Minnesota’s FFY2023 expenditures fully met federal Title V MCH Block Grant requirements. At least 30% of federal funds supported CYSHN, and at least 30% of federal funding provided preventive and primary care for children and adolescents, as specified in Section 501(a)(1)(D). Minnesota did not exceed the 10% administrative requirement at 4.8%. Minnesota’s Maintenance of Effort (1989 [Section 505(a) (4)]) of $6,184,197 was met and Minnesota exceeded federal match requirements of three dollars for every four dollars received. Minnesota’s FFY2023 Title V award was $9,477,092, of which we project all of it will be expended, and state and local match totaled $36,076,441 as reported on Form 2.

The Community Health Services Act of 1976 redesigned Minnesota’s public health system. Prior to 1977, over 2,100 local boards of health existed to serve Minnesota’s communities. Now called the Local Public Health Act, the legislation delineates the responsibilities of the state (MDH) and city and county governments in the planning, development, funding, and delivery of public health services. This partnership enables state and local governments to combine resources to serve public health needs in an efficient, cost-effective way, and is the infrastructure for nearly all public health efforts in the state. A Community Health Board (CHB) is the legal governing authority for local public health. The number of CHBs in the state has varied slightly over time but is currently at 51. CHBs work in partnership with MDH to prevent diseases, protect against environmental hazards, promote healthy behaviors and healthy communities, respond to disasters, ensure access to health services, and assure an adequate statewide public health infrastructure. Under the Local Public Health Act, CHBs address and implement the essential local public health activities and assure that a community health assessment and plan are completed, that community health needs are prioritized in a manner that includes community participation, and that needed public health services are developed and implemented.

Minnesota Statute § 145.88 distributes, by formula, two-thirds of Minnesota's federal Title V MCH Block Grant allocation to CHBs. State law requires CHBs to provide at least a 50% match for the federal Title V MCH Block Grant funds they receive each year, leveraging additional funding for local MCH efforts. Local tax dollars, other state grants and private insurance reimbursements predominately make up match requirements.

By state statute, CHBs must use Title V MCH Block Grant funds for low-income, high-risk populations to address health disparities, health services, and other health-related issues as described below:

1. High rate of infant mortality or children born with low birth weight.
2. Increased likelihood of complications during pregnancy.
3. Children who have or are likely to have a chronic disease or disability or special health need.
4. Access to subsidized family planning services.
5. Frequency and severity of childhood and adolescent health issues.
6. Preventing child abuse and neglect, reducing juvenile delinquency, promoting positive parenting and resiliency in children, and promoting family health and economic sufficiency through public health nurse home visiting.
7. Nutritional issues of women, infants, and young children through WIC clinic services.

While Minnesota statute broadly directs the use of these funds, local public health agencies conduct their own needs assessments and allocate or move funding between populations or types of services provided to meet emerging community needs or to respond to critical MCH issues. This ability to respond to emerging community needs or public health emergencies can result in variations between federal fiscal years as to populations served or types of service provided using Title V funds.

All CHBs report using all or a portion of their Title V funds to support their home visiting programs. More than half of CHBs use Title V funds to help support the Follow Along Program (described further in the Child Health Annual Report and Application Plan). About a fourth of CHBs use Title V funds to support access to family planning services. Other activities identified on CHBs annual work plans include breastfeeding support, injury prevention, adolescent health promotion activities, including school-based clinics, as well as public health assessment, case management, and referral services for CYSHN.  In the next reporting year, CHBs will be required to report their FTEs funded by Title V and their workplans will be incorporated into MDH’s REDCap reporting system.  This will enable reporting with greater detail on CHB use of their Title V funded activities and programs. 

Minnesota Statute § 145.882 subd. 2 directs up to one-third of Minnesota’s federal Title V MCH Block Grant allocation for state efforts to:

1. Meet federal requirements of a statewide needs assessment every five years and prepare the annual federal application and report.
2. Collect and disseminate statewide data on the health status of mothers and children.
3. Provide technical assistance to CHBs in meeting statewide outcomes.
4. Evaluate the impact of maternal and child health activities on the health status of Minnesota’s mothers and children.
5. Provide services to children under age 16 receiving benefits under Title XVI of the Social Security Act.
6. Perform other MCH activities as deemed necessary by the Commissioner of Health.

