Grant funds are increasingly used toward direct services in a state
that previously expanded public health service activities in FY2021, such activities may face
financial constraints and need to be scaled back. Congress may consider the degree to which such
situations occur and how, if at all, they affect national MCH needs.

97 HRSA, Title V Maternal and Child Health Services Block Grant to State Program. Guidance and Forms for the Title
V Application/Annual Report, p. 22.
98 For example, CMS data indicate that Medicaid enrollment grew by 32.6% from February 2020 to December 2022.
See https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-
enrollment/ for more information.
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Oversight and Accountability
State MCH Block Grant Performance Measurement Framework. In January 2024, MCHB
released updated State MCH Block Grant program guidance, which included a revised
performance monitoring framework. As discussed in the “Performance Measurement
Framework” section, NOMs and NPMs track progress toward state and national health priorities.
However, individual State MCH Block Grant programs are not the only factors affecting these
measures, and thus changes to NOMs and NPMs are not necessarily directly related to impact of
a singular program. Other federal and state programs (e.g., Title X programs, Healthy Start,
MIECHV, Medicaid), as well as interrelated societal issues, may affect the health and well-being
of certain populations. Due to the flexibility of funding and multifaceted nature of MCH issues,
determining the impact of a single funding stream on certain health indicators is challenging.
These estimates should be interpreted by policymakers accordingly.
The updated performance monitoring framework requires all states to report on two “universal
NPMs,” thereby attempting to “accelerate progress on federal and state priorities.”99 The
implementation of universal NPMs will facilitate the first estimate of two nationwide
performance measures, since all states were not previously required to report on specific NPMs.
Congress may choose to monitor the success of this new requirement and assess whether such
reporting supports a more comprehensive snapshot of State MCH Block Grant performance.
Additionally, the current framework does not assess the quality of health services provided under
State MCH Block Grant programs. Congress may consider whether additional oversight is needed
in this area.
SPRANS and CISS. Although the State MCH Block Grant program implements a formalized
Application/Annual Report across all recipients, reporting requirements can vary widely across
individual SPRANS and CISS grants depending on the topic and type of program being
implemented. As such, no centralized or structured reporting is available for all SPRANS- or
CISS-funded activities. A recent Government Accountability Office (GAO) report similarly
highlighted the need for improved standardization of performance metrics across other related
HRSA programs (i.e. MIECHV, Healthy Start, State MCH Block Grant)—a recommendation that
was agreed upon by HHS.100 Congress may consider whether current program monitoring
activities across MCH Services Block Grant programs, and the monitoring of new MCH
initiatives, are complementary or duplicative to the overarching goals of the MCH Services Block
Grant.

99 HRSA, Title V Maternal and Child Health Services Block Grant to State Program. Guidance and Forms for the Title
V Application/Annual Report, p. iv.
100 U.S. Government Accountability Office, Maternal and Infant Health: HHS Should Strengthen Process for
Measuring Program Performance, GAO-24-106605, March 2024, https://www.gao.gov/products/gao-24-106605.
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Appendix A. MCH Services Block Grant Federal
Funding History
Table A-1. MCH Services Block Grant Federal Funding History
FY2014-FY2024 ($ in Millions)
State MCH
Total Federal
Fiscal Year
Block Grant
SPRANS
CISS
Appropriations
2014
545.3
76.9
10.3
632.5
2015
549.6
77.1
10.3
637.0
2016
550.8
77.1
10.3
638.2
2017
549.5
80.4
10.3
640.2
2018
556.4
83.5
10.3
650.2
2019
555.4
109.1
10.3
674.8
2020
558.3
119.1
10.3
687.7
2021
561.6
138.8
10.2
710.6
2022
570.4
152.3
10.3
733.0
2023
593.8
212.1
10.3
816.2
2024
593.3
210.1
10.3
813.7
Source: Table prepared by CRS using final federal funding levels as reported in annual Department of Health
and Human Services, Health Resources and Services Administration Congressional Budget Justifications for
FY2014-FY2023. FY2024 figures reflect enacted totals, rather than final numbers based on P.L. 118-47 and the
Congressional Record, vol. 170, no. 51, book II, March 22, 2024, p.H1887.
Note: Funding levels are not adjusted for inflation.
