FY 2021 Annual Report

Georgia’s Maternal and Child Health State and Federal funds are allocated based on priority needs to be identified through the Maternal Child Health Block Grant (MCHBG) development process. This process includes reviewing health status and outcomes for women and children, projecting future needs, healthcare assess, development and implementation, capacity/infrastructure and program, expansion. As part of the Georgia Department of Public Health’s budget process, recommendations are made for funding levels for services to women, infant and children. 

The MCH Block Grant funding and expenditures for FY 2021 is based on actual expenditures and supported data. Expenditures are reported out of Oracle's PeopleSoft Financials and Uniform Accounting System (UAS), to ensure compliance requirements are met such as:

• MCH Program staff meets with stakeholders and local public health districts virtually on Teams Outlook, to conduct monthly, quarterly calls, and virtual site visits to ensure local public health districts are spending funds accordingly, to federal, other, or state requirements.
• The Program Financial Manager/Analyst generates reports monthly and quarterly to ensure all the requirements are met.
• Funds are allocated to the local public health districts based on Performance Measures, Data and Allocation Formula Methods to ensure compliance requirements are met.
• Local Public Health Districts are required to submit monthly and quarterly reports to State Program Managers to ensure oversight of expenditures such as:

Referral Log, Outreach Log, Patient Benefit Log, Specialty Clinic report, Preventive Participant Report, Data Report, Statistical Reporting, Programmatic Report and Satisfaction Survey for all patients receiving telemedicine services.

FY 2021 Title V 30/30/10 requirement expended $17,124,972. Of this amount follows: (See Form 2 lines 1A-1C):

• Preventive and Primary Care for Children 30%: 5,897,609 (34.4%)
• Children with Special Health Care Needs 30%: 6,658,592 (38.8%)
• Title V Administrative Costs 10%: 1,238,709 (7.3%)

FY 2021 State MCH Funds expended $107,243,628 exceeding the 75% State Match requirement of $12,843,729 for FY 2021 MCH Federal Allocation of $17,124,972. In addition to the required match for the MCH Block Grant - additional State Funds are used to support MCH programs and partnership activities in the MCH Population Domains: Women/Maternal Health, Child Health, Adolescent Health, Cross Cutting/Life Course, and Children with Special Health Care Needs. (See Form 2 line 3).

FY 2021 Program Income expended $174,979,677; funds were used to support the following:

• Regional Perinatal Centers (RPC) providing information and education to delivering facilities, staff, and women to ensure they deliver at the appropriate facility in instances where mother and baby may require specialized care.
• Georgia’s early intervention services program, Babies Can’t Wait (BCW), expanded its scope of services in 2018 to include the provision of autism related services. This expansion was due to Medicaid’s expansion of covered services to include adaptive behavioral services (ABS) for individuals under the age of 21 with autism spectrum disorders (ASD).

• Georgia added and successfully implemented Krabbe disease to the Georgia Newborn Screening panel. The implementation process included a public hearing and comment period; targeted communication to families via the NBS brochure; targeted information sent directly to hospitals, public health districts, Georgia Chapter of the American Academy of Pediatrics, Georgia Association of Family Physicians, and physicians who routinely submit NBS specimen; and general updates on the process shared during the Newborn Screening Advisory Committee (NBSAC) stakeholder meetings. NBS and NBS follow-up was sustained during the COVID-19 pandemic. Adjustments were made to protocols to maintain the urgency of follow-up while minimizing risk of exposure to the virus.
• Partnership with Immunization Vaccines for Children (VFC) program, which is used to fund infants less than 1 and children 1-22.
• Children Elderly Trust Fund, Georgia provides for programs for home delivered meals, transportation services for the elderly, and preschool children with special needs, including but not limited to disabled children, troubled children, school readiness programs, and other similar needs for the benefit of the citizens of Georgia.
• Title V District Program Income is derived from Medicaid Perinatal Case Management, Medicaid DSPS earnings, Family Planning Fees, Private Insurance, Health Check earnings and Outpatient Client Fees, for services provided to Pregnant and Postpartum Women, Preventive and Primary Care for Children and Reproductive Health Services to Women. The expenditures are tracked and monitored through the Uniform Accounting System (UAS) monthly/quarterly. The UAS data reports are reviewed quarterly for annual reporting.

FY 2021 Other Federal Funds expended $34,250,051; the amount represents the variation of federal funds managed under the Title V Administrator. These funds are used to support the need of preventing, promoting, and improving children and youth with special health care needs and pregnant women, mothers, and infants.

FY 2021 Federal-State Title V Block Grant Partnership Annual Report expended $299,348,277 and the Georgia Maintenance of Effort (MOE) sustained the level of $36,079,622. The FY 2021 State MCH Budget /Expenditure Grand total is $ $333,598,328. (See Form 2 line 11)

Priority Need: NPM Annual Report: 

Women’s/Maternal Health:

• GaPQC supported hospital neonatal teams by hosting the monthly webinar series to facilitate education and collaboration to include specialized webinars on COVID-19 and health equity. In December 2020, GaPQC developed and disseminated a statewide environmental scan survey to participating hospitals in partnership with the Georgia OBGYN Society. The assessment targeted maternal and neonatal hospital teams to identify improvement opportunities for all initiatives and future direction. The survey included questions about health equity and disparity reduction efforts at respective hospitals.
• The Women’s Health program will support the Athens and Waycross public health districts in implementing them

breastfeeding support and continuation plan.

Infant Mortality:

• The Infant Mortality Community Toolkit was developed to empower community members, leaders, and organizations with the information and resources necessary to promote infant health and reduce infant mortality in their communities. The Toolkit slide deck was presented to the Georgia Family Connections Regional Managers for

external review and feedback. The toolkit is being reviewed and plans are being developed to pilot the Toolkit in

Gwinnet and Columbus counties in the upcoming months.

Oral Health-Cross-Cutting/Life Course:

• The Oral Health Program provided Home Visitors a flipbook guide on oral health to help educate families on improving oral health behaviors. The flipbook was originally created by the Rhode Island state Oral Health Program and Oral Health Coalition with feedback from Home Visitors. The flipbook was adopted, with permission, and rebranded by Georgia DPH. Flipbooks were provided to all the Home Visitors in the state and provided to families through home visits.

Family and Community Support:

• In the current year, the Family and Community Supports (FACS) program continue the commitment to implement evidence-based, comprehensive, and community-based maternal and early childhood programs, including Healthy Families Georgia (HFG), Nurse Family Partnership (NFP), and Parents as Teachers (PAT). In-home, face-to-face home visiting services resumed on March 1, 2022, with required use of face masks. Each of the LIAs received the 2022 Continuity of Operations Plan (COOP) that provides COVID-19 State of Georgia Guidelines for Re-Initiation of In-Home Home Visits.
• The Georgia Strong Families Program (GSFP) Healthy Start is implemented in two public health districts that are atrisk for poor birth outcomes. The two public health districts are (1) South Health District, located in Valdosta (GSFPValdosta) serving Brook, Echols, and Lowndes counties, and (2) West Central Health District located in Columbus (GSFP-Columbus) serving Muscogee County.

Child Health:

• In the current year, developmental screening remains a priority and the Children 1st program collaborates with

partners to reinforce developmental screening as a key component of the child health system.

• The NBS team developed an unsatisfactory specimen process improvement map and action plan. The poster, “Prioritizing Newborn Screening Education: Engaging Hospitals to Improve NBS Quality and Reduce Unsatisfactory Rates in Newborn Screen Blood Specimens” was presented during a virtual panel at the Association of Public Health Laboratories (APHL) Continuous Quality Improvement annual national meeting in October 2021.
• The NBS program will continue to provide education to parents and providers. The program will continue to partner with organizations that engage providers, such as the GA-AAP and the Georgia Academy of Family Physicians, to participate in webinars, blast fax communications, professional development conferences, and grand rounds. Onsite and telephone technical assistance to birthing hospitals will continue as needed.

