Expenditures

Minnesota’s federal fiscal year (FFY) 2021 expenditures fully met federal Title V MCH Block Grant requirements. At least 30% of federal funds supported CYSHN, and at least 30% of federal funding provided preventive and primary care for children and adolescents, as specified in Section 501(a)(1)(D). Minnesota did not exceed the 10% administrative requirement at 7.8%. Minnesota’s Maintenance of Effort (1989 [Section 505(a) (4)]) of $6,184,197 was met and Minnesota exceeded federal match requirements of three dollars for every four dollars received. Minnesota’s FFY2021Title V award was $9,146,460, of which we project all of it will be expended, and state and local match totaled $18,930,444 as reported on Form 2.

The Community Health Services Act of 1976 redesigned Minnesota’s public health system. Prior to 1977, over 2,100 local boards of health existed to serve Minnesota’s communities. Now called the Local Public Health Act, the legislation delineates the responsibilities of the state (MDH) and city and county governments in the planning, development, funding, and delivery of public health services. This partnership enables state and local governments to combine resources to serve public health needs in an efficient, cost-effective way, and is the infrastructure for nearly all public health efforts in the state. The Community Health Board (CHB) is the legal governing authority for local public health. CHBs work in partnership with MDH to prevent diseases, protect against environmental hazards, promote healthy behaviors and healthy communities, respond to disasters, ensure access to health services, and assure an adequate statewide public health infrastructure. Under the Local Public Health Act, CHBs address and implement the essential local public health activities and assure that a community health assessment and plan are completed, that community health needs are prioritized in a manner that includes community participation, and that needed public health services are developed and implemented. The number of CHBs in the state has varied slightly over time but is currently at 51. 

Minnesota Statute § 145.88 distributes, by formula, two-thirds of Minnesota's federal Title V MCH Block Grant allocation to CHBs. State law requires CHBs to provide at least a 50% match for the federal Title V MCH Block Grant funds they receive each year, leveraging additional funding for local MCH efforts. Local tax dollars predominately make up match requirements.

By state statute, CHBs must use Title V MCH Block Grant funds for low-income high-risk populations to address health disparities, health services, and other health-related issues as described below:

1. High rate of infant mortality or children born with low birth weight,
2. Increased likelihood of complications during pregnancy,
3. Children who have or are likely to have a chronic disease or disability or special health need,
4. Access to subsidized family planning services,
5. Frequency and severity of childhood and adolescent health issues,
6. Preventing child abuse and neglect, reducing juvenile delinquency, promoting positive parenting and resiliency in children, and promoting family health and economic sufficiency through public health nurse home visiting and,
7. Nutritional issues of women, infants, and young children through WIC clinic services.

While Minnesota statute broadly directs the use of these funds, local public health agencies conduct their own needs assessments and allocate or move funding between populations or types of services provided to meet emerging community needs or to respond to critical MCH issues.  This ability to respond to emerging community needs or public health emergencies can result in variations between federal fiscal years as to populations served or types of service provided using Title V funds.

All CHBs report using all or a portion of their Title V funds to support their home visiting programs. More than half of CHBs use Title V funds to help support family home visiting and the Follow Along Program (described further in the Child Health Annual Report and Application Plan). About a fourth of CHBs use Title V funds to support access to family planning services. Other activities identified on CHBs annual work plans include breastfeeding support, injury prevention, adolescent health promotion activities, including school based clinics, as well as public health assessment, case management, and referral services for CYSHN.

Minnesota Statute § 145.882 subd. 2 directs up to one-third of Minnesota’s federal Title V MCH Block Grant allocation for state efforts to:

1. Meet federal requirements of a statewide needs assessment every five years and prepare the annual federal application and report;
2. Collect and disseminate statewide data on the health status of mothers and children;
3. Provide technical assistance to CHBs in meeting statewide outcomes;
4. Evaluate the impact of maternal and child health activities on the health status of Minnesota’s mothers and children;
5. Provide services to children under age 16 receiving benefits under Title XVI of the Social Security Act; and
6. Perform other MCH activities as deemed necessary by the Commissioner of Health.

Of the $3,086,662 retained to support the MCH and CYSHN programs within MDH, all will be expended by the end of the grant period and $759,263 went to meet MDH’s indirect rate of 21.7%. Retained funding supported key positions within the Director’s office, MCH and the CYSHN programs, coverage of shared resources that support program activities and inter-agency efforts targeted at children and their families.  