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Appendix B. State MCH Block Grant Funding,
by State
Table B-1. State MCH Block Grant Funding, by State
FY2022 ($ in Millions)
Total–All
State
Local
State
Total–All
Federal
MCH
MCH
Other
Program
Match
Federal and
State
Allocation
Funds
Funds
Funds
Income
Funds
State Funds
Alabama
11.7
38.3
—
0.9
29.0
68.3
80.0
Alaska
1.1
7.7
—
—
—
7.7
8.8
Arizona
7.6
5.8
—
6.7
—
12.5
20.1
Arkansas
7.1
4.0
—
0.5
13.0
17.5
24.7
California
39.6
36.0
20.7
—
31.2
87.9
127.5
Colorado
7.4
5.6
—
—
—
5.6
13.0
Connecticut
4.8
6.8
—
—
—
6.8
11.6
Delaware
2.1
10.0
—
2.1
—
12.0
14.1
Florida
20.5
14.9
—
224.7
13.7
253.3
273.8
Georgia
17.1
98.4
—
—
199.3
297.7
314.8
Hawaii
2.2
28.2
—
—
5.8
34.1
36.3
Idaho
3.3
—
2.5
—
—
2.5
5.8
Illinois
21.4
35.6
0.7
—
—
36.3
57.7
Indiana
12.4
33.8
—
—
—
33.8
46.2
Iowa
6.6
6.7
—
7.1
0.5
14.3
21.0
Kansas
4.9
3.4
3.2
—
—
6.6
11.5
Kentucky
11.4
50.0
—
—
48.0
98.0
109.4
Louisiana
12.9
10.2
—
2.9
5.4
18.5
31.3
Maine
3.3
3.9
—
—
—
3.9
7.2
Maryland
12.0
10.2
—
—
—
10.2
22.3
Massachusetts
11.2
71.0
—
—
—
71.0
82.3
Michigan
19.1
47.1
—
0.7
5.6
53.4
72.5
Minnesota
9.3
6.9
3.1
29.2
—
39.3
48.5
Mississippi
9.5
0.4
0.7
5.5
0.4
7.0
16.4
Missouri
12.5
10.0
—
—
—
10.0
22.5
Montana
2.3
2.9
6.0
—
3.2
12.0
14.3
Nebraska
4.0
2.9
0.3
—
—
3.2
7.3
Nevada
2.3
1.8
—
—
—
1.8
4.0
New Hampshire
2.0
5.1
—
1.7
—
6.7
8.7
New Jersey
11.8
148.8
—
—
—
148.8
160.6
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Total–All
State
Local
State
Total–All
Federal
MCH
MCH
Other
Program
Match
Federal and
State
Allocation
Funds
Funds
Funds
Income
Funds
State Funds
New Mexico
4.3
4.1
—
—
7.2
11.2
15.5
New York
38.8
29.3
36.9
—
26.2
92.4
131.2
North Carolina
17.9
45.8
—
57.7
70.3
173.8
191.8
North Dakota
1.8
1.4
0.1
—
—
1.5
3.3
Ohio
22.7
56.9
—
—
—
56.9
79.6
Oklahoma
7.4
8.0
1.1
—
—
9.1
16.5
Oregon
6.2
17.2
4.0
9.2
—
30.5
36.7
Pennsylvania
24.3
48.9
—
—
—
48.9
73.2
Rhode Island
1.7
2.2
—
2.3
39.6
44.1
45.8
South Carolina
11.8
14.0
4.9
0.7
17.4
37.0
48.8
South Dakota
2.2
1.6
—
—
0.9
2.4
4.7
Tennessee
12.2
11.6
—
—
2.0
13.6
25.8
Texas
36.7
40.2
—
—
—
40.2
76.9
Utah
6.2
17.5
2.7
14.8
1.1
36.2
42.3
Vermont
1.7
1.0
—
—
—
1.0
2.6
Virginia
12.7
9.3
—
1.7
2.3
13.3
26.0
Washington
9.0
7.6
—
—
—
7.6
16.5
West Virginia
6.2
11.9
—
—
20.5
32.4
38.6
Wisconsin
11.0
4.7
6.7
—
—
11.4
22.4
Wyoming
1.2
1.9
—
—
0.5
2.4
3.6
Other Jurisdictions
American Samoa
0.5
—
—
—
—
0.4
0.5
District of
7.0
30.8
—
—
—
30.8
37.8
Columbia
Federated States
0.5
0.1
0.8
—
—
0.9
1.5
of Micronesia
Guam
0.8
0.6
—
—
—
0.6
1.3
Marshall Islands
0.2
2.4
—
—
—
2.4
2.6
Northern
0.5
—
—
0.5
—
0.5
0.9
Mariana Islands
Palau
0.2
0.2
—
—
—
0.2
0.3
Puerto Rico
16.1
11.8
—
1.1
0.2
13.1
29.3
Virgin Islands
1.5
—
1.4
—
—
1.4
2.9
Total
$556.6
$1,087.3
$95.7
$370.0
$543.4
$2,096.8
$2,653.0
Source: Table prepared by CRS using final FY2022 federal allocation data reported in HRSA’s FY2024
Congressional Budget Justification, pp. 198-200. State funds, other local funds, and program income totals were
extracted from individual state Application/Annual Reports, Form 2, FY2022 Expenditures column. Each state
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Application/Annual Report is located on HRSA’s Title V Information System (TVIS);
https://mchb.tvisdata.hrsa.gov/Home/StateApplicationOrAnnualReport.
Notes: TVIS funding data are estimates/projections that are collected once each year at the time of application