Of the $3,159,031 retained to support the MCH and CYSHN programs within MDH, all will be expended by the end of the grant period and $779,733 went to meet MDH’s indirect rate of 22.4% in SFY2023 and 28% in SFY2024. Retained funding supported key positions within the Director’s Office, MCH and the CYSHN programs, coverage of shared resources that support program activities and inter-agency efforts targeted at children and their families.

Minnesota’s contribution to meet Title V MCH Block Grant match requirements totaled $36,076,441 from state and fee supported MCH programs under the administration of the CFH Division and local public health contributions. Table 1 below details the expenditures for FFY023 from state/fee funds, which help meet match requirements.

Table 1. Expenditures Meeting Title V Match Requirements, FFY2023

In addition, $117,416,055 in other federal funds were expended for maternal and child health activities. The majority of these federal funds supported WIC programmatic activities ($94,740,758). Please refer to Form 2 for a detailed list of all federal grant funds expended in FFY2023. Minnesota’s MCH and CYSHN programs are in a key position to influence, leverage and enhance this broad array of federal funding directed at Minnesota’s MCH population. Furthermore, the combination of Title V funds with state and federal funding enables CHBs, nonprofits and tribes, largely through grants and contracts, to provide robust programming and reach to pregnant women, infants, children and adolescents and the CYSHN population.

Because of the broad coverage of Minnesota’s public programs, limited medical, dental, or other direct services have been provided using Title V MCH Block Grant funds. CHBs are required to utilize Medicaid, and third-party reimbursement before using Title V funds and annually report the amount of third-party reimbursement and Medicaid reimbursement received. The Overview of the State provides a summary of the numerous public health programs offered in Minnesota.

How Title V Funds Addressed Health Equity

Please see Overview of the State: MDH-Health Equity. Additionally, details of how health equity is addressed through Title V related efforts is integrated throughout the domain narratives.

How Title V Funds Supported Family EngagementActivities

In September 2023, MDH partnered with Children’s Minnesota, Gillette Childrens Specialty Health Care, and others, to host a Supporting Family Caregivers Forum event. The event brought together 150 caregivers, family support organization staff, nonprofit personnel, health care professionals, policy makers, and state agency staff. The focus was on how to support family caregivers of children and youth with special health needs across multiple sectors. Attendees delved into the 2022 National Strategy to Support Family Caregivers. They also explored ways to support and learn from caregivers regarding decisions affecting them and their family members.

To better understand the needs of community-based family support organizations in an effort to revise the MDH approach to funding organizations more broadly, CYSHN section completed an environmental scan. From March to August 2023, 45 organizations took part in an environmental scanning process that included both an online survey and phone interviews. The survey, developed in collaboration with family support organizations, revealed four key themes and six actionable items that will be addressed this next budget period. For more information, see the 2023 Title V Report and 2025 Title V Application Plan.  This initiative will be continued in FFY25 to implement the action steps identified.

On Form 2, FFY23 Annual Report of Funds Expended, there were four discrepancies exceeding 10% from what was budgeted.  Field notes were completed on each of the following forms (1,5,6):

1. Federal Allocation

1. Preventive and Primary Care for Children: MDH was able to reduce administrative costs and redirect to Preventive and Primary Care for Children due to administrative staff vacancies. The administrative work was completed by staff who were funded with State dollars until the vacancies were filled. 

100. Title V Administrative Costs: MDH was able to reduce administrative costs and redirect to Preventive and Primary Care for Children due to administrative staff vacancies. The administrative work was completed by staff who are funded with State dollars until the vacancies were filled. 

5. Other Funds: Due to MDH staff and local Community Health Board staff prioritizing the COVID-19 pandemic, fewer funds were spent on other State programs, resulting in a reduction in the Other Funds category during this reporting period.
6. Program Income: Program income varies from year to year based on local Community Health Board expenditures reported. Program income is client fees that are collected by local public health and varies depending on who they are serving.

Please refer to FFY2023 expenditure information in Form 2 (MCH Budget/Expenditure Details), Form 3a (Budget and Expenditure Details by Types of Individuals Served), and Form 3b (Budget and Expenditure Details by Types of Services) for further detail. These forms and their field notes provide additional details and explanations about FFY2023 expenditures.

