FY 2020 Annual Report Expenditures

Georgia’s Maternal and Child Health State and Federal funds are allocated based on priority needs to be identified through the Maternal Child Health Block Grant (MCHBG) development process. This process includes reviewing health status and outcomes for women and children, projecting future needs and assessing current capacity/infrastructure. As part of the Georgia Department of Public Health’s budget process, recommendations are made for funding levels for services to women, infant and children. 

The MCH Block Grant funding and expenditures for FY 2020 is based on actual expenditures and supported data. Expenditures are reported out of PeopleSoft Financials and Uniform Accounting System (UAS), to ensure compliance requirements are met such as:

• MCH Program staff meets with local public health districts virtually, to conduct monthly, quarterly calls, and virtual site visits to ensure local public health districts are spending funds accordingly, to federal, other, or state requirements.
• The Program Financial Manager generates reports monthly and quarterly to ensure all the requirements are met.
• Funds are allocated to the local public health districts based on Performance Measures, Data and Allocation Formula Methods to ensure compliance requirements are met.
• Local Public Health Districts are required to submit monthly and quarterly reports to State Program Managers to ensure oversight of expenditures such as:

Referral Log, Outreach Log, Patient Benefit Log, Specialty Clinic report, Preventive Participant Report, Data Report, Statistical Reporting, Programmatic Report and Satisfaction Survey for all patients receiving telemedicine services.

The total FY 2020 Federal-State Title V Block Grant Partnership Annual Report expended $314,547,294              and the Georgia Maintenance of Effort (MOE) sustained the level of $36,079,622. The FY 2020 State MCH Budget /Expenditure Grand total is $350,243,995. (See Form 2 line 11)

The Federal MCH Block Grant funding supports the activities within Division of Health Promotion, which administers the MCH Services Title V Block Grant: MCH, Women’s Health, and Oral Health Programs. Program Partnership with Division of Health Protection: Injury Prevention, Adolescent Health, Epidemiology programs.

Federal MCH Block Grant Annual Report: The Title V funding focused on the priority need of the following programs: 

• Women’s/Maternal Health: The program continued to focus on improving access to health care, including access to the most effective forms of contraceptives; and preconception health to promote women's health prior to pregnancy and strategies to reduce maternal mortality. MMRC direct and lead initiatives to impact maternal birth outcomes. Centering Pregnancy empowers patients, strengthens patient/provider relationships, and builds communities through health assessment, interactive learning, and community building. Improve birth outcomes and decrease preterm birth rates through the implementation of a Centering Pregnancy Model Program. Women’s Health provided oversight and management of the NAS surveillance process in close collaboration with MCH EPI and birthing hospital staff. MCH uses Title V funds to provide services for women of reproductive age. Family planning clinics supported by State and TANF funding provides contraceptive counseling and preventive services. Cancer screenings and HPV vaccines are provided in the family planning clinics.
• Infant Mortality: The program aims to assure pregnant women in Georgia every opportunity to access comprehensive perinatal health care services appropriate to meet their individual needs. DPH continues to develop strong partnerships around the coordination of Regional Perinatal Centers (RPC) by providing information and education to delivering facilities, staff, and women to ensure they deliver

at the appropriate facility in instances where mother and baby may require specialize care.

• Oral Health-Cross-Cutting/Life Course: The Oral Health program provides training to organizational stakeholder’s school-based or school-linked public health and provides services including fluoride varnish, dental sealants, prevention education and comprehensive restorative treatment. School-based prevention programs are targeting high-risk children, tele-dentistry, cancer screenings, and tobacco prevention programs to pregnant women. The program participated in a work group to improve oral health access and care for pregnant women in Georgia through the HMHB.
•  Injury Prevention/Safe Sleep: The program developed and implemented the “Safe Infant Sleep to support hospitals in their efforts to educate families about safe sleep practices and provide education materials throughout the state. Injury prevention provision of general support to local coalition in helping promote safe and injury free lifestyles and behaviors. The Child Occupant Safety Project (COSP) aims to prevent

motor vehicle accident deaths among children.