and are not meant to be the final fiscal record of note. FY2022 expenditures were reported in July 2023 and may
not reflect final state, local, or program income expenditures.
Not all states submit data on the “other funds” or “program income” categories; these are indicated with a dash.
States are allowed to exceed the match requirement of at least $3 for every $4 in federal funds; this is called an
overmatch.
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Appendix C. Essential Public Health Services for
MCH Populations
1
Conduct ongoing assessment of the changing health needs of the MCH population to drive priorities for
achieving equity in access and positive health outcomes.
2
Expand surveillance and other data systems capacity to support rapid investigation of emerging health issues
that affect the MCH population.
3
Inform and educate the public and families about the unique needs of the MCH population.
4
Mobilize partners, including families and individuals, at the federal, state, and community levels in promoting
shared vision for leveraging resources, integrating and improving MCH systems of care, promoting quality
public health services, and developing supportive policies.
5
Provide expertise and support for the formation and implementation of state laws, regulations, and other
policies pertaining to the health of the MCH.
6
Integrate systems of public health, health care, and related community services to ensure equitable access
and coordination to achieve maximum impact.
7
Promote the effective and efficient organization and utilization of resources to ensure access to necessary
comprehensive services for CYSHCN and families through public health services, systems, and population
health efforts.
8
Educate the MCH workforce to build the capacity to ensure innovative, effective programs and services and
the efficient and equitable use of resources.
9
Support or conduct applied research resulting in evidence-based policies and programs.
10
Facilitate rapid innovation and dissemination of effective practices through quality improvement and other
emerging methods.
11
Provide services to address unmet needs in health care and public health systems for the MCH population.
Source: Adapted from Title V Maternal and Child Health Services Block Grant to State Program. Guidance and Forms
for the Title V Application/Annual Report, p. 4.
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Appendix D. State MCH Block Grant Funds,
by Source (FY2018-FY2022)
Table D-1. State MCH Block Grant Funds, by Funding Source
($ in Millions)
Funding Source
2018
2019
2020
2021
2022
Federal Allocation
536
545
547
549
557
State MCH Funds
2,884
2,773
1,046
1,063
1,088
Local MCH Funds
341
263
126
109
96
Other Funds
309
306
427
274
370
Program Income
2,443
2,228
443
517
543
Total
$6,512
$6,114
$2,590
$2,512
$2,654
Source: Table prepared by CRS using Annual Reports for state, local, other, and program income totals, found
on HRSA’s Title V Information System; https://mchb.tvisdata.hrsa.gov/Financial/FundingBySource. Final federal
allocations were derived from HRSA’s annual Congressional Budget Justifications, FY2020-FY2023.
Notes: TVIS funding data are estimates/projections that are collected once each year at the time of application
and are not meant to be the final fiscal record of note. For example, FY2022 data were reported in July 2023 and
may not reflect final state, local, or program income totals.
