The Title V Maternal and Child Health Block Grant federal-state partnership award supports the essential public health services and functions in the state for women, children and youth with special healthcare needs (CYSHCN), and families. In an environment where state funds are largely limited to carry out mandates and many federal awards or other funding streams are limited to specific activities, Title V supports the important work of improving overall systems of care and health. Without Title V funding in Louisiana, there would be no other entity responsible for working to improve the health and well-being of all women and children in the state. As such, a large portion of Title V investment is directed towards the public health systems and services level of the MCH pyramid. Many of the investments categorized under this foundational level of the pyramid have a reach that spans multiple population domains. For example, while screening and follow-up is foundational to the CYSHCN strategy around early detection and timely follow-up, this Title V investment reaches 99% of infants in Louisiana.

The Title V funds are allocated to many service areas and programs, each related to one or more of the following activity categories:  

• Maternal Health
• Reproductive Health
• Child Health
• Genetics
• Children and Youth with Special Health Care Needs (CYSHCN)
• Adolescent and School Health
• Maternal, Infant, and Early Childhood Home Visiting (MIECHV)

Just as some Title V-supported programs reach several population domains, program budgets can span multiple activities categories. Within each of these activities are reporting categories that correlate with the appropriate service level on the MCH pyramid.

The tables below illustrate how the federal and state MCH block grant dollars supported efforts to improve health outcomes within each population domain. Detailed descriptions of how funding supported state action plan strategies are outlined in the respective population domain narratives.

Title V Expenditures by Population Domain

Maternal/Women’s Health

The tables below illustrate how state and federal Title V funds complement other state funds to support the strategies described in the Maternal/Women’s Health domain. The Maternal Health and Home Visiting expenditures relate to the amount reported for ‘Pregnant Women’ in Form 3a, and the Reproductive Health expenditures relate to the amount reported for ‘Others’ in Form 3a.

Title V Reach – Pregnant Women

• Enabling Services – 3,908 pregnant women reached, as determined by:
  • Title X unduplicated females with positive pregnancy test FFY2022 (enabling);
  • Pregnant women served through MIECHV FFY2022 (enabling)

• Total Reach – 94.97% of all births in the state during CY2022.

Title V Reach – Other

• Enabling Services – 23,628 males and females age 22 and older reached
  • Mothers 22 years old and older served through MIECHV FFY2022
  • Males and females age 22 and older served through reproductive health clinics at PHUs during FFY2022. The Title V contribution to the reproductive health program does not fund direct services.

• Total Reach – 1.6% as estimated by all individuals ages 22-44 with access to no/low-cost reproductive health services through PHUs, all mothers 22 years old and older served through MIECHV FFY2022 and number of hits on Title V social media sites; divided by 2022 census data population of persons 22 and over.

Perinatal/Infant Health

The table below illustrates how state and federal Title V funds complement other state funds to support the strategies described in the Perinatal/Infant Health domain. The Child Health and Home Visiting expenditures relate to the amount reported for ‘Infants <1 year” in Form 3a.

Title V Reach – Infant <1

-        Enabling Services: 1,551 infants <1 year of age received enabling services through MIECHV during SFY2022.

• Total Reach: 98.5% of infants <1 year of age served through newborn screening during CY2022.

Child and Adolescent Health

The table below illustrates how state and federal Title V funds complement other state funds to support the strategies described in the Child Health and Adolescent Health domains. The Child Health, Home Visiting and Adolescent School Health expenditures relate to the amount reported for ‘Children 1 through 21 Years” in Form 3a.

 Title V Reach – Children 1 through 21

-          Enabling Services: 36,280 children reached, as determined by:

• Children >1 year old served through MIECHV FFY2022;
• Mothers 21 years old and younger served through MIECHV FFY2022;
• Children (ages 1-21) receiving immunizations at Public Health Units FFY 2022;
• Children served at School Based Health Centers (SBHC) during school year 2021-2022;
• Males and females 21 years old and younger served through reproductive health clinics at PHUs FFY2022.

-          Total Reach: 20.29% of children in Louisiana reached, as estimated by:

-        Children (ages 1-5) - All Medicaid-enrolled children ages 1-5 in Louisiana impacted by Title V/Tile XIX collaboration to strengthen EPSDT system.

-        Children (5-13) - Students in grades K-8 in schools with SBHC access;

-        Children (ages 14-21) All children 14-21 with access to no/low-cost reproductive health services through PHUs in Louisiana (universal reach).

