Virginia Maternal and Child Health Services Block Grant

1
Virginia Maternal and Child Health
ServicesBlock Grant

• Office of Family Health Services
• Virginia Department of Health

2
What is the Maternal and Child Health Block Grant?

• Title V (of the federal Social Security Act)
  authorizes annual financial awards to all states
  called Maternal and Child Health Block Grants
• Maternal and Child Health
  Block Grants
  have been
  awarded since 1981
• The general purpose of the
  money
  is to improve the
  health of all
  
  mothers and children

3
Who receives the MCH Block Grant in Virginia?
Virginia Department of Health is the authorized
agency to submit an application and plan for
Title V MCH funds and to receive and expend these
funds (Code of Virginia 32.1-77)
4
Where is MCH in the State Health Department?
State Health Commissioner
Deputy Commissioner for Public Health
Office of Family Health Services
Division of Womens and Infants Health
Division of WIC and Community Nutrition
Division of Child and Adolescent Health
Center for Injury and Violence Prevention
5
How much is Virginias Maternal and Child Health
Block Grant?
Total 26.0
6
Where do State matching funds come from?

• The Commonwealth of Virginia Maternal and Child
  Health Block Grant match includes
• State General Assembly earmarks for maternal and
  child health programs such as
  Resource Mothers
• Funds provided to health districts from
  local governments
• Income from programs

7
How does Virginia use Maternal and Child Health
funds?

• To help improve the health of women and children.
  Some examples include
• Prenatal care services through local health
  departments
• Regional Perinatal Councils Groups around the
  state working to improve the systems that provide
  prenatal care
• Care Connection for Children Six centers across
  the state that help families with children who
  have special health care needs get and understand
  insurance, medical care, and other support
  services

8
How does Virginia use MCH
funds?

• Other examples include
• Child Development Clinics Eleven clinics across
  the state that provide evaluations for
  developmental problems
• Services and programs at local health departments
  such as prenatal care, dental health, and child
  health
• Support programs and initiatives for injury
  prevention
• Providing on-going support to breastfeeding
  mothers

9
How does Virginia use Maternal and Child Health
funds?

• Other examples include
• Statewide training for communities to have tools
  and resources to battle childhood overweight
• Flouride rinse programs in schools where the
  community water system is not fluoridated
• Education materials for the
  New Parent Kit provided to
  all
  new parents in the state
• Staffing and administration
  of the
  Office of Family Health
  Services and its Divisions

10
What does Virginia have to do to get MCH funds?

• Congress allocates the amounts that states are
  eligible to receive for the Maternal and Child
  Health Block Grant
• States must submit an annual plan and report
  detailing how the funds were used in the past
  year and how they will be used in the future
• States must also conduct a needs assessment every
  five years
• Virginia is now conducting its five year
  assessment to be submitted in July 2005

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Other reporting requirements

• States must submit data and information on
• 18 National Performance Measures
• 8-10 State Performance Measures
• 6 Health Outcomes
• Health Systems and Status Indicators
• Financial expenditures
• Priority Needs
• To view our most recent
  application go to https//performance.hrs
  a.gov/mchb/mchreports/

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Purposes ofthe Maternal and Child Health
Services Block Grant
13
Purposes of MCH
Block Grants

• To enable each state
• To provide and assure mothers and children
  (especially those with low income or limited
  availability to services) access to quality MCH
  services
• To reduce infant mortality and the incidence of
  preventable diseases and handicapping conditions
  among children

Title V of the Social Security Act (Section 501)
14
Purposes of MCH
Block Grants

• To reduce the need for inpatient and long-term
  care services
• To increase the number of children appropriately
  immunized against disease and the
  number of low income children
  receiving health assessments and
  follow-up diagnostic and
  treatment services (EPSDT)

Title V of the Social Security Act (Section 501)
15
Purposes of MCH
Block Grants

• To promote the health of mothers and infants by
  providing prenatal, delivery, and postpartum
  care for low income, at- risk pregnant women,
  and to promote the health of children by
  providing preventive and primary care
  services for low income children

Title V of the Social Security Act (Section 501)
16
Purposes of MCH
Block Grants

• To provide rehabilitation services for blind
  and disabled individuals under the age of
  16 years receiving benefits under Title XVI,
  to the extent medical assistance for
  such services is not provided
  
  under Title XIX
• and

Title V of the Social Security Act (Section 501)
17
Purposes of MCH
Block Grants

• To provide and promote family-centered,
  community-based, coordinated care (including care
  coordination services as defined in the
  legislation) for children with special health
  care needs and to facilitate the development of
  community-based, systems of service for such
  children and their families.

