III.D.1. Expenditures
Financial Narrative
FY21 Budget Expenditures
For Federal Fiscal Year (FY) 2021, Idaho plans to expend the full Title V Maternal and Child Health (MCH) Block Grant award of $3,298,645. The Idaho MCH Program strives to spend each phase of the grant award within a 15-month period. The FY 2021 award was spent between July 1, 2021 through September 30, 2022. At the time of this grant application submission, final expenditure data were not available. Figures below are estimates of expenditures based on projections of spending and allocated budgets to each program area. Final expenditure data will be updated if the grant application is opened in TVIS for revisions prior to the MCH Block Grant Review Meeting in October 2022.
Federal-State Partnership
For FY 2021, the Federal-State Title V MCH Block Grant Partnership total was $5,788,629 The Idaho MCH Block Grant Program met the federal match requirement by utilizing non-federal funds (a mix of local and income funds) in the amount of $2,489,984. The state is exceeding its required Maintenance of Effort ($2,141,219) with the FY 2021 state match.
To meet the federal match, Idaho used $15,000 of state funds that were allocated for the first time in July 2017 for legislation requiring the Idaho Department of Health and Welfare (through the MCH Program) to develop and distribute educational materials regarding congenital cytomegalovirus (CMV). These funds are directly managed by the MCH Section Manager.
Idaho also used a portion of the Idaho Immunization Assessment Fund (IAF) in the amount of $2,473,984, which are considered local funds. This is a dedicated fund for state-supplied vaccines for privately insured children to support the Idaho Immunization Program (IIP) and Idaho as a universal vaccine state. The Department’s Financial Office monitors the match from the IAF to ensure the $3 match requirement is met, and the match from IAF is adjusted accordingly to align with federal expenditures for the corresponding Federal FY. The IIP is located in the Department of Health and Welfare’s Division of Public Health and continues to provide childhood vaccine products for all children residing in Idaho, including those with private insurance coverage who are not eligible for the federal Vaccines for Children (VFC) program. Improving childhood immunization rates is a MCH priority. Since July 1, 2010, non-VFC vaccine products for insured children have been purchased with funds collected from statutory mandatory assessments from insurers. While the IAF helps ensure the health of Idaho children, the money cannot be used for any purpose other than the purchase of childhood vaccines. Although the IAF is a state-managed fund, it is considered a local contribution as the funds are received from payers.
The MCH Program anticipates collecting $1,000 in program income for the budget phase to date. Program income is the result of the Children’s Special Health Program’s (CSHP) direct provision of medical foods and formula for children with phenylketonuria (PKU). CSHP has a cost-sharing requirement based on a sliding fee scale for family’s household income, and the CSHP collects insurance payments for eligible expenses for medical foods and formula from children with private and public health insurance. The program income is re-invested in the program and off-sets spending of federal funds.
The federal funds that are administered under the Title V Director totaled $5,953,509 in FY 2021 and include the following grant funds, all of which are Department of Health and Human Services funds:
- HRSA – Maternal, Infant, Early Childhood Home Visiting: $3,254,217
- OPA – Title X Family Planning: $1,691,000
- ACF – Personal Responsibility Education Program: $301,813
- ACF – Sexual Risk Avoidance Education Program: $306,479
- ACF – Temporary Assistance for Needy Families: $400,000
For FY 2021, the Idaho MCH budget across Title V funds, state match funds, and other federal funds is $11,742,138.
30%-30%-10% Requirements
FY 2021 MCH Block Grant funds were spent in accordance with the 30%-30%-10% requirements. For Federal FY 2021, 32.5% percent of funds ($1,072,857) was spent on “Preventive and Primary Care for Children” and 31.9% percent of funds ($1,055,236) was spent on “Children and Youth with Special Health Care Needs” (CSHCN). The total amount of funds spent on “Administration” was 6.1% percent ($200,000).
Budget Variations
For FY 2021, Idaho budgeted for $3,272,972 and received $3,298,645. Program income was projected to be $25,000 at the beginning of the grant phase and is anticipated to be approximately $1,000 by the end of the budget period. These funds are included in the total state match. This significant variance is due to a drop in seeking third-party reimbursement by DHW’s Central Revenue Unit.
State Action Plan and FY 2021 Budget
For FY 2021, MCH programmatic and infrastructure costs such as personnel, operating, needs assessment, evaluation, and data analytics are split evenly across population domains and the legislatively-defined categories as these costs support systems and services for all populations. Below is a description of programs and activities funded by Idaho MCH that are detailed in the state’s action plan, as well as a table breaking down funds expended and the reach within each respective MCH population domain.
|
MCH Population Domain |
FY 2021 Expended |
Percent of Population Reached* |
|
Pregnant Women |
$210,770 |
20% |
|
Infants (less than 1 year) |
$281,392 |
99% |
|
Children (1-21 years) |
$1,085,055 |
24% |
|
CSHCN |
$1,081,537 |
27% |
|
Others |
$450,106 |
4% |
*Based on data from Form 5b
The MCH Block Grant helped support the Idaho Bureau of Epidemiology to focus on state-level systems support for vaccine-preventable and reportable diseases among newborns and children. (Relevant populations: Infants; Children 1-21 years old).
The MCH Program funded the Idaho Family Planning Program’s subgrants to four PHDs and two Federally-Qualified Health Centers to provide family planning services in accordance with Title X regulations. The Title V contribution to the Family Planning Program makes up 12% of total funding for the program. Title X is the only federal grant program dedicated to the provision of comprehensive family planning, including contraceptive services, which helps to ensure planned pregnancies, proper birth spacing, and pre- and interconception care. Of individual clients served by Title X, approximately 75% are over the age of 19 years old. Therefore, 75% of the costs are allocated to the category for preventive and primary care for pregnant women, mothers, infants, and others, and 25% of the costs are allocated to the category for preventive and primary care for children. (Relevant populations: Others-Men and Women of Reproductive Age; Children 1-21 years old; Pregnant Women).
The MCH Program purchased safe sleep materials and safe sleep surfaces from Cribs for Kids and safe sleep board books for distribution to the seven local MIECHV programs to support safe sleep education and provision of safe sleep surfaces to families in-need. Home visitors were trained to conduct a safe sleep surface assessment in all family homes and provide relevant education and materials as needed. A Spanish-language, safe sleep media campaign was developed with the Department’s media and marketing contractor. (Relevant populations: Infants).
The MCH Program continued to fund educational materials for pregnant women. By Idaho law, the Idaho Department of Health and Welfare is required to develop and distribute packets of fetal development materials for women contemplating abortion which must be provided within 24 hours of the procedure. The three booklets in the packet include information on fetal development, the abortion procedure and associated risks, and a directory of pregnancy and child health services. (Relevant populations: Pregnant Women).
The MCH Program lead the operation and facilitation of the Maternal Mortality Review Committee (MMRC) during the FY 2021 budget period. This work is a result of a bill passed during the 2019 legislative session to create a MMRC. (Relevant populations: Pregnant Women; Women).
The MCH Program helped sponsor the annual Idaho Breastfeeding Summit hosted by the Idaho Breastfeeding Council. The conference provides breastfeeding-related education and training to lactation consultants, dietitians, health care providers, and families. (Relevant populations: Infants).
The MCH Program partnered with St. Luke’s Children’s Hospital and the Idaho Children’s Trust Fund to host a learning collaborative focused on maternal and pediatric ACEs screening (Relevant populations: Pregnant Women, Children 1-21 years old).
The MCH Block Grant partially funded (about 25%) the state’s poison control hotline through a contract with the Nebraska Poison Control Center. About half of the calls received by the poison center are regarding children under the age of 20. The MCH Program also purchased educational materials to raise poisoning awareness. (Relevant populations: All).
The MCH Program provided significant funding to the Idaho Suicide Prevention Program to support work in schools to expand and enhance the reach of suicide prevention education to children and adolescents in schools across the state. (Relevant populations: Children; Adolescents).
For the first time, the Idaho MCH Program allocated a portion of funds to support the development of a plan to increase the public health system’s capacity to address adolescent health issues with recommendations for strengthening and coordinating systems for adolescent health. (Relevant populations: Adolescents).
The MCH Program funded the Idaho Oral Health Program to subgrant with the seven PHDs to provide dental sealants, oral health screenings or assessments, fluoride varnish applications, oral health education, and facilitated dental home referrals to elementary school children as needed. (Relevant populations: Children 1-21 years old).
The MCH block grant supported the programmatic operations of the Idaho Newborn Screening Program as this is considered an essential population-based public health screening program. Operations include the next-business day courier service for first and second specimen providers, general office supplies, and brochure printing. (Relevant populations: Infants).