Minnesota’s contribution to meet Title V MCH Block Grant match requirements totaled $15,708,441 from state and fee supported MCH programs under the administration of the CFH Division. This was augmented by local public health contributions for a total match of $18,930,444. Table 1 below details the expenditures for FFY2021 from state/fee funds, which help meet match requirements.

Table 1. Expenditures Meeting Title V Match Requirements, FY2021

In addition, $126,396,956 in other federal funds were expended for maternal and child health activities. The majority of federal funds supported WIC programmatic activities ($105,917,334). Please refer to Form 2 for a detailed list of all federal grant funds expended in FFY2020. Minnesota’s MCH and CYSHN programs are in a key position to influence, leverage and enhance this broad array of federal funding directed at Minnesota’s MCH population.

It’s important to note that a portion of this reporting period included the COVID 19 pandemic response which involved many of our Title V local public health grantees and state employees. The flexible use of funding extended by the MCHB allowed grantees to use the funds to serve mothers, infants and children throughout the response, in both COVID response roles (i.e., quarantine management, vaccination clinics) as well as innovative telehealth home visiting and teleclinic services.  It also allowed state Title V employees to serve in COVID response roles that supported families and children, such as supporting public health and healthcare hotlines, contact tracing and managing grants and contracts for community-based providers to reach BIPOC families and children in vaccination outreach.

Because of the broad coverage of Minnesota’s public programs, limited medical, dental, or other direct services have been provided using Title V MCH Block Grant funds. Please refer to FFY2021 expenditure information in Form 2 (MCH Budget/Expenditure Details), Form 3a (Budget and Expenditure Details by Types of Individuals Served), and Form 3b (Budget and Expenditure Details by Types of Services). These forms and their field notes provide additional details and explanations about FFY2020 expenditures.

Budget

Please refer to budget information in Form 2 (MCH Budget/Expenditure Details), Form 3a (Budget and Expenditure Details by Types of Individuals Served), and Form 3b (Budget and Expenditure Details by Types of Services. These forms and their field notes provide additional details and explanations about the Minnesota’s Title V MCH Block Grant budget.

Minnesota’s federal Title V Maintenance of Effort of $6,184,197, and projected match requirements of $6,516,866, can be fully met using state general fund and fee-based appropriations (see below for a listing of the programs). Funds are budgeted for the MCH and CYSHN Directors and other key staff to attend at least one national MCH/CSHCN meeting and the required Block Grant Application/Annual Report review, should that resume onsite in Chicago.

For the FFY2023 Title V MCH Block Grant budget application we continue to align our administrative costs to align with the MCHB definition as suggested by reviewers at the 2020 annual review meeting and allocate those across the program areas (pregnant women and infants, CYSHN, and child and adolescent health) within the grant to more accurately reflect the administrative costs incurred by each area. We also account for funds spent on infant health into the Child and Adolescent area. There is a field note included in the TVIS form of this accounting which enables us to meet the 30%-30%-10% requirements.

As described earlier, two-thirds of the Title V MCH Block Grant are distributed by formula to all local public health agencies, called Community Health Boards (CHBs). These CHBs submit annual budgets and work plans, and report on expenditures of their federal Title V MCH Block Grant funding. Significant changes can occur between budgets and expenditures as the 51 CHBs may redirect funds during the year to respond to critical local needs or emerging health issues. This can create fluctuations in the populations served, total numbers of individuals served, and the types of services provided. This flexibility in funding may result in line-item differences of greater than 10% in block grant budget and actual expenditures. CHBs must provide a 50% match for the Title V MCH Block Grant funding they receive, and this funding supports almost half of Minnesota’s total federal match requirements.

State law allows the state to retain up to one-third of the federal MCH Block Grant. The state also supports all the indirect charges for the Title V MCH Block grant from the state portion of the funding.

