Title V Maternal and Child Health (MCH) Block Grant Funds

Programs with professional maternal and child health staff that provide services in one or more of the following areas and are targeted to low income and/or high risk populations.

Improved Pregnancy Outcome
Interventions in this area are provided to populations at high risk for poor pregnancy outcome due to medical complications associated with pregnancy and child birth, history of poor pregnancy outcomes, racial/ethnic health disparities, behavioral, environmental and socioeconomic risks including lack of insurance.

Family Planning
Family Planning means voluntary pre-pregnancy planning by individuals to attain or prevent pregnancy.

Children with Special Health Care Needs - Ages birth to 22
Interventions in this area address the needs of those children, birth through 21, who have, or are at increased risk for, a chronic physical, developmental, behavioral, or emotional condition or who require health and related services of a type or amount beyond that required by children generally.

Child and Adolescent Health - Ages 1 to 22
Interventions in this area address the frequency and severity of childhood and adolescent health issues, including injuries, with the purpose of decreasing child and adolescent mortality and morbidity.

Infant Health - Ages 0 to 1
Interventions in this area address infant morbidity and mortality.

Title V Block Grant activities must be targeted to individuals/families who are high risk and/or low income. Participation by other individuals who may also benefit from group outreach or educational activities is acceptable as long as participation does not result in diversion of project resources from targeted high risk and low income people.

Low Income:
Low income means an individual or family income determined to be at or below 175% of federal poverty guidelines. When serving a high risk person, low income means an individual or family income determined to be at or below 200% of the federal poverty level or is determined to meet income eligibility requirements of Medicaid or WIC. Individuals/families at or below 100% of federal poverty guidelines cannot be charged any fees for services provided using Title V funds. Income determination for adolescents seeking services is made based upon the adolescent's income.

High Risk:
High risk means a mother or child with a condition, which significantly increases the probability of disease, injury, death, or other adverse health related problem.

For persons seeking services in other than a group setting an eligibility determination procedure is needed for:

1. The income and family size information needed for income eligibility determination; and
2. The information needed for risk factor eligibility determination if income is above 100% of federal poverty guidelines.

Documentation of eligibility determination is required and must be retained in appropriate files.

A match of 50% is required for federal Title V funds (M.S. 145.882, Subd. 3, (b)). Funds eligible to meet match requirements include: local property taxes, reimbursements from third parties, fees, donations, nonfederal grants, or other state funds, including state funds received as part of the Local Public Health Act. Match funds must be used for eligible MCH services.

Funds not eligible for match include 1) any federal funds, i.e. EPSDT/Child and Teen Check Up, Local Collaborative Time Study (LCTS) funds, Temporary Assistance for Needy Families (TANF), bioterrorism funds or 2) any funds already used to meet match requirements for another funding source.

Indirect costs are expenses of doing business that cannot be directly attributed to a specific grant program or budget line item. These costs are often allocated across an entire agency and may include: executive and/or supervisory salaries and fringe, rent, facilities maintenance, etc. Indirect costs can either be your federally negotiated indirect rate or up to 10 percent of expenditures.

Direct Services
Direct services are preventive, primary, or specialty clinical services to pregnant women and children, including children with special health care needs, where Title V MCH Block Grant or Title V Match funds are used to reimburse or fund providers for these services through a formal process similar to paying a medical billing claim or managed care contracts. Do not include the costs of clinical services which are delivered with Title V dollars but reimbursed by Medicaid, or other public or private payers. Examples include, but are not limited to, preventive, primary or specialty medical care visits, emergency department visits, inpatient services, outpatient and inpatient mental and behavioral health services, prescription drugs, occupational and physical therapy, speech therapy, durable medical equipment and medical supplies, medical foods, dental care, and vision care.

Enabling Services
Enabling services are non-clinical services that enable individuals to access health care and improve health outcomes where MCH Title V Block Grant or Title V Match funds are used to cover these services. Enabling services include, but are not limited to: case management, care coordination, home visiting, referrals, translation/interpretation, transportation, eligibility assistance, health education for individuals or families, environmental health risk reduction, health literacy, and outreach. Do not include the costs for enabling services that are reimbursed by Medicaid, or other public and private payers. This category may include salary and operational support to a clinic or program that enable individuals to access health care or improve health outcomes. Examples include the salary of a public health nurse who provides prenatal care in a local clinic or compensation provided to a specialist pediatrician who provides services for children with special health care needs.