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Appendix E. State MCH Block Grant Expenditures,
by Service Category and Funding Source
Figure E-1. State MCH Block Grant Expenditures, by Service Category and
Funding Source
FY2022

Source: Table prepared by CRS using data from state Annual Reports, found on HRSA’s Title V Information
System; https://mchb.tvisdata.hrsa.gov/Financial/FundingByServiceLevel.
Notes: “Federal” funds reflect federal allotments from the State MCH Block Grant. “Non-Federal” funds may
include state, local, program income, and other funds, which may also include federal funds from other programs
under the control of the agency administering the State MCH Block Grant program (see “Funding”). TVIS
funding data are estimates/projections that are collected once each year at the time of application and are not
meant to be the final fiscal record of note. FY2022 expenditures were reported in July 2023 and may not reflect
final state, local, or program income expenditures.
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Appendix F. State MCH Block Grant Expenditures,
by Service Category (FY2018-FY2022)
Table F-1. State MCH Block Grant Expenditures, by Service Category
($ in Millions)
Service Category
FY2018
FY2019
FY2020
FY2021
FY2022
Direct
4,094
3,718
473
647
707
Enabling
1,325
1,327
996
829
1,023
Public Health Services & Systems
1,058
1,024
1,004
783
784
Total
$6,477
$6,070
$2,474
$2,260
$2,513
Source: Table prepared by CRS using data from state Annual Reports, found on HRSA’s Title V Information
System; https://mchb.tvisdata.hrsa.gov/Financial/FundingByServiceLevel.
Notes: TVIS funding data are estimates/projections that are collected once each year at the time of application
and are not meant to be the final fiscal record of note. For example, FY2022 expenditures were reported in July
2023 and may not reflect final state, local, or program income expenditures.
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Appendix G. State MCH Block Grant Expenditures,
by Population Group and Funding Source
Figure G-1. State MCH Block Grant Expenditures, by Population Group and
Funding Source
FY2022

Source: Table prepared by CRS using data from state Annual Reports, found on HRSA’s Title V Information
System; https://mchb.tvisdata.hrsa.gov/Financial/FundingByIndividualsServed.
Notes: “Federal” funds reflect federal allotments from the State MCH Block Grant. “Non-Federal” funds may
include state, local, program income, and other funds, which may also include federal funds from other programs
under the control of the agency administering the State MCH Block Grant program (see “Funding”). TVIS
funding data are estimates/projections that are collected once each year at the time of application and are not
meant to be the final fiscal record of note. FY2022 expenditures were reported in July 2023 and may not reflect
final state, local, or program income expenditures.
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Appendix H. State MCH Block Grant Expenditures,
by Population Group (FY2018-FY2022)
Table H-1. State MCH Block Grant Expenditures, by Population Group
($ in Millions)
Population Group
FY2018
FY2019
FY2020
FY2021
FY2022
Pregnant Women
304
290
303
310
342
Infants < 1 Year
409
409
367
303
327
Children 1 through 21 Years
928
939
826
828
905
CYSHCN
4,554
4,159
724
717
739
Others
242
226
222
205
181
Total
$6,437
$6,023
$2,442
$2,362
$2,494
Source: Table prepared by CRS using data from state Annual Reports, found on HRSA’s Title V Information
System; https://mchb.tvisdata.hrsa.gov/Financial/FundingByIndividualsServed.
Notes: TVIS funding data are estimates/projections that are collected once each year at the time of application
and are not meant to be the final fiscal record of note. For example, FY2022 expenditures were reported in July
2023 and may not reflect final state, local, or program income expenditures.
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Appendix I. State MCH Block Grant National Performance Measures
Table I-1. List of National Performance Measures (NPM)
Population
Measure
No.
