Guidelines for Using Title V Federal Maternal Child Health Block Grant (MCH) Funds

September 2006

I. Eligible Maternal and Child Health Program:

A program with professional maternal and child health staff, which provides one or more essential services in maternal and child health care to target populations of low income and/or high risk.

II. Categories of Service:

Improved Pregnancy Outcome:
Interventions in this service 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 action by individuals to attain or prevent pregnancy.

Children with Special Health Care Needs - Ages birth to 22:
Interventions in this service 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.

Child and Adolescent Health - Ages 1 to 22:
Interventions in this service area are provided to 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 service area are provided for the purpose of reducing infant morbidity and mortality.

III. Eligible Populations:

Minnesota Statute requires that all federal Title V Block Grant activities be targeted to persons who are high risk and low income.
Participation by other persons who may benefit from group outreach or educational activities conducted by the project is acceptable so 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 level. When serving a high risk person, low income means that the income of the high risk person or person's family is at or below 200% of the federal poverty level or is determined to meet Medicaid or WIC income eligibility requirements. Persons at 100% of poverty or below can not 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:
Means a mother or child with a condition, which significantly increases the probability of disease, injury, death, or other adverse health related problem.

IV. Intervention Examples

Improved Pregnancy Outcome

Interventions in this service area are provided to populations at low income or 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.

Examples of high risk criterion include but are not limited to:

1) Demographic Risks such as:

  1. Age 17 or less or still in high school
  2. Race or ethnicity
  3. Unmarried

2) Risks related to current pregnancy such as:

  1. Poor weight gain
  2. Inter-pregnancy interval less than 18 months
  3. Pregnancy induced hypertension
  4. Infections such as CMV
  5. Prenatal care initiated after the first trimester of pregnancy or inadequate prenatal care

3) Pregnancy Complications unrelated to current pregnancy such as:

  1. Entopic pregnancy
  2. Infection/History of bypass surgery
  3. High blood pressure
  4. Diabetes/Severe eating disorder or nutritional
  5. Complicated delivery
  6. Organic brain disorder
  7. Premature labor
  8. Closed head injury
  9. Depression
  10. Mental or cognitive health concern
  11. Infection
  12. Diabetes
  13. Hemorrhage
  14. Previous pregnancy outcome with low birth weight

4) Behavioral/Environmental Risks such as

  1. Smoking
  2. Alcohol and other substance abuse
  3. Poor nutritional status
  4. Exposure to medical or environmental toxic substances

5) Battering or domestic violence

Family Planning:

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

Children with Special Health Needs - Ages 0 to 22:

Interventions in this service 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 and / or participation in the development or implementation of care plans, IFSPs, IIIPs, and IEPs.

Examples of special health care needs and ‘increased risk’ include:

  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 44 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 service area are provided to 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 criterion include but are not limited to:

1) Health risks impacting young children such as:

  1. Poor nutritional status or other nutritional issues of concern
  2. Behavioral issues such as tobacco or alcohol
  3. Alcohol and other substance abuse in home environment
  4. Exposure to medical or environmental substances such as lead, methamphetamine, second had smoke

2) Young children living in environments with increased potential for falls, poisoning, tap water scalds, burns and smoke inhalation from fires, and unintentional injuries from firearms.

3) Family stressors impacting children such as:

  1. Young single first time mothers or family of divorce
  2. Family with a documented history of previous childhood abuse/neglect.
  3. Family residing in community with limited access to infant/toddler car seats.

4) Youth risk behaviors such as:

  1. Alcohol and other drug use
  2. Behaviors that may result in pregnancy, HIV, and STD;s
  3. Violence
  4. Suicide
  5. Physical inactivity
  6. Unhealthy dietary behaviors

Infant Health - Ages 0 to 1:
Interventions in this service area are provided for the purpose of reducing infant morbidity and mortality.

Examples of high risk criterion include but are not limited to:

1) Apgar of 6 or less at 5 minutes

2) Developmental delays

3) Issues of maternal depression or history of maternal depression

4) Health risks impacting infants such as:

  1. Feeding issues, poor nutritional status or other nutritional issues of concern
  2. Alcohol and other substance abuse in home environment
  3. Exposure to medical or environmental substances such as lead, methamphetamine, second hand smoke

5) Family stressors impacting infants such as:

  1. Young single first time mothers or family of divorce
  2. Family with a documented history of previous child abuse/neglect.

V. Determination and Documentation of Eligibility

For persons seeking services in other than a group setting an eligibility determination procedure is needed by which the client is asked for:

  1. The income and family size information needed for income eligibility determination; and
  2. The information needed for risk factor eligibility determination.

For persons determined eligible for services, a note should be made and retained documenting the income and/or risk factor which were the basis of the determination.

VI. Matching Requirement

As per statute, a match of 50% is required for federal Title V funds. 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.

Funds not eligible for match include 1) any federal funds including 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.

VII. Definitions for Legislative Priority Report

Direct Health Care/Medical Services
Usually these services are delivered on a one-on-one basis between a health professional and a patient in an office, clinic or emergency room. Examples include specialized medical visits for children with special health care needs, home visiting for birth of new baby, family planning services.

Enabling Services
Enabling services allow families to gain access to, and maximum benefit from basic services. Services may include transportation, translation, outreach, respite care, childcare, health education, family support services purchase of health insurance, case management coordination with Medicaid, WIC and Education.

Other Health Activities/Population Based Services
Unlike direct or enabling services, population based services are available for the entire MCH population. Services include newborn screening, lead screening, immunization, SIDS counseling, oral health, injury prevention, nutrition, public education. These services, offered at the local level must be offered County wide and must be of uniform quality.

Core/Infrastructure Building Public Health Activities Not Client Based
Infrastructure building activities are often less visible to the public. Activities directed at improving and maintaining the health status of all women and children by providing support for development and maintenance of comprehensive health services systems. Examples include needs assessment, evaluation, planning, policy development, coordination, quality assurance, standards development, monitoring, training, systems of care, information systems.