Georgia Shape Program:

• The COVID-19 pandemic required priority and activity shifts for the Georgia Shape program and its key partners. At

the wake of the pandemic, contingency plans were drafted and curated weekly to account for federal, state, and local

recommendations. These shifts impacted most of the reporting year.

Early Brain Development:

• To promote early childhood literacy, the Family and Community Supports (FACS) program supported the Language Environment Analysis (LENA) Start Program in Muscogee county as an important component of the Healthy Start program. This evidence-based community program engages families through LENA technology to increase conversations between parents/caregivers with their children during their early developmental years. The program helped to increase language nutrition, close the early-talk gap, support Kindergarten readiness, and build stronger families.

Congenital Syphilis:

• The Sexually Transmitted Diseases (STD) Office’s mission is to prevent STDs by providing quality intervention strategies, programmatic support, and education. With a focus on Congenital Syphilis, the STD team worked to promote first and third trimester testing for HIV and Syphilis, as well as improve the data quality of Congenital Syphilis cases. The following site visits and trainings were provided to public health district staff: Monthly Virtual TA Calls in lieu of site visits due to COVID-19.

MCH Epidemiology:

• The section carries out several activities to identify diseases and describe health conditions, assess the health of Georgians, and develop recommendations to control diseases and improve the overall health status in the state. conduct data analyses and disseminate information from surveillance systems, monitor and investigate reports of unusual health conditions and conduct active and passive surveillance to detect diseases and adverse health conditions.

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Injury Prevention/Safe Infant Sleep:

• The Safe Infant Sleep program continues to lead the Georgia Safe to Sleep Campaign and implement evidence-based interventions to reduce the number of preventable cases of SUID. Efforts are focused on ensuring accurate and consistent education provided to both professionals and caregivers, researching ways to address health inequities, and providing tools for families to practice Safe Infant Sleep. In the current year, hospitals continue to provide education and safe sleep education materials.
• The MCH Home Visiting program contracted the production of a Safe Infant Sleep educational training video for

home visitors. The video includes how to involve fathers and partners into safe sleep practices, as well as provide

advice on helping parents and caregivers find assistance with car seats.

Children with Special Health Care Needs:

• During the reporting year, the CMS program partnered with stakeholders to improve Georgia’s systems of care and

improve transitions for CYSHCN. In partnership with Parent to Parent of Georgia (P2PGA), youth and parent/caregivers had access to annual workshops on preparing for the transition from pediatric to an adult model of care. To assist with efforts in educating the public on transition, the CMS program revamped the DPH transition from

pediatric to adult care webpage.

FY 2023 Application Budget

The Maternal and Child Health (MCH) Title V Block Grant is administered in the MCH Section in the Health Promotion Division of the Department of Public Health (DPH). DPH has a system of accountability to monitor the allocation and expenditures of funds provided to the 18 public health districts. The division utilizes the program systems such as: Oracle's PeopleSoft Financials a recognized Enterprise Solution for financials, HR records, transactions, and operations. The Uniform Accounting System (UAS) is utilized to track district financial activity and districts submit MIERSs reimbursement to the State Office for services provided monthly. The Maternal and Child Health Section of the Georgia Department of Public Health administers audits, monitor programs monthly/quarterly and provides technical assistance.

FY 2023 Federal Application Budget is $17,274,806. The required 75% State Match for Georgia is $12,956,104, which includes federal earmarked for Preventive and Primary Care for Children and Children with Special Health Care Needs.