Short Title
Full NPM Title
Domain(s)
Domain
1
Postpartum Visit
A) Percent of women who attended a postpartum checkup within 12
Women/Maternal
Clinical Health
weeks after giving birth
Health
Systems
B) Percent of women who attended a postpartum checkup and received
recommended care components
2
Postpartum Mental Health
Percent of women screened for depression or anxiety following a recent live birth
Women/Maternal
Clinical Health
Screening
Health
Systems
3
Postpartum Contraception
Percent of women using a most or moderately effective contraceptive following a
Women/Maternal
Health
Use
recent live birth
Health
Behavior
4
Perinatal Care Discrimination
Percent of women with a recent live birth who experienced racial/ethnic
Women/Maternal
Social
discrimination while getting health care during pregnancy, delivery, or at
Health or
Determinants
postpartum care
Perinatal/Infant Health
of Health
5
Risk-Appropriate Perinatal Care
Percent of very low birth weight (VLBW) infants born in a hospital with a Level
Perinatal/Infant Health
Clinical Health
III+ Neonatal Intensive Care Unit (NICU)
Systems
6
Breastfeeding
A) Percent of infants who are ever breastfed
Perinatal/Infant Health
Health
B) Percent of children, ages 6 month through 2 years, who were breastfed
Behavior
exclusively for 6 months
7
Safe Sleep
A) Percent of infants placed to sleep on their backs
Perinatal/Infant Health
Health
B) Percent of infants placed to sleep on a separate approved sleep surface
Behavior
C) Percent of infants placed to sleep without soft objects or loose bedding
D) Percent of infants room-sharing with an adult
8
Housing Instability–Pregnancy
Percent of women with a recent live birth who experienced housing instability in
Perinatal/Infant Health, Social
the 12 months before a recent live birth
Women/Maternal
Determinants
Health,
of Health
Housing Instability–Child
Percent of children, ages 0 through 11, who experienced housing instability in the
and/or Child Health
past year
9
Developmental Screening
Percent of children, ages 9 through 35 months, who received a developmental
Child Health
Clinical Health
screening using a parent-completed screening tool in the past year
Systems
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Population
Measure
No.
Short Title
Full NPM Title
Domain(s)
Domain
10
Childhood Vaccination
Percent of children who have completed the combined 7-vaccine series
Child Health
Clinical Health
(4:3:1:3*:3:1:4) by age 24 months
Systems
11
Preventive Dental Visit–Pregnancy
Percent of women who had a preventive dental visit during pregnancy
Women/Maternal
Clinical Health
Health, Child Health,
Systems
Preventive Dental Visit–Child
Percent of children, ages 1 through 17, who had a preventive dental visit in the
and/or Adolescent
past year
Health
12
Physical Activity
Percent of children, ages 6 through 11, who are physically active at least 60
Child Health
Health
minutes per day
Behavior
13
Food Sufficiency
Percent of children, ages 0 through 11, whose households were food sufficient in
Child Health
Social
the past year
Determinants
of Health
14
Adolescent Well-Visit
Percent of adolescents, ages 12 through 17, with a preventive medical visit in the
Adolescent Health
Clinical Health
past year
Systems
15
Mental Health Treatment
Percent of adolescents, ages 12 through 17, who receive needed mental health
Adolescent Health
Clinical Health
treatment or counseling
Systems
16
Tobacco Use
Percent of adolescents, grades 9 through 12, who currently use tobacco products
Adolescent Health
Health
Behavior
17
Adult Mentor
Percent of adolescents, ages 12 through 17, who have one or more adults outside
Adolescent Health
Social
the home who they can rely on for advice or guidance
Determinants
of Health
18
Medical Homea–Overall
Percent of children with and without special health care needs, ages 0
CYSHCN, Child
Clinical Health
through 17, who have a medical home
Health, and
Systems
Adolescent Health
Medical Home–Personal Doctor
Percent of children with and without special health care needs, ages 0 through 17,
who have a personal doctor or nurse
Medical Home–Usual Source Of
Percent of children with and without special health care needs, ages 0 through 17,
Sick Care
who have a usual source of sick care
Medical Home–Family Centered
Percent of children with and without special health care needs, ages 0 through 17,
Care
who have family centered care
Medical Home–Referrals
Percent of children with and without special health care needs, ages 0 through 17,
who receive needed referrals
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Population
Measure
No.
Short Title
Full NPM Title
Domain(s)
Domain
Medical Home–Care Coordination Percent of children with and without special health care needs, ages 0 through 17,
who receive needed care coordination
19
Transition
Percent of adolescents with and without special health care needs, ages 12 through CYSHCN,
Clinical Health
17, who received services to prepare for the transition to adult health care
Adolescent Health
Systems
20
Bullying
Percent of adolescents with and without special health care needs, ages 12 through CYSHCN,
Social
17, who are bullied or bully others.