• Family and Community Support -Home Visiting: The program strengths-based, family-centered support strategies that give pregnant women and at-risk families with children from birth until kindergarten entry the resources and skills they need to raise children who are physically, socially, and emotionally healthy and ready to learn. The program was implemented to provide services that can potentially improve maternal and newborn health; reduce child injuries, abuse, and neglect; reduce crime and domestic violence; improve a family’s economic self-sufficiency and improve coordination and referral for other community resources and support.
• Refugee Health: The program promotes the physical, mental, and social well-being of all newly arriving refugees in the state of Georgia, which helps to ensure that refugees receive adequate healthcare.
• Child Health: The program plans to improve access to a medical home included expanding the use of telehealth technology, facilitate efforts to educate families about telehealth as an option for care, and provide ongoing evaluation. Children 1st serves as the single point of entry to child health services through DPH connecting children and families with public health and other prevention-based programs and services. Children 1st aims to identify all children ages birth to five who are at risk for poor health and development. The EDHI program maintains and support a comprehensive, coordinated, statewide screening and referral system promoting hearing screening and appropriate follow-up for all newborns through education, technical assistance and training regarding implementing and maintaining a quality newborn hearing screening program.
• MCH Epidemiology: The section carries out several activities to identify diseases and describe health conditions, assess the health of Georgians, and develop recommendations to control diseases and improve the overall health status in the state. conduct data analyses and disseminate information from surveillance systems, monitor and investigate reports of unusual health conditions and conduct active and passive surveillance to detect diseases and adverse health conditions.
• Georgia Shape/Child Health and Wellness: The program has served statewide coalitions, and virtual annual events as the agency’s child health and wellness program. Also, provides technical assistance and funding through various partnerships. Georgia Shape provides training and technical assistance (with the support for the Georgia Health Policy Center, HealthMPowers and Georgia Shape Sub-Group Partners) supports to 20-28 local schools awarded the Georgia Shape School Mini-Grant. Georgia Shape implements statewide model wellness policy for childcare centers serving children ages 2-5 that include requirements for increased physical activity, increased consumption of fruits and vegetables, and decreased screen time that aligns with national standards and Quality Rated's Physical Activity and Nutrition Standards.
• Early Brain Development: The program creates language-rich environments for children ages zero-three and remove barriers to language to ensure that all children have the opportunity for healthy early brain development and develop a method for measuring success at the population-level. The Reach Out and Read program for build language and literacy-rich environments for child, measures: the number of sites implementing the program, the number of providers who have been trained in the intervention, the number of families reached, the ages of children reached, and the number of books distributed to children.
• Fatherhood Initiative: The program developed the initiative with the goal to create strategies that increase awareness and advocacy across intra and inter-agency partners, creating a culture of inclusion for fathers across the state. The program continues to increase father engagement and involvement in MCH programs through

capacity building, collaboration, coordination, and providing resources to encourage father inclusion.

• Suicide Prevention: The program contracted with SPAN-GA to implement the Sources of Strength wellness program within several of Georgia’s middle and high schools. The program address awareness and education surrounding mental health and suicide also took place through the engagement of community and family members. State suicide prevention partners were engaged to develop an Injury and Violence Prevention Strategic Plan, using a Shared Risk and Protective Factors (SRPF) framework to identify the risk and protective factors shared across multiple forms of violence and injury.
• Children with Special Health Care Needs: MCH addressed all aspects of a well-functioning system for CYSHCN, with a focus on health care transition to adult care. MCH focuses on ensuring that all children in CMS, the state program for

CYSHCN, have a satisfactory transition plan. Enhancing the system of care for youth and young adults transitioning from pediatric to adult care as well as for families with CYSHCN to access timely pediatric medical care in rural areas of the state are priority areas for the CMS program. CMS partners with primary care providers, pediatric sub-specialists, healthcare vendors, state agencies and community-based resources to coordinate timely access to health care services and supports for eligible CYSHCN and their families. CYSHCN programs partner with health care providers and community-based resources to coordinate pediatric specialty and therapeutic care for CYSHCN and their families.