FY 2023 Federal Allocation earmarked 30%-30%-10% requirement: 

• Preventive and Primary Care for Children is budgeted for: 6,510,632 (37.6%)
• Children with Special Health Care Needs is budgeted for: 6,560,593 (37.9%)  
• Title V Administrative Cost is budgeted for: 1,276,933 (7.4%) 

FY 2023 Federal-State Title V Block Grant Partnership subtotal is $327,764,333. Of this this amount, the subtotal budget supports the following areas: Federal Allocation (5%), State MCH Funds (34%) and Program Income (61%). Georgia’s total Maintenance of Effort (MOE) from 1989 is $36,079,622.  As shown on Form 2, MCH efforts far exceeds the State Match and MOE requirements. FY 2023 State MCH Budget/Expenditure Grand Total is 363,494,783 (Including Other Federal Funds).                                                   

FY 2023 Title V Programs received additional State Funds in the Georgia’s State Appropriation Conference Committee House Bill 911. The State increase of funding reflects the following Programs:

1. Georgia’s Cost-of-Living Adjustment: to address agency recruitment and retention needs.
2. Women’s Health Services:
   1. Provide funds for a comprehensive care management pilot for high-risk pregnancy populations.
   2. Provide funds for a pilot program to perform echocardiograms of pregnant and postpartum women to address maternal mortality.
   3. Increase funds for two pilot projects for rural maternal health.
   4. Increase funds for grants to perinatal centers to fund autopsies. 
3. Genetics Sickle Cell Services: Provide funds for the Sickle Cell Foundation to support care coordination and expanded access to testing in rural areas.

FY 2023 Other Federal Funds received additional funds to support the following:

• Child Abuse Prevention Treatment Act: DFCAS will provide funding to DPH Georgia Home Visiting Program for expanding the services to six existing home visiting programs. The funds will be used for the development and monitoring of Plans of Safe Care (POSC).
• Healthy Start Grant:  The program received a supplement of community-based doulas to distribute for South Public Health District (Valdosta, GA). The funding will support the Healthy Mothers Healthy Babies of Georgia for Continuing Education & Training and Developing and Maintaining Go Beyond Data & Reporting System.
• Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) American Rescue Plan (ARP): The program received year 2 funding, to support new pilots and contractual services for the Home Visiting Program.

MCH Populations:

Women/Maternal Health: Title V continues its focus and efforts on improving maternal and infant health and eliminating racial disparities in maternal mortality. The MMRC is legislatively mandated and is coordinated by the Georgia Obstetrical and Gynecology Society (GaOBGYN). The MMRC reviews cases to determine causes of death and provides recommendations for maternal mortality reduction. The Women’s Health Office builds infrastructure and capacity to promote well-women visits, health, and wellness among women of childbearing age through the efforts of women’s health programming such as perinatal regionalization efforts, Perinatal Psychiatry, Education and Community Engagement (PEACE) for Moms and the implementation of the Alliance for Innovation on Maternal Health (AIM) bundles to include implementation of the AIM Obstetric Hemorrhage Bundle (HMG).

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Perinatal/Infant Health:  DPH continues to develop strong partnerships around the coordination of Regional Perinatal Centers (RPC) by providing information and education to delivering facilities, staff, and women to ensure they deliver at the appropriate facility in instances where mother and baby may require specialized care.

Family and Community Support home visiting expansion collaboration project with DFCAS to ensure that they operate programs relating to child abuse and neglect that include the POSC development of infants born and identified as being affected by substance use or abuse to ensure the safety and well-being of such infant.

Child Health: Promoting developmental screenings for children, including refugee children, and increasing the number of children who have a medical home were identified as Child Health priorities in the 2020 needs assessment. Children 1st facilitates early identification of at-risk children and links them with early interventions services, as well as other public health services and community-based resources.

The Injury Prevention Program State suicide prevention partners were engaged to develop an Injury and Violence Prevention Strategic Plan using a Shared Risk and Protective Factors (SRPF) framework to identify the risk and protective factors shared across multiple forms of violence and injury to inform guidance and/or recommendations provided to partners regarding laws, policies, and evidence-based strategies to prevent bullying.

Cross-Cutting/Life Course: The Oral Health Program will be contracting with Albany Area Primary Health Care to provide school-based or linked public health preventative and educational oral health services.

Children with Special Health Care Needs (CSHCN): The Children’s Medical Services (CMS) Program partners with health care providers, state agencies, and community organizations to coordinate health care service and supports for eligible CYSHCN and their families to ensure CYCHCN have a satisfactory transition plan and are linked with a medical home prior to discharge from the program.