Expenditures

Vermont uses our Title V funding as a complement to our other federal and state funding. To ensure maximal integration among statewide programming and services, we braid and blend Title V funding with these other sources. Vermont actively strives to ensure that Title V funding reflects national and state priorities and performance measures. We also use funding to test pilot projects with the plan to identify alternate sustainable funding down the line. In some cases, we use Title V funding to bridge gaps in funding of existing programs. We also routinely use Title V funding to support professional development of staff and sponsor key FCH initiatives by other organizations. Some examples include:

• Grant to UVM Medical Center in support of Developmental Behavioral Pediatrics
• Grant to UVM Medical Center in support of Genetics
• Grant to UVM Medical Center in support of the Child Abuse Physician
• Grant to UVM Medical Center to provide training and technical assistance to community-based sexuality health educators
• Grant to UVM Medical Center in support of the Vermont Center for Children, Youth and Families Autism Assessment Clinic
• Grant to Vermont Family Network in support of peer-to-peer network and family leadership
• Grant to Up for Learning in support of Getting to “Y” youth empowerment activities
• Grant to Center for Health and Learning in support of UMatter suicide prevention activities
• Grant to Vermont Afterschool in support of a statewide Youth Voice Coordinator, the creation of a Youth Council, and a Participatory Budgeting fund for youth
• Grant to United Way 2-1-1 to support a coordinated information and referral system to align the efforts of early childhood partners
• Child Health Advances Measured in Practice (CHAMP) quality improvement project with Vermont Child Health Improvement Program (VCHIP)
• Parents as Teachers (PAT) affiliation fees and curriculum subscriptions
• Staffing support for home visiting, MCH injury, and sexual and reproductive health
• Staffing support for Help Me Grow Vermont (HMG) outreach and training activities
• Staffing support for MCH leadership and operations

Expenditure documentation: Vermont began using its current accounting system in FY02. The system is named "VISION," which is an acronym for "Vermont Integrated Solution for Information and Organizational Needs". The accounting package includes the Financial and Distribution modules contained within PeopleSoft's software suite for Education and Government (E&G) version 9.2. It is designed to be an integrated financial and management tool. While most transactions are entered into VISION directly, payroll data are extracted from the Human Resource Management System (HRMS) and uploaded into VISION. The HRMS software is also a PeopleSoft product and is compatible with VISION. Upgrades to both VISION and HRMS will be implemented in tandem. The VISION system was implemented with as few Vermont-specific characteristics as possible so that future upgrades could be accepted with relatively minimal retrofitting work. VISION contains a number of modules that allow for a variety of functions, such as asset management, as well as expenditure tracking.

The Vermont Health Department can provide assurance that we have established "such fiscal control and fund accounting procedures as may be necessary to assure proper disbursement and accounting" [Sec 502(a)(3)].

Cost Allocation: The Vermont Health Department operates under a Cost Allocation Plan as approved by the DHHS Division of Cost Allocation. This Plan determines how we will collect certain overhead costs into cost pools and how those overhead cost pools will be allocated to the various programs and funding sources, including the Maternal and Child Health Block Grant. Because we have an approved Cost Allocation Plan, Vermont does not have an indirect rate agreement, which would be the alternate method for charging overhead costs to programs. Cost Allocation Plans—instead of indirect rate agreements—are relatively rare among Health Departments. Basically, the approved methods collect general overhead costs on a quarterly basis into cost pools at the division level and at the Department-wide level. Allowable charges from the Statewide cost pool are also determined. These three overhead cost pools (division, department and statewide) are then allocated to all the programs in the department (including state funded programs as well as federally funded programs). The allocation process is based on the relative direct salary costs of each program in the quarter.

The current Plan was initially approved by DHHS Division of Cost Allocation on February 28, 2006. The Vermont Agency of Human Services continues to work with Public Consulting Group, Inc., of Boston, on revisions to this plan as needed. Revisions to the plan are submitted to DHHS Division of Cost Allocation quarterly and are approved by DHHS quarterly.

Single State Audit. The State Auditor of Accounts arranges for an annual audit in compliance with the Single Audit Act, as well as in conformity with Section 506(a)(1) of the Maternal and Child Health Block Grant. The audit was performed by CliftonLarsonAllen (CLA) under contract with the Vermont Auditor of Accounts. Although the Maternal and Child Health Block Grant does not qualify as a "major" program for audit purposes, transactions may be tested as part of a general review of management control. There were no findings related to expenditures funded by the Maternal and Child Health Block Grant in FY 2022 or prior years. The audit report can be found on the State Auditor's website at http://auditor.vermont.gov.

Budget

In general, financial resources for Vermont’s FY24 Family and Child Health (FCH) program remain stable. The FCH program relies heavily on the Block Grant to support its core functions.  We continue to supplement the Block Grant with the availability of Medicaid and WIC funds and successful applications for selected categorical grant funding.

30%-30% Requirement: The Health Department calculates the amount of federal funds expended on each category. For FY22, Vermont anticipates 38% of expenditures will be made in Component B and 41.2% for Children with Special Health Care Needs.  The major programmatic change that impacted Vermont’s Title V budget was the completed movement of former Child Development Clinic developmental and autism assessment services from the Health Department to the University of Vermont Medical Center.  These services will now be funded through Enhanced Medicaid rate direct billing to the Department of Vermont Health Access (DVHA).  The State will no longer receive program income from Medicaid reimbursement for clinical services that were historically provided directly by the Health Department and the Autism Assessment Clinic at the Vermont Center for Children, Youth & Families.  Our FY22 expenditures show this full transition of services. In FY24, additional staffing costs associated with positions dedicated to health equity, family engagement and partnerships, and FCH program evaluation will be supported through this funding. Additional FCH staffing efforts are covered through the Maternal and Child Health Block Grant to maximize the distribution of other federal funding to community partners, such as injury prevention.

Administration costs: Administrative costs are defined in the same terms that they were defined in 1989: administrative costs are the extra-departmental costs that are allocated to the Health Department and to the programs within the Health Department. These costs are that component of the allocated costs that are attributable to the support services of payroll, buildings, etc. The definition of "administration" costs does not include costs such as the policy direction activities of the Health Commissioner, etc. The administrative costs of the Maternal and Child Health Block Grant can be readily determined by analysis of the allocated costs, and these costs are tracked on a quarterly basis to ensure that there is no increase in the costs that would exceed the allowable maximum. Administrative costs for FY22 are anticipated to be 1.9% of total costs.  Administrative costs are allocated on the basis of a program’s direct salary costs.

Maintenance of effort: [Sec. 505(a)(4)] The maintenance of effort amount for Vermont, based on the amount of unmatched State expenditures reported in 1989, is $167,093. We deduct one quarter of the maintenance of effort amount from our allowable claims each quarter rather than annually. Quarterly reductions of our allowable costs are more consistent with federal cash management directives than an end-of-year adjustment. This practice will continue in FY24.

Consolidated health programs: [Sec. 505(a)(5)(B)] Funds are used to support certain programs that were initiated under the provisions of the consolidated health programs, as defined in Section 501(b)(1). MCH Block Grant funds are used to support the Clinical Genetics Group, which was initiated under a section 1101 grant prior to 1981 and is referred to as a consolidated health program in Sec 501(b)(1)(C). The Clinical Genetics Group grant is $208,211. State General Funds (not Block Grant or other federal funds) are used to support the adolescent pregnancy program at the Addison County Parent Child Center, which was initiated under a Title VI grant prior to 1981, and is referred to as a consolidated health program in Sec. 501(b)(1)(D). The Addison County Parent Child Center grant is $32,820.

Other Federal funds: The other Federal funds used to support FCH-related goals are listed in Form 2. This list includes only those Federal funds under the direct control of Vermont's Title V Director; other divisions of the Vermont Health Department receive funding from the Federal grant sources listed. 

Vermont once again is the recipient of FY23 funding from the DHHS Title X Family Planning grant to fund statewide activities.

Source of State matching funds: The State match consists entirely of cash payments of State General funds or State Special funds (e.g., tobacco settlement funds). The State match is exclusively from non-federal funds. These non-federal funds are appropriated as described above and the use of these non-federal funds is monitored by the Agency of Human Services as well as the Health Department, as noted above.

Programmatically, we anticipate many of the same expenditures in FY24 as in recent years. Title V will continue to support the costs of MECSH Nurse Home Visiting as VDH works to finalize a funding model to expand these services.  Outgoing grant funding will continue to improve connections, information and education, transitions, leadership, cultural responsivity, and funding for Respite for families. Funding will also support the services of Vermont Afterschool, a public-private statewide partnership dedicated to providing quality afterschool, summer, and expanded learning experiences for all Vermont youth. Family and Child Health will financially support supplies for the 802 Smiles Network of School Dental Health Programs, which connects Vermont's various school dental health programs under one umbrella with the goal of increasing access to dental care for children.  Help Me Grow Vermont is currently being funded largely through the ESSA Preschool Development Grants Birth through Five, but Title V continues to support some program costs. The Parents as Teachers Family Support Home Visiting Program was implemented statewide on April 1, 2023, with Vermont Medicaid funding.