Title V of the Social Security Act (Section 501)
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Maternal and Child Health Bureau Pyramid of
Services
19
Maternal and Child Health Bureau Pyramid of
Services

• The Maternal and Child Health Bureau has
  developed a tool to think about the different
  kinds of services provided under Title V
• This tool called the pyramid has four levels
• Direct Services
• Enabling Services
• Population-Based Services
• Infrastructure-Building Services
• You may hear or read about these levels of the
  pyramid in MCH documents

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MCH Pyramid of Health Services
Direct Health Care Services (Gap filling)
ExamplesBasic health services and health
services for CSHCN
Enabling Services
Examples
Transportation, Translation, Outreach, Health
Education, Family Support Services, Purchase of
Health Insurance, Case Management, WIC,
Coordination with Medicaid
Population-Based Services

Examples Newborn Screening, Lead Screening,
Immunization, Sudden Infant Death Syndrome
Counseling, Oral Health, Injury Prevention
Infrastructure Building Services

ExamplesNeeds Assessment, Evaluation, Planning,
Policy Development, Coordination, Quality
Assurance, Standards Development, Monitoring,
Training, Applied Research, Systems of Care, and
Information Systems
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How the MCH Pyramid of Health Services links with
the Essential Services
Direct Health
Care Services
(Gap
filling)
7 Link
Enabling Services
3
Inform, educate, and empower
and 7 Link
Population-Based Services

3 Inform, educate, and empower,
7 Link, and
8 Assure
Infrastructure Building Services

1 Monitor, 2 Diagnose and
Investigate, 3 Inform, educate, and empower,
4 Mobilize, 5 Develop policies and plans, 6
Enforce, 7 Link, 8 Assure, 9 Evaluate, and
10 Research
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How are allocations made to the States?

• State allocation based on
• Amount awarded to State in 1981 prior to MCH
  Block Grant (All states 422 million total)
• Proportion of low income children that a State
  bears to the total number of such children for
  all the states (Remainder)

Title V of the Social Security Act (Section 502)
23
Matching Requirements

• States must provide a three dollar match for
  every four Federal dollars allocated
• In-kind matching is permitted
• Federal funds from other sources may not be used
  as match

Title V of the Social Security Act (Section 503)
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Virginia Maternal and Child Health Block Grant
Allocations FY 01-05
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Funding Use Requirements

• States will use
• At least 30 percent of Federal MCH Block Grant
  funds received for preventive and primary care
  services for children
• At least 30 percent of Federal MCH Block Grant
  funds received for services for children with
  special health care needs

Title V of the Social Security Act (Section 505)
26
Funding Use Requirements

• States will (use)
• State maintenance of effort (State will
  maintain the level of funds being provided solely
  by the State for maternal and child health
  programs at a level at least equal to the level
  provided in FY 1989)
• A fair method (as determined by the State) to
  allocate Block Grant funds within the State

Title V of the Social Security Act (Section 505)
27
MCH Block Grant Funds may not be used for

• Inpatient services, other than for children with
  special health care needs or high-risk pregnant
  women and infants and such other inpatient
  services as the Secretary may approve
• Cash payments to intended recipients of services
• Purchase of land, the purchase, construction,
  permanent improvement of any building or facility
  (other than minor remodeling), or the purchase of
  major medical equipment

Title V of the Social Security Act (Section 504)
28
MCH Block Grant Funds may not be used for

• Satisfying any requirement for the expenditure of
  non-Federal funds as a condition for the receipt
  of Federal funds. Further, Federal funds from
  other block grants (e.g. Preventive Health) may
  be transferred into the MCH Block Grant Program
  by States, but MCH Block Grant funds may not be
  transferred to any other program
• Providing funds for research or training to any
  entity other than a public or nonprofit entity

Title V of the Social Security Act (Section 504)
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State Application and
Needs Assessment
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States must regularly conduct a needs assessment

• States must conduct a needs assessment every five
  years
• The last maternal and child health needs
  assessment in Virginia was done in 2000.
• To read the last needs assessment go to
  https//performance.hrsa.gov/mchb/mchreports/
• Scroll down and click on States Needs Assessments

Title V of the Social Security Act (Section 505)
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The needs assessment must
identify the need for

• Preventive and primary care services for pregnant
  women, mothers and infants up to age one year
• Preventive and primary care services for children
• Family-centered, community-based services for
  children with special health care needs and their
  families
• A review of the data items to be used in the
  needs assessment

Title V of the Social Security Act (Section 505)
32
The 2005 MCH Needs Assessment

• Reviewed statistics on the health status of and
  services available to women, infants, and
  children
• Interviewed leaders (key informants) who know
  about and work in areas related to maternal and
  child health
• Held 5 public hearings across the state to hear
  peoples concerns
• Conducted a web-based survey for citizens and
  organizations who have an interest in maternal
  and child health

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How do we use the Needs Assessment

• The Needs Assessment was used to
• Identify priority areas
• Plan to address emerging problems
• Develop policy and programs that meet identified
  needs
• Allocate resources to priority areas and emerging
  problems
• Monitor the health status of the Virginia
  maternal and child health population

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What else is required for the MCH Block Grant?

• Each fiscal year the state must submit
• A plan for meeting the needs identified by the
  statewide needs assessment and
• A description of how the funds allotted to the
  State will be used for the provision and
  coordination services in the plan to include

Title V of the Social Security Act (Section 505)
35
The plan includes

• Goals and objectives for activities to address
  needs (Consistent with health status goals and
  national health objectives)
• Identification of areas in the State where
  services are to be provided and coordinated
• Identification of types of services to be
  provided and the categories or characteristics of
  individuals to be served and
• Information the State will collect in order to
  prepare required reports

Title V of the Social Security Act (Section 505)
36
In addition, States will use (have)

• Sliding Fee Scale
  Publication of a schedule of
  State charges for any services for which charges
  are made, assurance that charges will not be
  imposed on low income mothers and children, and
  will be adjusted to reflect the income,
  resources, and family size of individuals
• In Virginia, services provided at local
  health departments and through MCH programs, such
  as Care Connection for Children, are either free
  or fees are based on family size and income.
• http//www.vdh.virginia.gov/LHD/LocalHealthDi
  stricts.asp

Title V of the Social Security Act (Section 505)
37
In addition, States will use (have)

• Coordination
  State agency participation
  on coordinating activities of the Title V
  programs with those of EPSDT, supplemental food
  programs (WIC), and other health, developmental
  disability and family planning programs to avoid
  duplication of effort and to ensure effectiveness
  of all programs.
• In Virginia, MCH staff work within their own
  agency and with other agencies such as Mental
  Health (Part C) and Medical Assistance Services
  through groups and committees such as the
  Interagency Coordinating Council and Prenatal,
  Infants, and Children Subcommittee to coordinate
  activities.

Title V of the Social Security Act (Section 505)
38
In addition, States will use (have)

• Standards
  Guidelines for frequency and content
  of health care assessments/services and methods
  for assuring quality of such assessments/services
• In Virginia, the Bright Futures Guidelines
  for Health Supervision have been adopted.
  http//www.brightfutures.org/
• http//www.vahealth.org/brightfutures/index.ht
  m

Title V of the Social Security Act (Section 505)
39
In addition, States will use (have)

• Medicaid outreach and assistance
  Provision of outreach services to identify
  pregnant women and infants who are eligible for
  services under the States Medicaid program and
  assist them in applying for Medicaid assistance
• In Virginia, information and assistance is
  provided through prenatal care services and case
  management services in local health districts.

Title V of the Social Security Act (Section 505)