The Title V Maternal and Child Health (MCH) Block Grant is a federal-state partnership focused on improving the health of women, children, and families. Originally enacted in 1935, Title V of the Social Security Act authorizes federal funding for programs and projects to improve the health of mothers and children across the country. Since 1981, Title V mainly consists of a block grant to states and territories, and in 1989, additional changes to federal law increased the accountability and reporting requirements of states.
Generally, the purpose of the Title V MCH Block Grant program is to enable each state to: 1) provide and assure mothers and children access to quality health services (in particular those with low income or with limited availability of health services); 2) promote the health of mothers and infants by increasing access to prenatal, delivery, and postpartum care for low income, at-risk pregnant women; 3) promote the health of children by increasing access to preventive and primary care services; and, 4) promote family-centered, community-based, coordinated care (including care coordination services, for children and youth with special health care needs (CYSHCN) and facilitate the development of community-based systems of services for such children and their families. (https://www.ssa.gov/OP_Home/ssact/title05/0501.htm)
The promotion and assurance of access to care and improved health outcomes is at the heart of the program purposes, even when Title V dollars are not directly financing health care services. In 2023, states reported that Title V MCH Block Grant programs reached more than 94% of all pregnant women, 98% of infants, and 59% of children (including CSHCN) nationwide.
A recent Say Ahhh! Health Policy blog post covered our earlier report, The Role of the Title V MCH Services Block Grant in Improving Maternal and Infant Health. Its companion report, Strengthening Title V: A Nationwide Examination of Variability in State Budgets for the MCH Block Grant, examines variation in federal and non-federal funding budgeted for the Title V MCH Block Grant in each state and territory overall for FY2023. Strengthening Title V takes a broad look at Title V budgets, specifying the shares budgeted for the three Title V focus populations: children 1-21, CSHCN, and pregnant women and infants. The report details the federal and non-federal funds budgeted by state MCH agencies, including sources of non-federal funds. While this report analyses data from FY2023, Figure 1 shows a similar pattern of investment and expenditures across recent years.
The Title V program provides federal block grant dollars to support the MCH infrastructure and services in each of the 59 jurisdictions (states, DC, and US territories referred to hereafter as states). State matching funds (ratio of $3 non-federal funds for every $4 in federal funds) are required under federal law. Many states secure and budget funds beyond this 3:4 matching requirement resulting in an “overmatch.”
The four categories for the non-federal match under Title V include: 1) state funds (i.e., appropriated by state legislatures), 2) program income (e.g., Medicaid and other revenue generated from payments for services delivered), 3) local dollars, and 4) ‘other” funds (e.g., tobacco taxes). The report shows that the 59 states and territories most often use state dollars as their primary source for the Title V MCH Block Grant match. In 37 states, more than half of state Title V matching dollars come from state funds; in 22 states, state dollars make up 100% of their Title V match. Only two jurisdictions (Idaho and Micronesia) use local funding as more than half of their non-federal match, while 43 states report no local funding used. In six states, funds from program income are more than half of the non-federal match, and 29 states do not use this source of funds. In six states, ‘other’ funds make up more than half of their non-federal match, while 39 states report no use of these dollars. (See Figure 2).
While state funds are the most often used source of non-federal matching funds, it is difficult to determine exactly what counts as state funding. Information provided in Title V applications does not distinguish whether or not states have access to undesignated general state revenue as part of their non-federal matching funds for Title V. When states use funding designated for other state programs for their match, the Title V program does not have full discretion in how the funds are used. For example, some state legislatures have designated funds specifically for home visiting, school health, immunization, or other priorities. If state funds are designated for a distinct subset of MCH activities, they would be unavailable to support other MCH needs in the state.
Since 1989, states have been required to use at least 30% of their federal MCH Block Grant allocations for CYSHCN, 30% for services for preventive and primary care services for children, and no more than 10% for administrative expenditures. (https://www.ssa.gov/OP_Home/ssact/title05/0500.htm) This means that 30% remains available for services for either of these groups of children or for other populations such as pregnant women and infants. All states meet the requirement to invest 30% of their federal Block Grant allocation for preventive care for children 1-21 and for CSHCN. Across states, the percentage of non-federal funds budgeted for primary care for children 1-21 ranges from a low of 1% to more than 78%. For CSHCN, the range is from less than 1% to 75%. The range of non-federal funds budgeted for pregnant women and infants ranges from less than 1% to 80%. Notably, only 10 states budget at least 30% of their federal dollars, and 25 states budget at least 30% of their combined funds for pregnant women and infants.
The report recommends that the federal Maternal and Child Health Bureau in the Health Resources and Services Administration (https://mchb.hrsa.gov/), in partnership with states: 1) improve guidance to states by requesting more specificity about state funds used for the Title V match, 2) encourage greater investment in pregnant women and infants, and 3) conduct routine aggregate analysis of state Title V budgets.
As the anchor for investments and program infrastructure for maternal and child health, continued and expanded funding for the Title V MCH Block Grant is essential. This report documents the need for continued and additional federal Title V MCH Block Grant funding. This analysis also can inform decisions by state legislatures about the level of state general revenues committed to MCH efforts, and it can support state agency staff who conduct needs assessments, prepare plans, and formulate budgets. Promoting the health of all women, children, and families requires dedicated resources matched to priority needs.