FY20 Title V 30/30/10 requirement expended $17,133,550. Of this amount follows: (See Form 2 lines 1A-1C):

• Preventive and Primary Care for Children 30%: $5,309,922 (30.99%)
• Children with Special Health Care Needs 30%: $6,679,661 (38.99%)
• Title V Administrative Costs 10%: $1,570,205 (9.16%)

Types of Service Federal: (Form 3b Federal)  

• Direct Services: $3,469,639   
• Enabling Services: $4,358,321
• Public Health Services and System: $9,305,590

Types of Service Non-Federal: (Form 3b Non-Federal) 

• Direct Services: $47,773,714   
• Enabling Services: $56,417,246
• Public Health Services and System: $193,222,783

The State MCH Funds expended $115,221,18 exceeding the State required match of $12,850,163 for FY 2020 MCH Federal Allocation of $17,133,550. In addition to the required match for the MCH Block Grant - additional State Funds are used to support MCH programs and partnership activities in the MCH Population Domains: Women/Maternal Health, Child Health, Children 1st, Adolescent Health, Immunizations, GA Shape, Oral Health, Early Brain Development, Refugee Health and Children with Special Health Care Needs. (See Form 2 line 3)

The Other Funds expended $177,165,919; funds were used to support: (See Form 2 line 5)

• Six Regional Perinatal Centers (RPC), to provide advanced care for high-risk mothers and infants.
• Reimbursement of Babies Can’t Wait Special Instruction Services, support the need of Part C Early Intervention to provide coordination, comprehensive and integrated system of services for infants and toddlers with special needs, birth to 3 and their families.
• Georgia Newborn Screening, the program comprised of six major components to ensure every newborn receives adequate screening for these 35 conditions and infants that screen positive for a condition receive appropriate and timely follow up such as: Education, Screening, Follow-up, Medical Diagnosis, Management and Evaluation.
• Partnership with Immunization Vaccines for Children (VFC) program, which is used to fund infants less than 1 and children 1-22.
• Children Elderly Trust Fund, Georgia provides for programs for home delivered meals, transportation services for the elderly, and preschool children with special needs, including but not limited to disabled children, troubled children, school readiness programs, and other similar needs for the benefit of the citizens of Georgia.

The Program Income expended $5,026,641, this income is derived from Medicaid Perinatal Case Management, Medicaid DSPS earnings, Family Planning Fees, Private Insurance, Health Check earnings and Outpatient Client Fees, for services provided to Pregnant and Postpartum Women, Preventive and Primary Care for Children and Reproductive Health Services to Women. The expenditures are tracked and monitored through the Uniform Accounting System (UAS) monthly/quarterly. The UAS data reports are reviewed quarterly for annual reporting.  (See Form 2 line 6)

The Other Federal Funds expended $35,696,701 this amount represents the variation of federal funds managed under the Title V Administrator. These funds are used to support the need of preventing, promoting, and improving children and youth with special health care needs and pregnant women, mothers, and infants.

Other Federal Funds consist of:

• Temporary Assistance for Needy Families (TANF)
• Maternal, Infant and Early Childhood Home Visiting Program (Formula)
• Healthy Start Initiative Eliminating Racial/Ethnic Disparities
• Georgia Perinatal Quality Collaborative Grant (GaPQC)
• Universal Newborn Hearing Screening (UNHS)
• Georgia Early Hearing Detection and Intervention (EHDI)
• Preventive Health Services Block Grant (PHHS)
• Infants and Toddlers with Disabilities (Part C)
• Georgia Oral Health Prevention Program

FY 2022 Application Budget

The Georgia Department of Public Health has a system of accountability to monitor the allocation and expenditures of funds provided to local health districts. The department utilizes the computer program systems such as: PeopleSoft Financials and Uniform Accounting System (UAS), where state and local health districts' administrative personnel input budgets (funds that are allocated by programs such as Children with Special Health Care Needs) and expenditures. The Maternal and Child Health Section of the Georgia Department of Public Health administers audits, monitor programs monthly/quarterly and provides technical assistance when needed.