Public Health Services and Systems
Public health services and systems are activities and infrastructure to carry out the core public health functions of assessment, assurance, and policy development, and the 10 essential public health services where MCH Title V Block Grant or Title V Match funds are used to cover these services. Examples include the development of standards and guidelines, needs assessment, program planning, implementation, and evaluation, policy development, quality assurance and improvement, workforce development, and population-based disease prevention and health promotion campaigns for services such as newborn screening, immunization, injury prevention, safe-sleep education and antismoking. Reporting on public health services and systems should not include costs for direct clinical preventive services, such as immunization, newborn screening tests, or smoking cessation.

Improved Pregnancy Outcome
Interventions in this area rare provided to individuals or populations at low income or high risk for poor pregnancy outcomes due to medical complications associated with the pregnancy and child birth, history of poor pregnancy outcomes, racial/ethnic health disparities, behavioral, environmental, and socioeconomic risks. Examples of high risk criterion include but are not limited to:

Demographic Risks such as:

• Age 17 or less or still in high school
• Race or ethnicity
• Unmarried

Risks Related to Current Pregnancy such as:

• Poor weight gain
• Inter-pregnancy interval less than 18 months
• Pregnancy induced hypertension
• Infections such as CMV, HIV, STIs
• Prenatal care initiated after the first trimester of pregnancy or inadequate prenatal care

Pregnancy Complications unrelated to current pregnancy such as:

• Entopic pregnancy
• Infection/History of bypass surgery
• High blood pressure
• Diabetes
• Complicated delivery
• Premature labor
• Depression, mental or cognitive health concern
• Previous poor pregnancy outcome

Behavioral/Environmental Risks such as:

• Smoking, alcohol and other substance abuse
• Poor nutritional status
• Exposure to medical or environmental toxic substances

Domestic Violence

Family Planning
Interventions in this area are provided to populations at low income and high risk of unintended pregnancy. Examples of high risk include but are not limited to individuals experiencing health disparities, geographic isolation, age or other barriers.

Children and Youth with Special Health Needs – Ages 0 to 22
Interventions in this area are provided to address the needs of those children, birth through 21, who have, or are at increased risk for, a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. Examples of interventions include screening activities designed to identify children who may be experiencing delays (such as the Follow-Along Program), family support activities, educational activities, identification of service needs, arranging for services, on-going service coordination/case management activities or participation in the development or implementation of care plans, IFSPs and IEPs.

Examples of high risk include but are not limited to

1. Low birth weight (less than 2500 grams) or prematurity (less than 37 weeks gestation).
2. Conditions identified through newborn screening programs (such as sickle cell disease, PKU, hearing loss).
3. Any of the around 70 conditions identified at birth through the Birth Defects Information System.
4. Acquired conditions such as traumatic brain injury, spinal cord injury
5. Chronic health conditions such as cystic fibrosis, epilepsy, diabetes, asthma
6. Suspected or confirmed mental or behavioral conditions such as attachment disorder, attention deficit hyperactivity disorder, fetal alcohol spectrum disorder
7. Suspected or confirmed developmental disabilities such as intellectual disabilities, autism, and cerebral palsy.

Child and Adolescent Health – Ages 1 to 22
Interventions in this area address the frequency and severity of childhood and adolescent health issues including injuries with the purpose of decreasing child and adolescent mortality and morbidity.

Examples of high risk include but are not limited to:

1. Physical inactivity, unhealthy dietary behaviors
2. Exposure to second hand smoke or other environmental toxins
3. Homelessness
4. Exposure or use of alcohol and other drugs
5. Exposure to violence
6. Living in unsafe environments
7. Suicidal thoughts

Infant Health – Ages 0 to 1
Interventions in this area address reducing infant mortality and morbidity.

Examples of high risk include but are not limited to:

1. Developmental delays
2. Maternal depression or history of maternal depression
3. Alcohol and other substance abuse in home
4. First time mother
5. Teen mother