Title V - Maternal & Child Health Block Grant

• Women - of reproductive years and during pregnancy
• Mothers
  
• Infants*
  
• Children*
  
• Adolescents*
• Their families

     *including those with special health care needs

In 1935, Title V of the Social Security Act set a solid, stable foundation to support MCH. Going strong for over 85 years, Title V is the oldest public health program in our Nation.    

Title V - MCH Block Grant focuses on primary prevention and early care, resulting in positive, lifelong impacts. By contrast, limited or inadequate care before and during pregnancy, and during the early years of a child's life, may lead to poor health outcomes throughout a person's life. Title V investments today ensure hope for a healthy tomorrow. 

Title V legislation requires Nebraska to conduct a statewide, comprehensive needs assessment every five years.  The state is also required to submit an Annual Application & Report every July 15 to receive Title V MCH Block Grant funding. The combined 2022 Application & 2020 Report will be submitted in 2021.

Block grant funds have some flexibility to support a wide range of activities that address state and national needs.  Nebraska can invest the grant differently than other states based on its unique needs, all within certain guidelines.

The Nebraska Department of Health and Human Services (DHHS), Division of Public Health, applies for and receives the annual award.  DHHS is responsible to the federal government for administering Nebraska's MCH Block Grant.  No more than ten percent (10%) can be used for administrative costs.  Nebraska expends less than four percent (4%) to administer the grant.

DHHS may use the grant funds to provide health services and related activities consistent with its annual application.  Related activities include planning, implementation, education/awareness, and evaluation to improve health of the MCH population. Thousands of Nebraska individuals and families benefit from a wide variety of established programs, innovative practices, and special projects. The federal 2020 Title V MCH Block awarded to Nebraska currently supports:

• Fourteen (14) DHHS programs with statewide impact.
• Twenty-nine (29) subaward agreements at the local level. These include 25 community-based organizations plus the four federally-recognized Tribal governments headquartered in Nebraska.

Title V requires each annual allotment awarded to DHHS use at least 30 percent (30%) for preventive and primary care services for Children and at least another 30 percent (30%) for services for children with special health care needs (CSHCN). Children are defined as a child from the 1st birthday through the 21st year.

The most recent expense  report (2019 grant) shows in pie charts​ the breakdown by programs and populations. The 2020 grant is in-process, and will be reported in September 2021.

The federal 2021 block grant is released in quarterly installments to DHHS during the period October 1, 2020-September 30, 2021. DHHS can perform work with the 2021 grant funds during that time period and the following year.

Each year, Congress approves a funding amount for the Maternal and Child Health Block Grant. Individual State funding allotments are determined by a formula. The award to DHHS is based on the proportion of low-income children in Nebraska compared to the total number of low-income children in the entire U.S. Nebraska's annual funding is typically around $4 million. Each annual award is available to Nebraska during a two-year period. 

Nebraska must match every $4 of federal Title V money by at least $3 of state and/or local money (i.e., non-federal dollars). If the federal allotment is $4 million, Nebraska's federal-state investment is at least $7 million annually.

Investments are quite varied because it is a “block grant", allowing States to determine its MCH needs. Right here in Nebraska, and across our Nation, Title V is at work every day, and around-the-clock in some cases, in many different ways.

Nebraska's State Action Plan responds to the priorities from the statewide Title V Needs Assessment​​.​ The needs assessment was completed in September 2020 for the five-year period 2021-2025. Eighty-six (86) people who represent a variety of Nebraska interests were actively engaged in the assessment and planning process.

The MCH Block Grant and other non-federal matching resources finance activities in the State Action Plan. The grant also helps support state statutory requirements that have an MCH focus. A variety of MCH interests in every part of Nebraska are addressed because of the grant-supported programs/activities and its many partners. A federal-state partnership is achieved with Title V.

DHHS Division of Public Health considers the best ways the grant funds can support statewide MCH needs.  Nebraska's Title V MCH Block Grant supports a number of programs, services and special projects for healthy beginnings of Nebraska's MCH population. 