The Federal-State Title V Block Grant Partnership total for FY 2022 is $326,525,906. Of this amount, MCH expects to fund the FY 2022 budget from 6% Federal MCH Block Grant, 33% from State MCH Funds, 59% from Other Funds and 2% from Program Income. Georgia’s total Maintenance of Effort (MOE) from 1989 is $36,079,622.  As shown on Form 2, MCH effort far exceeds the Match and MOE requirements. The total FY 2022 State MCH Budget Grand Total is 359,325,738 (including the Other Federal Funds in the total budget).                                                         .                                                                                    

The FY2022 Federal Application request amount is $19,613,858. The required State Match for Georgia is $14,710,394, which includes federal earmarked for Preventive and Primary Care for Children and Children with Special Health Care Needs.

FY 2022 Federal MCH Block Grant 30%-30%-10% requirement:  

• Preventive and Primary Care for Children is budgeted for: $6,998,735 (35.7%)
• Children with Special Health Care Needs is budgeted for $7,146,252 (36.4%)  
• Title V Administrative Cost is budgeted for $1,499,921 (7.6%)
• All Others is budgeted for $3,968,950  

MCH Populations:

Pregnant Women: Title V is used in this area for Women’s/Maternal Health Services providing access to high-quality perinatal care to Georgians as we recognize that there is a direct relationship between perinatal birth outcomes and the quality of health care services.

Centering Pregnancy program will continue to support public health districts in their goal to provide Centering Pregnancy services to women in the community.

Breast and Cervical Cancer Program (BCCP) provides breast and cervical cancer screening to women in Georgia who are low income uninsured or underinsured, rarely/never screened and between the ages of 40‐64 for breast cancer screening and 21‐64 for cervical cancer screening.

Maternal Mortality Review Committee (GA MMRC) to reduce the Maternal Mortality rate and identify pregnancy-associated deaths (deaths during or within a year of pregnancy).

Neonatal Abstinence Syndrome (NAS) and Centering Pregnancy services to decrease the rate of preterm and low weight babies, increase breastfeeding rates to lead to better pregnancy spacing in Georgia.

Family and Community Support -Home Visiting the program gives pregnant women and families, particularly those considered at-risk, necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn.

Infants Less Than 1 Year Old: Title V-leveraged services for this population include: Infant Mortality, Maternal Mortality, Neonatal Intensive Care Unit (NICU) Benefits and Administration - 6 tertiary centers statewide which provide clinical care and education services for high-risk newborns, education, and the prevention of sudden infant death syndrome (SIDS) and Other Infants Deaths (OID). Georgia Newborn Screening (NBS) Program and Epidemiology provides data and surveillance for MCH programs.

Children 1-22 Years Old: Children1st facilitates early identification of at-risk children and links them with early interventions services, as well as other public health services and community-based resources. The Oral Health Program contract with Richmond County Board of Health to provide dental services to mothers and children in the Augusta Health District and to provide training opportunities for pediatric dental residents in a mobile clinic environment.

The Injury Prevention program is committed to define the problem, identify risk and protective factors, develop, and test prevention strategies, and assure widespread adoption of proven injury prevention principles and strategies as it relates to areas: Suicide Prevention Program SPAN-GA and Safe to Sleep programs.

Child Occupancy Safety Program (COSP) Motor vehicle related injuries continue to be a leading cause of death for children under 14 years of age. The Child Occupant Safety Project, utilizing local partners, conducted monthly education classes to train caregivers on proper use and installation of child safety seats.

Children with Special Health Care Needs (CSHCN): Children Medical Services provides care coordination, early and continuous screening for children with special health care needs and other needed medical/health services for eligible children and their families.

Federal MCH Block Grant Budget:

Other Federal Funds Budget:

Other Funds Budget: