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The Title V Maternal Child Health Block Grant (MCH) is administered by the Maternal and Child Health Bureau (MCHB) and aims to promote and improve the health and well-being of children and mothers. As one of the largest federal U.S. grant programs, over 59 states and jurisdictions were funded by this program, providing healthcare and public health services to about 56 million people.1 The MCH Block Grant is composed of three separate funding programs. The first and largest funding program is the block grant, which is provided to and allows states and territories to provide services to mothers and children. The second funding program is the Special Projects of Regional and National Significance (SPRANS) program, which is a competitive grant program that funds research and training projects on low-income pregnant women, mothers and children. The third and last funding program area is the Community Integrated Service Systems (CISS), which is also a competitive program that funds projects that support the development and expansion of integrated services at the community level. It is estimated that 86% of all pregnant women, 99% of infants, and 55% of children in the United States benefitted from services supported by Title V in 2017.2 3
Block Grant Program
Under the block grant program, there are four types of eligible funded services that states can deliver: 1) direct health care services, otherwise known as “gap filling” services, that may not be covered by health insurance or other funding sources; 2) enabling services which can include transportation, health education, and outreach services; 3) population-based services such as immunization, lead screening, nutrition, and injury prevention; and 4) infrastructure building services, which includes needs assessments, policy development, monitoring, applied research, and standards development.4 While lead abatement or remediation is not explicitly called out as an allowable service, states have the power to determine the services that can be funded through their respective block grant programs. States must submit an application to the Secretary of the Department of Health and Human Services that includes a statewide needs assessment (conducted every 5 years) and a plan for meeting the needs outlined in the assessment in order to receive block grant funds.5
State block grant allocations from the federal government are determined by a formula that compares the proportion of low-income children in a state with the total number of low-income children within all states. In addition to the federal allocation, there are four other categories of funding for the federal-state partnerships under this program: local MCH funds from local jurisdictions, program income from funds that are collected by maternal and child health agencies that include health maintenance organizations (HMO) payments and Medicaid reimbursements, state MCH funds of at least a $3-$4 match to federal allotments, and other funds from the Centers for Disease Control, the Women, Infants, and Children program, and other agencies that support maternal and child health.6 7
States are required to spend at least 30% of their allocation on children with special health care needs (CSHCN), 30% for services for preventive and primary care services for children, 40% or services for either of these groups and for other appropriate maternal and child health activities and may use no more than 10% on administrative costs.8
Special Projects of Regional and National Significance (SPRANS)
By law, fifteen percent of the money appropriated to the MCH Services Block Grant Funding is awarded competitively through SPRANS to public and private not-for profit organizations.9 Priority research areas for SPRANS awards are often determined by the Health Resources and Services Administration. Though Congress sometimes specifies focus areas, including set-asides funding, in legislation. Since the SPRANS program is primarily for research and training programs and services, it is unlikely that lead hazard remediation would be funded through this program.
Community Integrated Service Systems (CISS)
The CISS program receives 12.75% of any amount that Congress appropriates to the MCH Services Block Grant Similarly, applicants for the CISS program must “seek to increase service delivery capacity” at the local level and promote community-based health systems for mothers and children.10 Thus, it is unlikely that CISS would fund lead abatement or remediation directly but could fund the development of a lead remediation program.
Under Title V MCH program, activities related to lead hazard remediation would likely fall under the scope of the Block Grant Program since it is the most flexible. For lead hazard remediation to become an eligible expense, three things need to happen:
- A statewide needs assessment should be conducted that outlines the need for homes to be remediated of lead.
- The state should develop a plan to address the need to remediate lead in homes that includes cross-sector partnerships, workforce considerations, opportunities to leverage other sources of funding and financing.
Lead hazard remediation must be outlined in the state’s application to HHS and must be approved by the Secretary.