Children and Youth with Special Health Care Needs (CYSHCN)

The table below illustrates how state and federal Title V funds complement other state funds to support the strategies described in the CYSHCN domain. The CYSHCN expenditures relate to the amount reported for ‘CSHCN” in Form 3a.

Title V Reach – CYSHCN

• Direct and Enabling Services: 8,260 CYSCHN reached, as determined by:
• CYSHCN served at CSHS (direct and enabling services)
• CYSHCN served at OPH Genetics Clinics (direct and enabling services)
• CYSHCN served through Title V-supported external clinics (enabling only)
• CYSHCN served at sites with Title V-sponsored care coordinators (enabling only)
• Families of CYSHCN served through the Family Resource Center (enabling only)

• Total Reach: 20.29% of CYSHCN reached. Estimate is based upon the assumption that CYSHCN are served at the same rate as reported for all children age 1-21 since CYSHCN are not excluded from those services

Significant Variations

Preventive and Primary Care for Children expenditures were higher than budgeted due to State funding utilization to support preventive and primary care for children activities. CYSHCN expenditures were less than budgeted in part due to lower funding cost of mental health consultation, education, and training to providers supporting CSHS parents and families. Mental health consultation was supported in part with funding from the Pediatric Mental Healthcare Access grant award. State MCH Funds were higher than budgeted due in part to state funding utilization to support Preventive and Primary Care for Children activities. Program Income was higher than budgeted due to higher billing services for Genetics and CYSHCN due in part to back billing for reimbursable services.

Legislative Requirements

Program Offices are responsible for obligating charges to program reporting categories and incurring cost in designated block grant child health activities.  The Louisiana Department of Health (LDH) Office of Management and Finance (OMF) Fiscal Office is responsible for monitoring the earmarking requirement. Children Ages 1-21, Maternity and Infants ages < 1, and CYSHCN percentages by reporting category are provided by the Program Office and applied against the total charges for each reporting category. The results are compared to determine if the 30-30 spending requirement for CYSHCN and children is met. The preventive and primary care services for children represent 41%, and for Children and Youth with Special Health Care Needs represent 35% of the Block Grant budget.

The LDH Office of Public Health (OPH) obtained state general funds for MCH Services that equals or exceeds the level of such funds provided during state fiscal year 1989. The state support in state fiscal year 1989 was $6,207,276. Compliance verification was performed and documented by the Fiscal Office at the end of grant federal fiscal year.

The OMF Fiscal Office performed compliance verification that Medicaid revenue received during the grant year for MCH Block Grant-funded programs are expended on the activity that generated the revenue and used prior to MCH Block Grants funds to finance the respective program. 

Administrative costs are the portion of costs incurred by the following service units that are directly allocated to Maternal and Child Health Services Programs in accordance with the Louisiana Department of Health Cost Allocation Plan: Office of Assistant Secretary-OPH; Policy, Planning and Evaluation; Administrative Services Operations and Support Services; LDH-Office of the Secretary (Office of Technology Services (OTS); Fiscal Services; Human Resources Section; etc.). Collectively, these costs are referred to as Executive Overhead costs. Compliance verification of the 10% administrative restriction was performed and documented by the OMF Fiscal Office at the end of the state fiscal year. The administrative cost was $3,114,542 for FFY2022. The amount of the federal share is $1,268,630 or 10.0% of the federal funds requested and are within the administrative cost limit requirement.

Title V’s flexible and outcome focused funding allows Louisiana to address the state’s Priority Needs which are rooted in the MCH Essential Services. Very few of today’s public health problems have simple straightforward solutions. As described throughout this application, the funding supports robust analytic capacity to monitor and describe health and wellbeing, guide programs, and inform public policy; preventive and educational services that are grounded in best practices and evidence to promote optimal health and wellbeing; policy and educational initiatives to improve access to medical, behavioral health, and supportive services, and to improve community health; and partnerships with communities, government, and academia to advance common goals.

Title V Budget by Population Domain

The tables below illustrate how the federal and state MCH block grant dollars and external funding will support the state action plan strategies described throughout this application as represented on the FY24 Budgeted Application Form 3A. Detailed descriptions of how funding will enable BFH to meet goals and objectives and address the priority needs are outlined in the respective population domain narratives.

Maternal/Women’s Health (Others)

Perinatal/Infant Health

Child and Adolescent Health

Children and Youth with Special Health Care Needs

Additional Federal MCH Funding Sources

As more Title V funds are used to support public health services and systems, BFH has sought external funding opportunities to complement and further the strategies outlined in the domain narratives. Below is a list of additional federal funding sources that enhance the state Title V program:

American Recovery Plan Act-Pediatric Mental Health Care Access ($1,093,606)-

The overarching goal is that all children and adolescents in Louisiana, especially those in rural and underserved areas, will have equitable access to comprehensive integrated behavioral health services by increasing the capacity among primary care providers to screen, diagnose, treat and refer as needed to mental health and supportive services.

State, Local and Tribal Territory Based Projects to Assess Emerging Surveillance Issues in Substance Use and Mental Health ($280,607) - The primary purpose of SLTT grant is to pilot projects related to capacity building in responding to public health issues related to substance use, mental health and behavioral health.

Louisiana State Based Perinatal Quality Collaborative ($275,000) - The purpose of the LaPQC is to improve the quality of care for mothers and babies through networks of teams working together.

Sudden Unexpected Infant Death Case Registry (SUID) ($95,600) - This grant works to improve data quality relating to SUID occurrences.

Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS) ($165,998) - This program works with states and territories to ensure that infants are screened for hearing loss no later than one month of age, infants who do not pass the screening for hearing loss get a full hearing evaluation no later than 3 months of age, and infants with a hearing loss receive intervention services no later than 6 months of age.

Louisiana Title X Family Planning Services Grant ($4,788,720) - This program plays a vital role in providing access to a wide range of family planning and preventative health services. 

Louisiana Maternal, Infant and Early Childhood Home Visiting Program (MIECHV)-Formula ($10,381,042) - The MIECHV program provides home visiting services to promote preventative health practices and positive parenting techniques to benefit Louisiana families. 

Louisiana Emergency Medical Services for Children State Partnership Program and Louisiana Emergency Medical Services for Children Targeted Issues ($615,650) - Grants H3306702 EMS C $190,650 and H3433242 EMS C Targeted Issue $425,000. Both under CFDA# 93.127 EMSC is an initiative designed to reduce child and youth morbidity and mortality caused by acute illness or injury. The focus the Targeted Issue grant is to improve system readiness by creating a statewide consortium of Pediatric Emergency Care Coordinators (PECCs) in emergency medical service agencies. Establishing this statewide system of collaboration will provide resources, support networks, education, training, and personnel development that will ultimately improve pediatric emergency care across Louisiana. 

Early Childhood Comprehensive Systems (ECCS) ($255,600) - The focus of this grant is to enhance early childhood systems building and demonstrate improved outcomes in children’s developmental health and family well-being indicators.

National Violent Death Reporting System (NVDRS) ($380,086) - This grant allows for the collection of data related to violent deaths with the intent of applying this information in ways to develop prevention programs.

Newborn Hearing Screening (NBS) ($234,980) - This grant allows data collection in order to improve newborn screening program evaluation and to build capacity for assessment of screening, including timeliness, follow up services for newborns and children diagnosed with heritable disorders.

Pregnancy Risk Assessment Monitoring Systems (PRAMS) ($175,000) - This grant allows for the collection of state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy with the intent of applying this information in ways to develop prevention programs.

Rape Prevention and Education Program ($561,455) - This grant supports collaborative work with diverse stakeholders, including state sexual violence coalitions, educational institutions, rape crisis centers, community organizations and other state agency partners to guide implementation of  sexual violence prevention efforts.

Maternal Depression ($648,135) - The purpose of this program is to strengthen partnerships and collaboration by establishing a state-focused Maternal Health Task Force, improving state-level data surveillance on maternal mortality and severe maternal morbidity, and promoting and executing innovation in maternal health service delivery.

Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees ($450,000) - This funding supports the coordination of Maternal Mortality Review Committees (MMRCs) to identify and characterize maternal deaths for identifying prevention opportunities.

State Systems Development Initiative (SSDI) Grant Program ($100,000) - The purpose of SSDI is to develop, enhance and expand Louisiana’s Title V MCH data capacity to allow for informed decision making and resource allocation that supports effective, efficient and quality programming for women, infants, children and youth, including children and youth with special health care needs. These efforts seek to ensure the continued effectiveness and readiness of Title V-supported programs in responding to the changing needs of Louisiana’s MCH population.

