The Florida Department of Health (Department) has an ongoing commitment to provide Maternal and Child Health (MCH) services to women and children in Florida. This commitment includes continued support to county health departments, local programs, and other providers for MCH services.

The expenditures for Annual Report Fiscal Year (FY) 2022 are presented in Forms 2, 3a, and 3b of the Title V Block Grant application. The Department received $20,343,339 in Title V funds in FY 22-23 (October 1, 2022 - September 30, 2023). Of that amount, Children’s Medical Services (CMS) received $9,069,002.22 and the MCH program received $11,084,336.45. In addition, CMS provided $1,200,000 of their share of the Block Grant to fund Florida’s Healthy Babies initiative which is carried out by county health departments and overseen by MCH. This made MCH’s share $12,284,336.45 and CMS’s share $7,869,002.55

The MCH program anticipates expending $12,284,336.45 by the end of the grant period (September 30, 2023). MCH anticipates expending 10% of the grant on administrative costs. As in prior years, the Department will meet the Title V requirement as specified in Section 501(a)(1)(D): a 30/30/10 split, as shown on Form 2. CMS projects full utilization of Title V Block Grant funds by September 30, 2023.

CMS has various other state and federal funding sources. CMS receives $1.5 million from Title XIX, and $184,712,679 for XXI Children’s Health Insurance Program (CHIP) funding which supports the operations of the CMS Health Plan and the services provided to its annual average of 109,482 members. For Medicaid and CHIP related activities, CMS draws down the allowable federal match. CMS also receives $11,680,643 in state funds for additional programs and activities separate from the CMS Plan. In October 2021, CMS was awarded $445,000 annually for the Pediatric Mental Health Care Access (PMHCA) Grant, which is anticipated through September 2026, an additional $300,000 in supplemental PMHCA expansion funding was awarded through September 2023.

For Children and Youth with Special Health Care Needs (CYSHCN) that are uninsured or underinsured, CMS received $834,883 in state funds that is used to provide direct specialty health care services, as part of its Safety Net Program. Statutorily, CMS Title V funds are expected to be fully spent or used as part of this program. This year, safety net expenditures totaled close to $1.7 million. The increase is reflective of the need for access to the specialized services of Applied Behavioral Analysis, which is not a covered benefit under some health plans.

CMS’s general revenue funds are used to provide support for CYSHCN through various legislative supported member projects and contracts with tertiary care systems and their condition specific programs (i.e., diabetes, pulmonary, chronic kidney), with Title V CYSHCN funding used to help support (i.e., HIV, hematology/oncology). This state-federal partnership helps ensure a cadre of condition specific specialists across the state to help support access and quality services for CYSHCN. Specific to CMS’ existing tertiary care system partners, Title V CYSHCN funding supports a quality improvement learning collaborative, in partnership with the National Institute for Child Health Quality. The secondary gain of this framework of peer-to-peer learning, is the formation of a statewide network of existing partners starting to collaborate on statewide quality improvement projects, within and across institutions and conditions.

Title V CYSHCN funding supports the identified priority need for access to patient centered medical homes. This is done in partnership with the University of Central Florida’s Health Advancing Resources to Change Health Care program, who provides practice transformation technical assistance to primary care providers, so they are prepared to become a recognized or accredited quality program.

In support of the priority need to increase access for children’s mental/behavioral health treatment, Title V CYSHCN and PMHCA Grant funding is provided to support the Florida Pediatric Behavioral Health Collaborative. This includes six regional behavioral health hubs and a statewide psychiatric hotline that come together to form a statewide network. This integrated behavioral health model includes skill building training for primary care providers to be better equipped to identify and treat common pediatric behavioral health needs, and access to psychiatric consultation, and care coordination services. Funding supports a third-party evaluation component to systematically evaluate and analyze standardized metrics.

Title V CYSHCN funding was also used to support:

• Promotion of community system of care collaboration, including two pilot models for regional networks for access and quality.
• Supplemental funding to medically complex care clinic.
• Statewide and regional family leaders.
• Florida Family Leader Network focused on professional development for family leaders statewide.
• Workforce development training, education, and support including child parent psychotherapy, quality improvement, health care transition, infant mental health, trauma informed care.
• System (geo) mapping, including a children’s need index.