The MCH Program provided significant funding to Idaho’s Physical Activity and Nutrition Program (IPAN) to enhance current programming focused on encouraging healthy behaviors in young children and scale the Farm-to-Early Child Care and Education Project across the state. (Relevant populations: Children 1-21 years old).
The MCH block grant funded the Children’s Special Health Program (CSHP), which is a legislatively defined program that offers financial assistance to uninsured children who meet certain diagnostic, age, and residence criteria with a co-pay based on a sliding fee scale. The program directly pays for formula and medical foods for children with phenylketonuria (PKU) enrolled in the program. Program income is received as reimbursements for medical foods and formula from families with insurance and from co-pays. Program income is then reinvested back into the CSHP. The program also pays for client travel to seek care out of state when care is not available in-state. (Relevant populations: CSHCN).
To address the need for medical specialists, the MCH Program funded specialty pediatric clinics for PKU, Cystic Fibrosis, and other conditions throughout the state. The MCH program used funds to support personnel time for a metabolic specialist from Oregon to host PKU clinics via telehealth in northern and eastern Idaho. (Relevant populations: CSHCN).
As mandated by OBRA legislation, the MCH Block Grant fulfills its role of informing parents, families, and others of available services and providers in the state by the provision of funding to the Idaho 2-1-1 CareLine. The CareLine provides information and referral services on a variety of MCH, CSHCN, Infant Toddler Program, and Medicaid issues. (Relevant populations: All).
Title V Payment of Claims
Title V funds the Children’s Special Health Program (CSHP), which is a legislatively defined program that offers financial assistance to uninsured children (except for PKU and cystic fibrosis diagnoses) who meet certain diagnostic, age, and residence criteria with a co-pay based on a sliding fee scale. Title V is the payer of last resort and does not cover claims for services that are covered by Idaho Medicaid. The CSHP requires that all new clients apply for Idaho Medicaid benefits prior to enrollment into the program. This ensures linkage with public insurance for those who were otherwise uninsured and allows for coordination of benefits for those diagnoses that can carry health insurance.
III.D.2. Budget
Financial Narrative
FY23 Budget Projections
For Federal Fiscal Year (FY) 2023, Idaho is budgeting for a Title V Maternal and Child Health (MCH) Block Grant award amount of $3,298,645. This amount is based on the federal authorization award for FY 2021. The FY 2023 grant is expected to be spent over a 15-month period that aligns with the start of the state’s FY of July 1, 2022, and will continue through September 30, 2023.
For FY 2023, the Federal-State Title V MCH Block Grant Partnership total is projected to be $5,792,629. To meet the MCH Block Grant match requirement for the FY 2023 grant application, the state will be utilizing $2,493,984 in non-federal funds (mix of state, local, and program income funds). This includes $15,000 of state funds allocated to develop and distribute cytomegalovirus (CMV) educational materials through the MCH Program.
The local funds in the amount of $2,473,984 come from the Idaho Immunization Assessment Fund (IAF). This is a dedicated fund for state-supplied vaccines for privately insured children to support the Idaho Immunization Program (IIP). The Department’s Financial Office monitors the match ratio requirement of $4 federal:$3 state to ensure it is met, and the IAF match is adjusted accordingly to align with federal expenditures. The IIP provides childhood vaccine products for all children residing in Idaho (universal supply state), including those with private insurance coverage who are not eligible for the federal Vaccines for Children (VFC) program. Improving childhood immunization rates is a MCH priority. Since July 1, 2010, non-VFC vaccine products for insured children have been purchased with funds collected from statutory mandatory assessments from insurers. While the IAF helps ensure the health of Idaho children, the money cannot be used for any purpose other than the purchase of childhood vaccines. Although the IAF is a state-managed fund, it is considered a local contribution as the funds are received from payers.
The MCH Program expects about $5,000 in program income. Program income is the result of the Children’s Special Health Program (CSHP) direct provision of medical foods and formula for children with phenylketonuria (PKU). CSHP has a cost-sharing requirement based on a sliding fee scale for family’s household income, and the CSHP collects insurance payments for eligible expenses for medical foods and formula from children with private and public health insurance.
Because the state match from the IAF can only be spent on immunizations, the contribution of Title V federal funds is Idaho’s only source of flexible funding that can be used to meet the needs of Idaho’s MCH populations. Without Title V MCH Block Grant funds, Idaho would not be able to address any of the priorities or meet any of the needs outlined in the state action plan.