Adolescent Health
Determinants
of Health
Source: Table prepared by CRS using data from HRSA, Title V Maternal and Child Health Services Block Grant to State Program. Guidance and Forms for the Title V
Application/Annual Report, OMB No: 0915-0172, pp. 8-9, https://mchb.tvisdata.hrsa.gov/Home/Resources.
Notes: The two bolded NPMs represent the universal performance measures, which all block grant recipients must report on.
CYSHCN = Children and Youth with Special Health Care Needs.
NPMs with multiple sub-measures (e.g., “A” and “B” components) include NPM numbers 1, 6, and 7.
NPM numbers 8, 11, and 18 have multiple population domains and/or sub-components. These can be individually selected and count once toward the minimum
requirement of 5 NPMs
a. HRSA defines “Medical Home” as “an approach to providing comprehensive, high quality health care that is accessible, family-centered, continuous, comprehensive,
coordinated, compassionate and culturally effective. Care occurs in an environment of trust and mutual responsibility between the family, patient, and primary care
provider.” For more information, see https://mchb.tvisdata.hrsa.gov/Glossary/Glossary.
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Appendix J. State MCH Block Grant National
Outcome Measures
Table J-1. List of National Outcome Measures (NOM)
Short Title
Full NOM Title
Severe Maternal Morbidity
Rate of severe maternal morbidity per 10,000 delivery hospitalizations
Maternal Mortality
Maternal mortality rate per 100,000 live births
Teen Births
Teen birth rate, ages 15 through 19, per 1,000 females
Low Birth Weight
Percent of low birth weight deliveries (<2,500 grams)
Preterm Birth
Percent of preterm births (<37 weeks gestation)
Stillbirth
Stillbirth rate per 1,000 live births plus fetal deaths
Perinatal Mortality
Perinatal mortality rate per 1,000 live births plus fetal deathsa
Infant Mortality
Infant mortality rate per 1,000 live births
Neonatal Mortality
Neonatal mortality rate per 1,000 live births
Postneonatal Mortality
Postneonatal mortality rate per 1,000 live births
Preterm-Related Mortality
Preterm-related mortality rate per 100,000 live births
SUID Mortality
Sudden Unexpected Infant Death (SUID) rate per 100,000 live births
Neonatal Abstinence Syndrome
Rate of neonatal abstinence syndrome per 1,000 birth hospitalizations
School Readiness
Percent of children meeting the criteria developed for school readiness
Tooth Decay/Cavities
Percent of children, ages 1 through 17, who have decayed teeth or cavities in
the past year
Child Mortality
Child mortality rate, ages 1 through 9, per 100,000
Adolescent Mortality
Adolescent mortality rate, ages 10 through 19, per 100,000
Adolescent Motor Vehicle Death
Adolescent motor vehicle mortality rate, ages 15 through 19 per 100,000
Adolescent Suicide
Adolescent suicide rate, ages 10 through 19 per 100,000
Adolescent Firearm Death
Adolescent firearm mortality rate, ages 10 through 19 per 100,000
Child Injury Hospitalization
Rate of hospitalization for non-fatal injury per 100,000 children, ages 0
through 9
Adolescent Injury Hospitalization
Rate of hospitalization for non-fatal injury per 100,000 adolescents, ages 10
through 19
Women’s Health Status
Percent of women, ages 18 through 44, in excellent or very good health
Children’s Health Status
Percent of children, ages 0 through 17, in excellent or very good health
Children’s Obesity
Percent of children, ages 2 through 4, and adolescents, ages 6 through 17,
who are obese (BMI at or above the 95th percentile)
Postpartum Depression
Percent of women who experience postpartum depressive symptoms
Postpartum Anxiety
Percent of women who experience postpartum anxiety symptoms
Behavioral/Conduct Disorders
Percent of children, ages 6 through 11, who have a behavioral or conduct
disorder
Adolescent Depression/Anxiety
Percent of adolescents, ages 12 through 17, who have depression or anxiety
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Short Title
Full NOM Title
CYSHCN Systems of Care
Percent of children and youth with special health care needs (CYSHCN), ages
0 through 17, who receive care in a well-functioning system
Flourishing—Young Child
Percent of children, ages 6 months through 5, who are flourishing
Flourishing—Child/Adolescent
Percent of children with and without special health care needs, ages 6
through 17, who are flourishing
Adverse Childhood Experiences
Percent of children, ages 0 through 17, who have experienced 2 or more
Adverse Childhood Experiences
Source: Table prepared by CRS using data from HRSA, Title V Maternal and Child Health Services Block Grant to
State Program. Technical Assistance Resources, p. 31. Available at https://mchb.tvisdata.hrsa.gov/Home/Resources.