Please refer to budget information in Form 2 (MCH Budget/Expenditure Details), Form 3a (Budget and Expenditure Details by Types of Individuals Served), and Form 3b (Budget and Expenditure Details by Types of Services. These forms and their field notes provide additional details and explanations about the Minnesota’s Title V MCH Block Grant budget.

Minnesota’s federal Title V Maintenance of Effort of $6,184,197, and projected match requirements of $7,107,819, can be fully met using state general fund and fee-based appropriations (see below for a listing of the programs). Funds are budgeted for the MCH and CYSHN Directors and other key staff to attend at least one national MCH/CSHCN meeting and the required Block Grant Application/Annual Report review that may resume onsite in Chicago.

For the FFY2025 Title V MCH Block Grant budget application, we continue to align our administrative costs to align with the MCHB definition as suggested by reviewers at the 2020 annual review meeting and allocate those across the program areas (pregnant women and infants, CYSHN, and child and adolescent health) within the grant to more accurately reflect the administrative costs incurred by each area. We also account for funds spent on infant health into the Child and Adolescent area per the technical assistance received from MCHB staff. This enables us to meet the 30%-30%-10% requirements.

Two-thirds of the Title V MCH Block Grant are distributed by formula to all local public health agencies, called Community Health Boards (CHBs). These CHBs submit annual budgets and work plans, and report on expenditures of their federal Title V MCH Block Grant funding. Significant changes can occur between budgets and expenditures as CHBs may redirect funds during the year to respond to critical local needs or emerging health issues. This can create fluctuations in the populations served, total numbers of individuals served, and the types of services provided. This flexibility in funding may result in line-item differences of greater than 10% in block grant budget and actual expenditures. CHBs must provide a 50% match for the Title V MCH Block Grant funding they receive, and this funding supports almost half of Minnesota’s total federal match requirements.

State law allows the state to retain up to one-third of the federal MCH Block Grant. The state also supports all the indirect charges for the Title V MCH Block grant from the state portion of the funding.

The FFY2025 Title V MCH Block Grant supports 27 positions, which equals 20.08 Full-Time Equivalent (FTE) positions within the CFH Division, with some fluctuations due to personnel changes and intermittent hiring of student workers. Title V funding is budgeted to cover key positions within the MCH and CYSHN Sections and Directors Office, important statewide initiatives, and the MDH indirect rate. This essential funding enables the state to provide critical expertise in the delivery of MCH health programs at the local level, supports important state responsibilities, and provides oversight and monitoring of the grant. Positions fully or partially covered by federal funds include:

• Title V CYSHN Director
• MCH Assistant Section Manager
• SSDI Coordinator
• MCH Epidemiologist
• Title V Coordinator
• Family Planning Coordinator
• Adolescent Health Coordinator
• School Health Nurse Consultant
• Child and Adolescent Health Supervisor
• Women Health Supervisor
• CYSHN Capacity Building Unit Supervisor
• CYSHN Policy and Program Planners
• CYSHN Coordinated Care Systems Specialist
• Health Educator (MCH and CYSHN)
• Follow Along Program Coordinator
• Financial specialists (6)
• Administrative assistant
• IT specialist /website support of MCH and CYSHN programs
• Student workers (2)

The Title V MCH Block Grant funding supports several initiatives that bring the CFH Division into state policy discussions, promote, monitor, and improve Minnesota’s MCH populations, advance health equity efforts, and support collaboration between state agencies. Examples of such initiatives that use FFY2025 funds include:

• Supporting staffing of the Children Cabinet, which is comprised of key state agency commissioners and charged with creating an equitable system that supports pregnant and parenting families ($46,000).
• Partial funding to support costs associated with MDH’s maternal mortality review committee including abstractor contracts, support for community members on the committee, and report production costs.
• For further understanding of how Minnesota uses Title V funding to address health equity please see Overview of the State: MDH-Health Equity. 