The FFY23 Title V MCH Block Grant supports 28 positions, which equals 22.64 Full-Time Equivalent (FTE) positions within the CFH Division, with some fluctuations due to personnel changes and intermittent hiring of student workers. Title V funding is budgeted to cover key positions within the MCH and CYSHN Sections and Directors Office, important statewide initiatives, and the MDH indirect rate. This funding enables the state to provide critical expertise in the delivery of MCH health programs at the local level, supports important state responsibilities, and provides oversight and monitoring of the grant. Positions fully or partially covered by federal funds include:

• Title V CYSHN Director
• MCH Assistant Section Manager
• SSDI Coordinator
• MCH Epidemiologist (2)
• Title V Coordinator
• Family Planning Coordinator
• Adolescent Health Coordinator
• State School Health Nurse Consultant
• Child and Adolescent Health Supervisor
• Maternal and Child Health Quality Improvement Specialist
• CYSHN Policy and Program Planners
• CYSHN Coordinated Care Systems Specialist
• Health Educator (MCH and CYSHN)
• Follow Along Program Coordinator
• Financial specialists (6)
• Administrative assistant
• IT specialist/website support of MCH and CYSHN programs
• Student workers (3)

The Title V MCH Block Grant funding supports several initiatives that bring the CFH Division into state policy discussions, promote, monitor, and improve Minnesota’s MCH populations, advance health equity efforts, and support collaboration between state agencies. Examples of such initiatives that use FFY2021 funds include:

• Supporting staffing of the Children Cabinet, which is comprised of key state agency commissioners and charged with creating an equitable system that supports pregnant and parenting families ($46,000).
• Supporting partial funding of a Safe Sleep Initiative/Bereavement Support Grant for families experiencing sudden infant death, including funds for Safe Sleep information booklets ($65,000).
• Funding a family-to-family peer support grant for parents/caregivers of CYSHN ($113,000).

Funding to support costs associated with MDH’s maternal mortality review committee including abstractor contracts, support for community members on the committee, and report production costs.   The following state appropriations augment CHBs match to fully meet federal match or Maintenance of Effort requirements:

State Fiscal Year (SFY) 2022 General Revenue Funds (total $37,647,441):

• Fetal Alcohol Syndrome activities ($2,000,000)
• Family Planning ($5,181,441)
• Positive Alternatives Program ($3,485,000)
• Family Home Visiting ($20,168,000 – a portion will be used for MIECHV match)
• Birth Defects Information System ($1,772,000)
• Deaf and Hard of Hearing Programs ($874,000)
• Child and Teen Checkups ($190,000)
• State funding for management, supervisory and administrative support ($1,338,000)
• Women’s Right to Know ($136,000)
• Maternal Mortality Reviews ($163,000)
• Healthy Babies Grants ($260,000)
• Anti-Racism Curriculum Grant ($294,000)
• Midwife/Doula Capacity Building ($171,000)
• CMV Education/Outreach ($161,000)
• CYSHN grants ($160,000)

State Fiscal Year 2022 Fee Funds (total $1,159,000):

• State abstinence education program ($52,000), from a portion of the marriage license fee
• Long term follow-up program for children diagnosed with a newborn screening condition ($1,432,000), from the newborn screening fee.

Other federal funds under the administration of the CFH Division supporting maternal and child health efforts include:

State Fiscal Year 2022 Interagency Agreements (total $11,482,455):

• Minnesota Department of Human Services provides:
  • Temporary Assistance for Needy Families (TANF) funding for the Family Planning program ($1,156,000) and the Family Home Visiting program ($8,557,000)
  • Medicaid funding to support the Child and Teen Checkups (EPSDT) program ($487,597).
•  Minnesota Department of Education provides:
  • Part C funds to support the Follow-Along Program ($320,000)
  • Part B funds to support transition of adolescents into adult systems of care ($60,000)
  • Federal Preschool Development year 3 implementation grant to support early childhood development and learning, including the full roll out of the Help Me Grow (now called Help Me Connect) system ($1,162,185).

Other Federal Grant funds (total over $93,440,891):

• SSDI ($100,000)
• PRAMS ($160,020)
• DOJ Incarcerated Parents ($226,429)
• ECCS Health Integration ($255,600)
• Pediatric Mental Health ($445,000)
• Universal Newborn Hearing ($235,000)
• WIC ($111,192,397), including breastfeeding support grants)
• Sexual Risk Avoidance Education Grant ($692,524)
• Personal Responsibility Education Program ($846,646)
• Maternal, Infant, and Early Childhood Home Visiting ($8,826,241)
• Maternal, Infant, and Early Childhood Home Visiting ARP 1&2funds ($2,857,557)
• Birth Defects Information System ($375,000)
• Preventive Block Grant for Adverse Childhood Events ($124,711)
• CDC-Perinatal Quality collaborative grant ($250,000)

Federal Title V MCH Block Grant funds have remained relatively consistent while salaries and fringe benefits have increased. However, the 2021 legislative session added several new state- funded maternal and child health initiatives, which has allowed expansion of our MCH activities to complement our Title V budget activities.