• About 72% of the 2020 grant is needed for DHHS internal allocations authorized for state-level programs and operations.  In some cases within those programs, contractual agreements are sought to purchase services that the program cannot do itself to carry out its role. 
• About 23% of the 2020 annual allotment DHHS subawards to community-based organizations to support time-limited projects, responding to local priorities that align with Nebraska priorities. 
• Another 5% of the annual allotment is set aside for the four federally-recognized American Indian Tribes headquartered in Nebraska. In respect for sovereignty and our special government-to-government relationship, the Nebraska-based Tribes address the MCH priorities of their respective Tribal nations. Tribal priorities often are similar to the state's priorities.​

Communities and individuals throughout Nebraska benefit from the Title V MCH Block Grant by activities supported by the federal grant and the non-federal matching resources. The result may not be obvious in all cases, because it focuses on population-based prevention work. It begins with a proven method of assessment that leads to objectively selecting priorities to focus the work.

• Nebraska's needs assessment process is data-driven. Without data, an issue/need cannot be identified. 
• Once identified, the data is essential to developing a problem statement and a case for inclusion to the list of 10 priorities. 
• Stakeholders play a significant role in the assessment process, specifically in identifying and prioritizing identified problems and in providing input on the development of action strategies for priority issues.
• The priorities guide the work over a five-year period.
• The list of 10 priorities and the strategies/activities to intervene are monitored and measured in Nebraska's Action Plan by the very indicators that led to their identification.
• This creates a circular process and should yield progress/improvement on the priority needs over the five years.

Strategies in the State Action Plan are state-level activities. Subawards at the local level offer flexible options to address priorities using strategies chosen by the community.    

State-level work receives support from the grant and non-federal resources working together:

• Newborn Screening*
  
• Birth Defects Registry
• Early Hearing Detection & Intervention
  
• Child and Maternal Death Review
• Medically Handicapped Children's Program*
• Maternal Child Adolescent School Health (MCASH)
• Reproductive Health
• Pregnancy Risk Assessment Monitoring System (PRAMS)
• Immunizations*
• Women's Health Initiatives
• Oral Health
• Injury Prevention
• Nebraska Perinatal Quality Improvement Collaborative (NPQIC)*

Other state-level programs support MCH with non-federal match and do not receive Title V MCH Block Grant funds.

• Every Women Matters State Pap Plus
• Sexually Transmitted Infection Prevention
• Elemental Formula Reimbursement
• Health Disparities and Health Equity

Subawards at the local level offer flexible options to address priorities using strategies chosen by the community.  Altogether local projects and state-level programs safeguard the health and well-being of Nebraska women, mothers, infants, children (including children with special health care needs), adolescents and their families.

There are no individual eligibility requirements to receive the benefits of Title V. Programs with other funding may have eligibility requirements to receive services. The Title V federal grant does not provide funds directly to individuals.  Instead it funds DHHS programs and other organizations to provide services. 

Less than 1% of Nebraska's 2019 Title V MCH Block Grant paid for direct health services. These are preventive, primary, or specialty clinical services used to fund providers for these services to pregnant women, infants and children, including children with special health care needs. Providers must seek third-party reimbursement for health services to an insured individual. The grant will not pay costs reimbursed by Medicaid, CHIP or other public or private payers.  That leaves grant funds available for persons who are unable to pay for direct services. A larger percentage (38%) paid for enabling service, those services typically not covered by insurance.  Enabling services are important for persons to fully access direct services, including those direct services paid by another source. Examples include: case management; care coordination; interpretation/translation; and transportation. A total 70,696 Nebraskans received an individually-delivered direct or enabling service at a cost of approximately $3.7 million (2019 grant plus non-federal match). 

Other grant-support services maintain and improve, or develop systems of care that broadly serve the entire population.  The largest percentage (62%) of the 2019 grant was invested in population-based health activities and system support.  Examples include: screening all babies born in Nebraska to detect conditions that could cause death or disability without immediate attention; data collection and assessment; health education; and public awareness campaigns. These population-based services are available to and impact a lot of people.  Expenditures for public health services and systems comprise the other 43.1% or approximately $2.8 million (2019 grant plus non-federal match), reaching an average 74% of the MCH population. 

Many Nebraskans receive the benefits of Title V and may not be aware that Title V MCH Block Grant was behind it.  For a glance at how the 2019 allotment was invested, see the pie charts​ showing the expenditures by types of services, programs and MCH populations.