a. The perinatal mortality rate is calculated by adding the total number of fetal deaths of 28 weeks or more
gestation and total number of early neonatal deaths (less than seven days old). This sum is divided by the
total number of live births and fetal deaths at 28 weeks or more gestation, per 1,000 live births. Fetal death
data are published annually by the National Center for Health Statistics (NCHS), which defines fetal death
as “the spontaneous intrauterine death of a fetus.” Fetal deaths later in pregnancy, such as at 28 weeks or
more, are sometimes referred to as stillbirths. Fetal deaths do not include induced terminations of
pregnancy, also known as abortion. Additional information is available at https://www.cdc.gov/nchs/nvss/
fetal_death.htm.
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Appendix K. Family-to-Family Health Information
Centers (F2F HIC): Legislation and Appropriation
History
Table K-1. F2F HIC Legislation and Appropriation History
Mandatory
Appropriations
Law
(millions)
Years
Changes
Deficit Reduction Act of
$3
FY2007
Authorized and appropriated
2005, (P.L. 109-171)
$4
FY2008
incremental funding increases for
$5
FY2009
FY2007-FY2009; established statewide
program under Title V of the Social
Security Act.
Patient Protection and
$5
FY2010–FY2012
Authorized and appropriated funding
Affordable Care Act, (P.L.
for FY2010-FY2012.
111-148)
American Taxpayer Relief
$5
FY2013
Authorized and appropriated funding
Act of 2012, (P.L. 112-
for FY2013.
240)
Bipartisan Budget Act of
$2.5
FY2014 (half-year)
Authorized and appropriated funding
2013, (P.L. 113-67)
for FY2014 (half-year).
Protecting Access to
$2.5
FY2014 (half-year)
Authorized and appropriated half-year
Medicare Act of 2014,
$2.5
FY2015 (half-year)
funding for both FY2014 and FY2015.
(P.L. 113-93)
Medicare Access and
$5
FY2015 (full)–
Authorized and appropriated full-year
CHIP Reauthorization Act
FY2017
funding for FY2015-FY2017; Struck
of 2015, (P.L. 114-10)
partial funding for FY2015.
Bipartisan Budget Act of
$6
FY2018–FY2019
Authorized and appropriated funding
2018, (P.L. 115-123)
for FY2018-FY2019; required F2F HIC
to be developed in all territories and at
least one developed for tribal
communities.
Sustaining Excellence in
$6
FY2020–FY2024
Authorized and appropriated funding
Medicaid Act of 2019,
for FY2020-FY2024.
(P.L. 116-39)
Consolidated
$1.5
Through January 1,
Authorized and appropriated funding
Appropriations Act, 2024
2025
for the first quarter of FY2025.
Source: CRS analysis of legislation on Congress.gov.
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Appendix L. Other Title V Programs
In addition to the MCH Services Block Grant, Title V of the Social Security Act contains a
number of sections that were added or amended by the Patient Protection and Affordable Care
Act (ACA, P.L. 111-148, as amended). This appendix provides a summary of those sections and
references to other CRS reports, where relevant.
SSA §510, Separate Program for Abstinence Education
This program provides funding to states for abstinence education. This program was formerly
known as the Title V Abstinence Education Grant Program, as authorized by the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA; P.L. 104-193). The
Bipartisan Budget Act of 2018 (BBA; P.L. 115-123) renamed the ACA-reauthorized program to
the Title V Sexual Risk Avoidance Education Program. The program focuses on implementing
sexual risk avoidance, meaning voluntarily refraining from sex before marriage. Grantees may set
aside funds to conduct rigorous and evidence-based research on sexual risk avoidance.