Title V funds were expended to enhance the MCH system of care and ensure more infants have the best possible start in life. The Department continues to partner with the Florida Perinatal Quality Collaborative (FPQC) housed at the University of South Florida. The collaborative works with Florida’s birthing hospitals on the following projects:

• Improve perinatal quality indicators.
• Family centered care to increase awareness of the importance of skin-to-skin contact for newborns in the neonatal intensive care unit.
• Improve care for postpartum women before and after being discharged from the hospital.
• Improve the recognition of the broad, social, economic, cultural, and environmental conditions that may affect birth outcomes.

During FY 22-23, the MCH Section contracted with a consulting firm to analyze outcomes of Florida’s Healthy Start program. This included a gap analysis based on meetings with, and documentation provided by, the Florida Association of Healthy Start Coalitions and the Department’s MCH Section, as well as public documentation related to best practices in performance management and evidence-based practices (EBPs). The gap analyses addressed the performance management system and outcome measures, EBP designation, data collection, and organizational capacity. The results of this analysis will be used to identify holistic programmatic improvement and monitoring of the statewide Healthy Start program.

Title V funds were also utilized to support the following MCH initiatives:

• Promote school-based sealant programs to children and increase positive consent rates from parents.
• Promote awareness of the adolescent health program.
• Partner with Count the Kicks on a statewide stillbirth prevention campaign.
• Partner to develop and implement a drowning prevention campaign.
• Support the school health program in Okaloosa County.
• Provide funding to all 67 county health departments to implement the Florida Healthy Babies program, which includes implementation of activities to address the following MCH priority areas:

• Infant mortality,
• Maternal mortality and morbidity,
• Well woman care,
• Unplanned pregnancy prevention,
• Dental/oral health, and
• Broad social, economic, cultural, and environment factors.

• Fund four regional part-time nurse abstractors, and epidemiology staff for data analysis, and additional staff as needed to support the statewide Maternal Mortality Review Committee.
• Fund 32 Healthy Start Coalitions who provide prenatal and infant services designed to improve birth outcomes and infant development.
• Fund a Fetal and Infant Mortality Review Consultant.
• Fund a council coordinator to oversee meeting activities for the Information Clearinghouse on Developmental Disabilities Advisory Council and the Rare Disease Advisory Council.

In Fiscal Year (FY) 2022-2023, Florida's Maternal and Child Health (MCH) Section and Children’s Medical Services (CMS) requested $20,776,333 in Title V MCH Block Grant funds. However, we were awarded $20,343,339. For FY 23-24, the Florida Department of Health (Department) is applying for $20,849,898. This amount is based on the amount approved from Florida’s legislature for FY 23-24. States must match every four dollars of federal Title V funding they receive by at least three dollars of state and/or local funding. The required state General Fund match for FY 23-24 is $15,637,424. This match is met with the General Revenue appropriation the Department receives for Healthy Start. In FY 23-24, House Bill 5 provided funding for the purpose of establishing Fetal and Infant Mortality Review Committees through recurring funds from the General Revenue Fund in the amount of $1,602,000. In FY 23-24, the Department received $4,400,000 in state funds to implement fatherhood engagement activities. Funding was disbursed via contracts with the 32 Healthy Start Coalitions and utilized for fatherhood engagement curriculum, home visiting services for fathers, oversight, and enhancements to the Healthy Start data system to capture services and outcomes. Additionally, the Florida’s Healthy Start program received an additional $9,580,165 for Healthy Start services provided to non-Medicaid eligible clients.

Florida’s Title V program complies with allocating and spending at least 30 percent of the federal allotment for preventive and primary services for children and at least 30 percent for services for children with special health care needs. A total of $7,672,749 is budgeted toward preventive and primary care services for children, which exceeds the 30 percent of the FY 23-24 estimated allotment. A total of $1,166,222.20 is budgeted for pregnant women, and a total of $7,598,754.16 is budgeted for children with special health care needs, a total of 36 percent.

For FY 23-24, the estimated administrative cost is $2,084,990 or 10 percent of the federal allotment, which is at the 10 percent threshold for administrative spending. The budgeted administrative costs in this application represent the grant funds used to administer the Title V program for MCH and include, but are not limited to, contract management, budgeting, policy development, personnel, and clerical support for these functions. Florida will continue to provide the maintenance of effort amount of $155,212,322 as required.