American Recovery Plan Act (ARPA) for Home Visiting ($3,282,780) - Grants X1141905 $1,067,248 and X1145257 $2,215,532, both under CFDA# 93.870. The purpose of the grant is to provide emergency supplies to families through the purchase and distribution of prepaid grocery cards. In accordance with the requirements for use of funds to provide emergency supplies, LA MIECHV will ensure that the home visiting teams coordinate with local diaper banks to the extent practicable.

Louisiana Comprehensive Suicide Prevention Plan ($784,000) - The purpose of this funding opportunity is to implement and evaluate a comprehensive public health approach to suicide prevention in order to reduce suicide morbidity and mortality, with attention to one or more vulnerable populations representing a significant proportion of the suicide burden (i.e. large numbers) and with suicide rates greater than the general population (e.g., veterans, tribal populations, rural communities, LGBTQ, homeless, other) in a jurisdiction(s) (e.g., state, city/county, tribe).

Legislative Requirements

Accountability and oversight of federal funds and program income are achieved by utilizing the Organization and Work Breakdown Structure Element Category codes in LaGov. LaGov is a comprehensive financial information system for the State of Louisiana and serves as the accounting, purchasing and human resource system for the Office of Public Health as well as other departments in the Executive Branch of Louisiana government. All financial data processed into LaGov is held in a financial database from which various tables and ledgers can be accessed to provide detailed and summary information. These capabilities allow monitoring multi-year grants and provide for state fiscal year, grant fiscal year, and grant inception-to-date reporting.

Grant expenditures are identified by coding charges to unique Reporting Category codes established to capture the costs of eligible activities under the award. Expenditure Organization codes are used to identify the source of the charges. Similarly, federal revenue and program income are credited to the same Reporting Category codes used to capture the grant expenditures. The required 4:3 match of state funds are budgeted on MCH activities. The Office of Management and Finance (OMF) Fiscal Office will ensure that the state funds budgeted as match are expended and the required match amount met for all federal funds drawn down in FY24. The match requirement information is included in the Program Financial Status Report (PFSR) prepared monthly by the OMF Fiscal Office. The process of compiling the PFSR involves each Program Accountant extracting year to date costs on a monthly basis by Federal Aid number utilizing ad hoc reporting software. All reports include Revenue, Expenditures, Encumbrances and Cost Allocations. Louisiana maintains expenditure and budget documentation for the MCH Block Grant consistent with the requirements in Section 505(a) and Section 506(a). In compliance of Section 506(b)(1), Louisiana Legislative Auditors (LLA) Office conducts an independent audit of the agency yearly.

Program Offices are responsible for obligating charges to program reporting categories and incurring cost in designated block grant child health activities. The OMF Fiscal Office is responsible for monitoring the earmarking requirement. Children Ages 1-21, Maternity and Infants ages < 1, and CYSHCN percentages by reporting category are provided by the Program Office and applied against the total charges for each reporting category. The results are compared to determine if the 30-30 spending requirement for CYSHCN and children is met. The preventive and primary care services for children represent 40% and Children and Youth with Special Health Care Needs represent 37% of the Block Grant budget. The definitions and descriptions of the services for these project components can be found in the program narratives.

The State OPH intends to pursue and expects to obtain state general funds for MCH Services that equals or exceeds the level of such funds provided during state fiscal year 1989. Compliance verification will be performed and documented by the Fiscal Office at the end of each state fiscal year. The state support in state fiscal year 1989 was $6,207,276.

Administrative costs are the portion of costs incurred by the following service units that are directly allocated to Maternal and Child Health Services Programs in accordance with the Louisiana Department of Health Cost Allocation Plan: Office of Assistant Secretary-OPH; Policy, Planning and Evaluation; Administrative Services Operations and Support Services; LDH-Office of the Secretary (Office of Technology Services (OTS); Fiscal Services; Human Resources Section; etc.). Collectively, these costs are referred to as Executive Overhead costs. Compliance verification of the 10 percent administrative restriction will be performed and documented by the OMF Fiscal Office at the end of the federal fiscal year. The estimated administrative costs for the total budget are $2,976,512 for fiscal year 2024. The estimated Federal share is $1,295,766 or 10.0% of the federal funds requested and are within the administrative cost limit requirement.