The authorization and funding have been extended multiple times, most recently through FY2024
in the Consolidated Appropriations Act, 2024 (CAA 2024; P.L. 118-42). For more information on
this program, see CRS Report R45183, Teen Pregnancy: Federal Prevention Programs.
SSA §511, Maternal, Infant, and Early Childhood Home Visiting
Programs (MIECHV)
The MIECHV program provides grants to states, territories, and tribal entities for the support of
evidence-based early childhood home visiting programs. The program seeks to provide and
strengthen home visiting services to families residing in at-risk communities and to improve
coordination of supportive services. MIECHV is collaboratively administered by the Maternal
and Child Health Bureau within HRSA and the Administration for Children and Families.
The authorization and funding have been extended multiples times, most recently through
FY2027 under the Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of
2022 (Section 6101 of the Consolidated Appropriations Act, 2023; CAA 2023; P.L. 117-328). For
more information on this program, see CRS In Focus IF10595, Maternal, Infant, and Early
Childhood Home Visiting Program.
SSA §512, Services to Individuals with a Postpartum Condition and
Their Families
This program provides grants for epidemiologic research, improved screening and diagnosis,
clinical research, and public education to expand understanding of the causes and treatments for
postpartum depression and related conditions. The ACA authorized funding of $3 million for
these grants for FY2010, and such sums as necessary for each of FY2011 and FY2012. No funds
have been appropriated for this program.
SSA §513, Personal Responsibility Education
The Personal Responsibility Education Program (PREP) is administered by the Administration
for Children and Families. PREP is defined as a program designed to educate adolescents on both
abstinence and contraception for prevention of pregnancy and sexually transmitted infections,
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including HIV/AIDS, and at least three of the six stipulated adulthood preparation subjects. The
adulthood preparation subjects are (1) healthy relationships, (2) adolescent development, (3)
financial literacy, (4) parent-child communication, (5) educational and career success, and (6)
healthy life skills.
Established in 2010 by the ACA (P.L. 111-148, as amended), PREP funding and authorization
have been extended multiple times, most recently through the first fiscal quarter of FY2025 by
Division G of the Consolidated Appropriations Act, 2024 (CAA 2024; P.L. 118-42). For more
information on this program, see CRS Report R45183, Teen Pregnancy: Federal Prevention
Programs.
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Appendix M. Abbreviations Used in This Report
ACA
Patient Protection and Affordable Care Act
CDC
Centers for Disease Control and Prevention
CHIP
State Children’s Health Insurance Program
CISS
Community-Integrated Services System Program
CMS
Centers for Medicare & Medicaid Services
CYSHCN
Children and Youth with Special Health Care Needs
ESM
Evidence-Based (or informed) Strategy Measures
FY
Fiscal Year
GAO
Government Accountability Office
HHS
Department of Health and Human Services
HMO
Health Maintenance Organization
HRSA
Health Resources and Services Administration
MCH
Maternal and Child Health
MCHB
Maternal and Child Health Bureau
MIECHV
Maternal, Infant, and Early Childhood Home Visiting Program
NOM
National Outcome Measure
NPM
National Performance Measure
OBRA
Omnibus Budget Reconciliation Act
PHSA
Public Health Service Act
SSBG
Social Services Block Grant
SPRANS
Special Projects of Regional and National Significance Program
SSA
Social Security Act
TVIS
Title V Information System
WIC
Special Supplemental Nutrition Program for Women, Infants, and Children

Author Information

Alexandria K. Mickler

Analyst in Health Policy

Acknowledgments
This report benefitted from expert review by CRS colleagues Evelyne Baumrucker, Elayne Heisler, and
Karen Lynch. CRS Visual Information Specialist Amber Wilhelm produced the graphics. Angela Napili,
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Maternal and Child Health Services Block Grant: Overview and Issues for Congress

CRS Senior Research Librarian, provided instrumental resources throughout the development of this report,
and Sylvia Bryan, CRS Research Assistant, provided valuable assistance compiling funding data. Previous
products written by Carmen Solomon-Fears, former CRS Specialist in Social Policy, and Victoria Elliott,
former CRS Analyst in Health Policy, supported the development of this report.

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
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under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
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subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
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