The FY2023 legislative session provided approximately $23 million in new state general funds to the Child and Family Health Division to support new programs serving MCH populations. For more detail on these legislative wins, See Overview of the State: Legislative Priorities and Wins. Funding was rescinded for Women’s Right to Know program and the Positive Alternatives program was reduced from $3.4 million to one-time funds that will end in June 2024. The following state appropriations augment the match from CHBs to fully meet federal match and Maintenance of Effort requirements and demonstrate the state and federal partnership with MCHB:

State Fiscal Year (SFY) 2024 General Revenue Funds (total $35,873,000):

• Fetal Alcohol Syndrome activities ($3,222,000)
• Sexual and Reproductive Health Services ($11,901,000)
• Positive Alternatives Program ($400,000)
• Family Home Visiting ($4,468,000)
• Birth Defects Information System ($1,772,000)
• Deaf and Hard of Hearing Programs ($874,000)
• State funding for management, supervisory and administrative support ($1,558,000)
• Maternal Mortality Reviews ($163,000)
• Healthy Babies Grant ($283,000)
• Midwife/Doula Capacity Building ($171,000)
• CMV Education/Outreach ($161,000)
• CYSHN grants ($160,000)
• Help Me Connect ($385,000)
• Healthy Beginnings Grants ($8,078,000)
• School Based Health Clinics ($1,279,000)
• Pregnancy and Substance Use ($170,000)
• Drug Overdose Grants ($828,000)

SFY 2024 Fee Funds (total $2,208,000):

• State abstinence education program ($52,000), from a portion of the marriage license fee
• Long term follow-up program for children diagnosed with a newborn screening condition ($2,156,000), from the newborn screening fee.

Federal funds received from the Minnesota Department of Human Services and the Minnesota Department of Education support a broad array of services for women, infants, children with special health needs and families throughout Minnesota. They include:

SFY 2024 Interagency Agreements (total $10,347,777):

• Minnesota Department of Human Services provides:
  • Temporary Assistance for Needy Families (TANF) funding for the Family Planning program ($1,156,000) and the Family Home Visiting program ($8,557,000)
  • Medicaid funding to support the Child and Teen Checkups (EPSDT) program ($574,777).
•  Minnesota Department of Education provides:
  • Part B funds to support transition of adolescents into adult systems of care ($60,000)

Other federal funds under the administration of the CFH Division supporting maternal and child health efforts have increased by $17.5 million over the last reporting period as a result of new federal grants applied for and received (see last 8 grants listed) and additional WIC funds received. These funds include:

Other Federal Grant funds (total $144,349,346):

• SSDI ($100,000)
• PRAMS ($175,000)
• ECCS Health Integration ($255,600)
• Pediatric Mental Health ($445,000)
• Universal Newborn Hearing ($310,000)
• WIC ($126,536,584), including breastfeeding support grants
• Sexual Risk Avoidance Education Grant ($659,724)
• Personal Responsibility Education Program ($849,442)
• Maternal, Infant, and Early Childhood Home Visiting ($8,826,241)
• Maternal, Infant, and Early Childhood Home Visiting ARP 1&2funds ($2,857,557)
• Birth Defects Information System ($375,000)
• Preventive Block Grant for Adverse Childhood Events ($169,311)
• State Maternal Health Innovation Program ($1,000,000)
• Early Hearing Detection and Intervention (EHDI) State Programs ($38,781)
• ELC SetNet ($118,919)
• Pediatric Mental Health Expansion ($300,000)
• Congenital Heart Defects ($400,000)
• Sickle Cell Data Collection ($31,070)
• Reimagine Black Youth Mental Health ($400,000)
• Preventing Maternal Mortality: Supporting Maternal Mortality Review Committees ($462,921)
• Incarcerated Parents with Minor Children ($222,146)

Funding Challenges and FFY25 Legislative Wins

Federal Title V MCH Block Grant funds have remained relatively consistent while salaries and fringe benefits have increased 10% over the biennium (2023-2025). As a result of those rising costs, some administrative staff were moved onto state funds that were underutilized in some programs decreasing our administrative costs and reallocated that funding to Preventive and Primary Care for Children. Vacancies also created some saving in administrative costs and the work was covered by state funded staff. 

The 2024 legislative session added four maternal and child health grant initiatives with one time funding which will allow expansion of our MCH activities to complement our Title V budget activities. Those new legislative items are outlined in the Overview of the State: Legislative Priorities and Wins and will be reflected in the next Title V budget reporting period.

There were no significant variations or discrepancies in the FFY2025 budgeted amounts on forms 2, 3a, or 3b to report.