Form 2, MCH Budget/Expenditure Details, shows $3,259,555 in federal Title V fund expenditures. See the Expenditure workbook attachment for a detailed breakdown of expenditures for the Federal/State Partnership.

Form 3a, Budget and Expenditures Detail by Types of Individual Served, reports federal-state partnership expenditures for FFY22 in the amount of $17,249,549 excluding admin funds.  Of this amount, $2,902,831 was funded by federal Title V.  The state match expenditure is reported at $6,763,553. This exceeds both the state match requirement of $4,883,780 and the maintenance of effort requirement of $5,035,775.

Figure 1 displays the distribution of Title V expenditures by population served. Federal Title V funds expended for child health primary and preventive care was $497,434 or approximately 15 percent of the total Title V expenditures.  At the time of submission, expenditures remain to be claimed in the Preventive and Primary Care for Children budget category; This category is fully obligated. HHS anticipates this budget category to be fully expended by the end of the budget period and will meet the minimum 30% requirement as indicated in the budget.

The federal Title V expenditure for children and youth with special health care needs is reported at $2,165,395 or 66 percent of the federal block grant funds expended for the year. 

Administration expenditures of $356,724 represent 11 percent of the federal Title V expenditures to date. At time of submission this amount reflects charges to administrative costs (MCH Director salary, travel, and other expenses) for the Title V Block Grant. The final indirect costs will be pulled prior to closeout based on actual expenses and will not exceed the 10% maximum.

Current expenditures are based on the expenditures reported on 3/31/2023.  All funds are obligated and are on target to be fully expended by the end of the budget period. For FFY22 funds, the Iowa HSS is using considerable Title V funds to replace the signifycommunity data system, following the sun setting of their case management system. Nearly $2.1M in Title V funding is obligated to this project. The Iowa Connected project (replacing Signify) was built on a deliverable-based budget and since the new system did not roll out until June 19, 2023, the invoicing has not happened at the time of application submission. Additionally, funding is obligated to local Title V MH and CAH agencies through the end of September 2023.

Form 3b, State Title V Program Budget and Expenditures by Types of Services, shows resources dedicated to Public Health Services and Systems continue to increase for MCH compared to the proportional of funds directed to direct services.  Continued improvement has been achieved in reporting on expenditures by pyramid level. 

Figure 2 reflects Title V expenditures by pyramid level and Figure 3 illustrates the pyramid level distribution for the combined federal-state partnership.

As you will see from the Expenditure attachment, Iowa’s Title V program is a blend of Title V funds, state match, program income and other federal/state funds.

Through the Title XIX/Title V MOU, Iowa’s local Title V contractors are designated a Medicaid provider status (Screening Center and/or Maternal Health Center) by virtue of their Title V application.  These contractors are required to bill Medicaid for services for clients enrolled in Medicaid.  Title V contractors are also able to provide Presumptive Eligibility to receive immediate coverage for those clients that may be eligible, but do not have Medicaid at the time of service.  Title V direct care expenditures cover services for those that do not have another source of payment for services.  Title V contractors are also encouraged to enroll with third party payers, as well; however, many have had little luck in enrolling with private insurance companies based upon their clinic status.  Iowa Administrative Code for Iowa’s MCAH program outlines that Title V is the payer of last resort.

The audit of Iowa's Title V, Maternal and Child Health Block Grant expenditures is included in the State of Iowa Annual Comprehensive Financial Report. The audit is conducted by the state Auditor's Office under the requirements set forth in the Single Audit Act of 1984, the Single Audit Amendments of 1996 and Title 2, US Code of Federal Regulations, Part 200, Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Uniform Guidance). The most recent report is for the period July 1, 2020 to June 30, 2021. The Iowa Department of Public Health had no findings in the 2021 State of Iowa Single Audit Report for the Title V program, AL Number 93.994. The report is submitted to the federal clearinghouse by the Department.