For FY 23-24, the Department has budgeted a total of $30,503,423 in other Federal Funds under the control of the Title V MCH Director. This includes $3,571,021 for the Sexual Risk Avoidance Education Grant, $1,61,556 for the Rape Prevention and Education Program, $11,800,000 for Title X Family Planning, $650,000 for the Perinatal Mental Health Grant, $450,000 for the Preventing Maternal Deaths Grant, $11,625,846 for the School Health Program, and under the control of Title V CYSHCN Director, $445,000 for the Pediatric Mental Health Care Access grant is included.

For the coming year, Title V CYSHCN funds have been budgeted towards the following activities and initiatives to address the identified priority needs and enhance the system of care for the CYSHCN population:

• Addressing the priority need for access to Patient Centered Medical Home (PCMH) contract continuation with University of Central Florida’s Health Advancing Resources to Change Health Care for practice transformation. This includes a pilot to explore a population health approach utilizing a learning action network and the addition of a behavioral health (BH) designation for those already PCMH interested in expanding their service delivery model.
• Increasing capacity of the Florida Pediatric Behavioral Health Collaborative and it’s Behavioral Health Hubs (BHH):
  • Expanded contract requirements including referral capacity with the six university or tertiary care centers operating as regional BHHs, to help address magnified mental health need due to impact of COVID-19.
  • Contract for external evaluation of program and outcomes measures collected by the BHHs.
  • Statewide pediatric psychiatric consultation line with care coordination.
  • Marketing activities including media campaigns promoting behavioral health and resiliency.
• Transition related initiatives including updating transition education modules, new transition website, and a clinic based direct service transition program.
• Professional networking and development for family leaders throughout the State, as part of the Florida Family Leader network.
• Support of one statewide and two regional family leaders.
• Continued quality improvement learning and collaboration for tertiary care system under contract with the Department, and their condition specific program’s serving CYSHCN.
• Support the funding of the Department’s contracts with tertiary care system program’s such as HIV and Hematology/Oncology.
• Community collaboration, including continued support for two pilot regional networks for access and quality models.
• Services for uninsured or underinsured as statutorily required as part of the Department’s Safety Net Program.
• Unmet data needs including development of data dashboard and oversampling, while maintaining system mapping needs.
• Data and communications support.

For the coming year, Title V funds have been budgeted for the following activities and initiatives to enhance service delivery and positive health outcomes for the MCH population:

• Staff for the MCH Section to implement Title V initiatives and programs.
• Contract with the Florida Perinatal Quality Collaborative to engage perinatal stakeholders to improve maternal and infant health outcomes through design, implementation, and evaluation of processes, and to enhance quality improvement efforts.
• Increase the number of clients served in Florida’s school-based dental sealant programs.
• Provide funding to all 67 County Health Departments to implement the Florida Healthy Babies program, which includes implementation of the following MCH priority areas:
  • Infant mortality,
  • Maternal mortality and morbidity,
  • Well woman care,
  • Unexpected pregnancy prevention,
  • Dental/oral health, and
  • Broad social, economic, cultural, and environment factors.
• Implement the Count the Kicks statewide stillbirth prevention campaign.
• Fund four regional part-time nurse abstractors, an epidemiology staff for data analysis, and additional staff as needed to support the statewide Maternal Mortality Review Committee.
• Fund 32 Healthy Start Coalitions who provide prenatal and infant services designed to improve birth outcomes and infant development.
• Expand the capabilities of the phone application developed by the University of Florida for postpartum mothers to assess their health status and prevent poor postpartum outcomes.
• Fund the development of an electronic prenatal screening form.
• Support the school health program in Okaloosa County.
• Fund a Council Coordinator to oversee meeting activities for the Information Clearinghouse on Developmental Disabilities Advisory Council and the Rare Disease Advisory Council.

• Development of a Healthy Babies dashboard. This dashboard will improve the efficiency of submission and reporting processes for county health departments related to their Healthy Babies activities.
• Fund an organizational analysis and compensation study to identify areas of improvement with regard to compensation, staff adequacy, and recommendations for maximizing staffing levels specific to MCH duties and responsibilities.
• Fund a medical records technician to bridge the gap of coding fetal records to improve efficiency and consistency of death certificates available to FIMR teams.
• Fund continued service by FedEx and Haye’s E-government Resources for the secure transfer of sensitive information for Maternal Mortality Review Committee operations.