UTAH 2021 EXPENDITURES - FINANCIAL NARRATIVE

Overview

The Title V federal funding, in conjunction with non-federal state monies and other federal funds, were obligated and expended to support Utah’s Title V requirements, National and State Performance Measures, and priority needs. Approximately one-third of Title V funding supported Children with Special Health Care Needs (CSHCN) and an additional eighteen percent supported the MCH work of 13 local health departments across the state. The remaining Title V funding supported other critical MCH programs such as: Newborn Safe Haven, Baby Your Baby, Maternal and Infant Health, Mother to Baby/Pregnancy Risk Line, Family Youth Outreach, Oral Health, and Early Childhood Utah. To ensure alignment with Title V requirements, MCH Block Grant leadership and Division of Family Health leadership met throughout the year to review expenditures across all program and budget areas.

Expenditures (FY 2021 Annual Report Year)

Utah’s Title V state match (as reflected on Form 2, line 3, “State MCH Funds” in Annual Report Expended) exceeded federal match and Maintenance of Effort requirements. State match is composed of state general funds, including funds for Early Intervention, Home Visiting, Newborn Safe Haven, maternal mental health, and Children with Special Health Care Needs. Fluctuations in actual State Funds expended can occur each year based on one-time funding as match and maintenance of effort requirements for other federal funds or transfers being received from other agencies. Form 2, line 5, “Other Funds” in the Annual Report Expended represents WIC rebates, and other revenue from other State Agencies (Department of Workforce Services, Department of Human Services), as well as revenue agreements with private nonprofits. Program Income (Form 2, line 6) included fee revenue such as Pregnancy Risk Line collections, Baby Watch family fees, and newborn screening kit fees.

Form 2, “Other Federal Funds,” showed Utah’s MCH work was also supported by a variety of other federal funds in FY 2021 including: Women, Infants and Children (WIC); State Systems Development Initiative; Pregnancy Risk Assessment Monitoring System, Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees, Part C Early Intervention, Early Childhood Utah Developmental Screening, and Maternal, Infant and Early Childhood Home Visitation funds.

Utah tracked expenditures to comply with the Title V 30/30/10 legislative requirements. That is, a minimum of 30% of total funding must be expended for CSHCN; a minimum of 30% of total funding must be expended for preventive and primary care for children; and a maximum of 10% of total funding can be expended for Title V administration.

Each program tasked with oversight of activities related to the National and State Performance measures identified budgetary needs to accomplish the objectives outlined in the Evidence-Based Strategy Measures. The funding needs were outlined in internal programmatic budget allocations at the beginning of the fiscal year. Each Program Manager and Bureau Director who are accountable for a line item(s) on the budget met regularly with Division Finance staff to track and monitor expenditures and assure budgets were not overspent.

In FY 2021, 33.53% of Title V expenditures were allocated to CSHCN; 51.86% of expenditures were for preventive and primary care and 8.46% of expenditures were for Title V administrative costs.

To ensure that the 30/30/10 requirement was properly documented and to record expenditures by the MCH Pyramid of Services, the Bureau of Maternal and Child Health allocated MCH Block Grant Funds throughout the Utah Department of Health to the following: the Bureau of Maternal and Child Health, the Bureau of Children with Special Health Care Needs, the Bureau of Health Promotion, and also contracted Title V funds with the 13 Local Health Departments (LHD).

UTAH BUDGET (FY 2023 Application Year)

Together with state general funds and other federal funds, the Title V MCH/CSHCN block grant is used to address Utah’s MCH/CSHCN priority needs, improve performance related to targeted MCH/CSHCN outcomes, and expand systems of care for the MCH/CSHCN populations. Utah’s Title V Leadership Team meets on a regular basis to discuss all aspects of Title V, including the budget and how federal and non-federal funds are being used to address the state’s MCH needs. The table below illustrates projected Title V funding allocations for FY 2023:

Through state level programs and initiatives, as well as local health department activities, these appropriations, as well as future budget appropriations, will be used to support work related to the following Needs Assessment conducted during FY 2021:

 

Utah’s commitment to adhere to the 30/30/10 Title V legislative requirement was discussed in the preceding Expenditures section. For FY 2023, this commitment is again reflected in Form 2 (Lines 1A, 1B, and 1C) in the Application Budgeted. For FY 2023, 51.6% of the total Title V budget is designated for preventive and primary care for children; 34.2% is designated for Children with Special Health Care Needs; and 9.5% is designated for administrative costs. Title V leadership will hold budget discussions throughout the fiscal year to ensure that the budget and spending are on track, and to address any new or unplanned MCH/CSHCN needs.

Each program tasked with oversight of activities related to the National and State Performance measures identifies budgetary needs to accomplish the objectives outlined in the Evidence-Based Strategy Measures. The funding needs are outlined in internal programmatic budget allocations at the beginning of the fiscal year. Each Program Manager and Office Director who are accountable for a line item(s) on the budget will meet regularly with Division Finance staff to track and monitor expenditures and assure budgets are not overspent.

Utah meets the required Title V state match, which is a $3 match in non-federal funds for every $4 of federal Title V funds. Utah continually exceeds the required match. Budgeting of match is found in Utah’s “State MCH Funds” (Form 2, line 3) and is composed of state general funds including: Division of Family Health Director’s Office, Newborn Safe Haven, Informed Consent and Abortion Module, Home Visiting, Maternal Mental Health, Children with Special Health Care Needs, Birth Defects Network, Early Hearing Detection and Intervention, and Early Childhood Utah. Along with other federal funds, these state MCH dollars are a critical component of Utah’s MCH infrastructure. Form 2, line 5, “Other Funds” reflects funds including transfer funds from other state agencies, and WIC Formula Rebates. “Program Income” (Form 2, line 6) includes Teratology collections and donations and Baby Watch Early Intervention Family Fees. Other federal funds anticipated in FY 2023 are indicated in Form 2, line 9, and are similar to funds noted in the Expenditures section.

Challenges

As has been the case for several years now, Utah continues to face challenges related to the Title V budget. The current annual working Title V budget is $6.6 million. Utah continues to modify the budget to align with the annual $6.1 million award from HRSA. Funding allocations continue to change to ensure we are spending within the level of our annual federal award, as well as prioritizing the outcomes from the Needs Assessment that was conducted in FY 2021. The most recent changes to bridge the gap between ongoing obligations and the grant award include:

• Securing outside grant funding for MCH/CSHCN Projects.
• Lease savings from consolidation of space. All MCH/CSHCN programs now reside at the Multi-Agency State Office Building, with cost savings as a result of reduced space needs from a statewide shift to teleworking.
• Cost savings as a result of attrition.

Further challenges include significant budget reductions to the state appropriations Department and Division-wide, due to loss of revenue stemming from the COVID-19 pandemic. Due to these reductions, the Office of Maternal and Child Health experienced a reduction of state funding for the State Dental Director position and maternal mental health.