The FFY24 Title V appropriation is projected to be $6,611,198, based on the current Notice of Grant Awards received. As itemized in the budget included in the attachments section, this expected allocation is budgeted as follows: $1,364,097 (21%) for maternal health services; $50,051 (1%) for infant health services; $2,334,401 (35%) for child health services; $2,201,259 (33%) for services to children with special health care needs; and $661,120 (10%) for program administration. Budgeted items for preventive and primary care for children, children with special health care needs, and administration satisfy federal legislative requirements. Figure 5 below illustrates the budget plan for Title V allocation by population served.  Figure 6 represents the Title V allocation by levels of the pyramid.  

See forms 2, 3a, and 3b and the included budget attachment in supporting documents for detailed information.

The projected state match is $6,285,103.  Iowa continues to exceed the state maintenance of effort of $5,035,775, established in 1989 and exceeds the required match of $4,883,780. This amount has increased from previous years.

The total budget for the federal-state partnership is projected to be $22,120,053. Figure 7 illustrates the allocation of funds by level of service for the total partnership budget.  The attachment provides budget details by level of servi ce, as well as population group served. The Federal/State Partnership Budget supports the activities proposed within the State Action Plan for each population domain.

Administrative cost is allocated to each of the pyramid levels and is included in the above partnership amount.  Similarly, administrative costs are included in the amount listed for the categories that follow. 

Public Health Services and Systems

Estimated budget for continuing development of core public health functions and system development are $13,331,894 or 60 percent of the total federal state partnership budget.  This amount includes support services and salaries for maternal infant health, child health, and EPSDT.  This category includes 36 percent of the funding for local child health agencies and 23 percent of local maternal health funds.  In addition, it will include contract services with the University of Iowa, Departments of Pediatrics, Perinatal Review Team, Healthy Child Care Iowa, EPSDT dental and IDPH 1st Five Initiative.  CHSC's budget for public health services and systems is estimated at $2,074,951 (35 percent of the CYSHCN budget).

Enabling Services

The federal-state partnership budget for continuation of enabling services are estimated at $4,617,404 representing 21 percent of the partnership budget.  This category includes 50 percent of the funding for local child health agencies and 47 percent of local maternal health funds.  Healthy Families toll free information and referral line, TEEN Line, Hawki Outreach, EPSDT, STD testing, immunization, lead poisoning prevention, and birth defects and audiological services are included in this category. CHSC's budget for enabling services is estimated at $1,802,919. CYSHCN services in this category include EPSDT Ill and Handicapped Waiver Services. 

Direct Health Care Services

The federal-state partnership budget for continuation of direct care services are estimated at $4,170,755. This represents approximately 19 percent of the partnership budget.  The amount includes 14 percent of the funding for local child health agencies and 30 percent of local maternal health funds.  In addition, this category includes Birth Defects Institute and Regional Genetics Services; dental treatment, and dental sealant projects; and child vision screening. CHSC projects a direct care budget of $1,999,738 or approximately 34 percent of the CYSHCN budget. 

Other State/Federal Funds

The funds in this column of the budget attachment are not eligible for match but enhance Iowa’s MCH system. Examples of these programs include funding received through the Omnibus agreement within HHS these services include: EPSDT, I-Smile™, hawki outreach, and Healthy Child Care Iowa.

Other federal funds directed toward MCH include:

State Systems Development Initiative (HRSA/MCHB)

Title X Family Planning

Early ACCESS (IDEA, Part C)

Iowa Newborn Screening Surveillance Project (CDC)

Personal Responsibility Education Program--PREP (ACF)

Pregnancy Risk Assessment Monitoring System (PRAMS) (CDC)

Sexual Risk Avoidance Education Program (ACF)

Care Coordination for ASD/DD (HRSA)

EPSDT – HCBS IS (HRSA)

Peer Support MHDS (HRSA)

Pediatric Mental Health Care Access (HRSA)

Maternal Health Innovation (HRSA)