All funding for any activities under the management of the MCH Director related to this population come from federal funds. The state expects to exceed its required Maintenance of Effort ($2,141,219) with the state match.
The other federal funds that are administered under the Title V Director will total $5,749,224 in FY 2023 and include the following grant funds, all of which are Department of Health and Human Services funds:
- HRSA - Maternal, Infant, Early Childhood Home Visiting (MIECHV): $2,972,068
- HRSA – MIECHV American Rescue Plan Act (ARPA): $287,639
- OPA – Title X Family Planning Services: $1,460,000
- ACF – Personal Responsibility Education Program: $314,815
- ACF – Sexual Risk Avoidance Education Program: $314,702
- ACF – Temporary Assistance for Needy Families: $400,000
For FY 2023, the expected Idaho MCH budget across Title V funds, state match funds, local funds, and other federal funds is $11,541,853.
FY 2023 MCH Block Grant funds are expected to be spent in accordance with the 30%-30%-10% requirements. For the FY 2023 MCH Block Grant, 34% percent of funds ($1,108,216) are proposed for Preventive and Primary Care for Children and 31% percent of funds ($1,017,037) are proposed for Children and Youth with Special Health Care Needs (CSHCN). The total amount of funds proposed for Administration is 6% percent ($200,000). Based on guidance received by Idaho Department of Health and Welfare (DHW) fiscal staff, administrative costs are defined as the indirect costs charged to the grant. Indirect costs include activities and services that benefit the administration of all programs within DHW and are not directly charged to programs, such as human resources, IT, fiscal support, facility services, security, office space, and public health administration.
State Action Plan and FY 2023 Budget
The MCH block grant will continue to contribute funds for the Idaho Family Planning Program’s subgrants to four local public health districts and two federally-qualified health centers to provide family planning services in accordance with Title X regulations. The Title V contribution makes up approximately 13% of total funding for the program. Title X is the only federal grant program dedicated to the provision of comprehensive family planning, including contraceptive services, which helps to ensure planned pregnancies, proper birth spacing, and pre- and interconception care. Approximately 75% of Title X clients are over the age of 19 years old. Therefore, 75% of the costs are allocated to preventive and primary care for pregnant women, mothers, infants, and others, and 25% of the costs are allocated to preventive and primary care for children. (Relevant populations: Others-Men and Women of Reproductive Age; Children 1-22 years old; Pregnant Women).
The MCH Program will continue to fund educational materials for pregnant women. By Idaho law, the Idaho Department of Health and Welfare is required to develop and distribute packets of fetal development materials for women contemplating abortion which must be provided within 24 hours of the procedure. The three booklets in the packet include information on fetal development, the abortion procedure and associated risks, and a directory of pregnancy and child health services. (Relevant populations: Pregnant Women).
During the 2019 legislative session, Idaho lawmakers passed a bill mandating the creation of a Maternal Mortality Review Committee (MMRC). The MCH Program leads the implementation and facilitation of the MMRC. This is a significant step for Idaho to improve the health of all mothers by striving to eliminate preventable deaths to pregnant and postpartum women. This includes supporting a 1.0 FTE to increase capacity to conduct this work and the development of a perinatal quality collaborative (PQC). Title V funds will support efforts to establish a statewide PQC that can take action on MMRC recommendations to improve quality of care for mothers and babies. (Relevant populations: Pregnant Women; Women).
The MCH Program will provide level funding to the Idaho Tobacco Prevention and Control Program (ITPCP) to offer a smoking cessation program tailored for pregnant and postpartum women, their partners, and households with young children (under the age of one year) in the seven public health districts and one tribal health center. This homegrown program, modeled from the evidence-based program “Baby and Me – Tobacco Free,” offers diaper incentives for pregnant women, post-partum women, and household members who quit smoking. (Relevant populations: Pregnant women; Infants; Others).
The MCH Program will help sponsor the annual Idaho Breastfeeding Summit hosted by the Idaho Breastfeeding Council. The conference provides breastfeeding-related education and training to lactation consultants, dietitians, health care providers, and families. This is considered a perinatal special project. (Relevant populations: Infants).
The MCH Program will purchase safe sleep materials and safe sleep surfaces from Cribs for Kids and distribute to the seven local MIECHV programs to support safe sleep education and provision of safe sleep surfaces to families in-need. Additionally, home visitors will be trained to conduct a safe sleep surface assessment in all family homes and provide relevant education and materials as needed. Title V funds will support an Idaho-developed, safe sleep media campaign and educational materials in English and Spanish. (Relevant populations: Infants).
The MCH block grant will continue to partially fund the state’s poison control hotline through a contract with the Nebraska Poison Control Center. About half of the calls received by the poison center are regarding children under the age of 20. The MCH Program will also purchase educational materials to raise poisoning awareness. (Relevant populations: Pregnant Women; Infants; Children; Adolescents; Others)
The MCH Program will provide a small budget to the Idaho Bureau of Epidemiology to focus on state-level systems support for vaccine-preventable and reportable diseases among newborns and children. (Relevant populations: Infants; Children 1-22 years old).
The MCH block grant will continue to provide funding for personnel and operations of the Idaho Newborn Screening (NBS) Program as this is considered an essential population-based public health screening program. Operations include next-business day courier service for first and second specimen providers, general office supplies, brochure printing, and the transfer of legacy data from the Oregon State Public Health Laboratory to the Washington State Public Health Laboratory. (Relevant populations: Infants).
The MCH Program will continue to provide level funding to the Idaho Physical Activity and Nutrition (IPAN) Program to enhance current programming focused on encouraging healthy behaviors in young children and expand the Farm-to-Early Child Care and Education Programs Project to new areas of the state. (Relevant populations: Children 1-22 years old).
The MCH block grant will continue to support the Idaho Oral Health Program’s efforts to provide oral health education, dental sealants, fluoride varnish, and referrals to a dental home for elementary school children. Funds will also support oral health educational trainings to childcare providers, Head Start teachers, and home visitors. (Relevant populations: Children 1-22 years old).
The MCH Program will provide level funding to the Idaho Suicide Prevention Program to enhance the reach of suicide prevention education to children and adolescents, promote school policy development, and support post-vention activities in schools across the state. (Relevant populations: Children; Adolescents).
The MCH Program will allocate a small portion of funds to support the development of a working group to increase the public health system’s capacity to address adolescent health issues with recommendations for strengthening and coordinating systems for adolescent health. (Relevant populations: Adolescents).
The MCH block grant will continue to fund and operate the Children’s Special Health Program (CSHP), which is a legislatively-defined program that offers financial assistance to uninsured children who meet certain diagnostic, age, and residence criteria with a co-pay based on a sliding fee scale. The program directly pays for formula and medical foods for children with phenylketonuria (PKU) enrolled in the program. Program income is received as reimbursements for medical foods and formula from families with insurance and from co-pays. Program income is then reinvested back into the CSHP. The program also pays for client travel to seek care out of state when care is not available in-state. (Relevant populations: CSHCN).
The MCH Program will partner with Idaho Parents Unlimited (IPUL), the state's Family to Family Resource Center, to increase family engagement, provide caregiver/parent education, assist with family navigation, and provide program consultation. Funds will be used to adapt digital resources that empower teens and young adults to take an active role in their transition into adulthood. (Relevant populations: CSHCN).
To address the need for access to medical specialists, the MCH Program will continue to fund specialty pediatric clinics for PKU, Cystic Fibrosis, and other conditions throughout the state. The MCH Program will continue to use funds to bring a metabolic specialist from Oregon twice per year to host PKU clinics in northern and eastern Idaho. The MCH Program will continue to use funds for dissemination of transition-to-adulthood kits for CSHCN to help empower them to take a primary role in their healthcare. (Relevant populations: CSHCN).
The MCH Program will continue to support topical statewide learning collaboratives for health care professionals focused on quality and practice improvement for MCH populations. Topics will align with improving maternal and pediatric care in primary care settings, or topics relevant to prenatal and postpartum care. (Relevant populations: Children 1-22 years old; Pregnant Women).
The MCH Program will allocate a small portion of funds to support implementation of the Get Healthy Idaho initiative as a community-led, place-based model to improve social determinants of health and health equity. (Relevant populations: Children 1-22 years old; CSHCN; Infants, Pregnant Women, Women, Others).
The MCH Program provides funding to several activities that benefit all population domains. These activities include the needs assessment and evaluation contract with a university partner, support for the Idaho CareLine which links citizens with information for human and social services (per OBRA legislation), and the MCH Analytics Unit which supports collection of perinatal data and provides data analysis support to all MCH Programs.
Budget Variations
While new projects and activities will be funded in FY 2023, there are no significant budget variations expected between budgeted amounts and previous years’ expenditures for the categories identified on Forms 2 and 3.
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