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Special Edition: Title V Technical Assistance MeetingExpand Special Edition: Title V Technical Assistance Meeting
Title V Technical Assistance Meeting

 View from Washington

By Brent Ewig, MHS
Director, Public Policy & Government Affairs, AMCHP

My wife and I recently began making plans for a trip sometime next spring to celebrate our 10th wedding anniversary. Check with me this time next year for photos and stories of what I'm sure will be a fantastic adventure! More immediately, AMCHP is observing two policy-focused anniversaries. These include the 50th anniversary of the Social Security Amendments of 1965 – which created the Medicaid program on Jul. 30, 1965 - and the 80th anniversary of the underlying Social Security Act – which created Title V maternal and child health program on Aug. 14, 1935.

Both Medicaid and the Title V MCH Services Block Grant are commonly thought of as 'health' programs, and improving health is certainly central to their statutory mission and purpose. However, the anniversary of the Social Security Act provides us an opportunity to reflect on the intersection of health and poverty, and the role of federal legislation in both alleviating the ill effects of poverty and preventing poverty in the first place. 

Focusing on Medicaid first, the evidence shows that beneficiaries were as likely as those with private insurance, and significantly more likely than uninsured adults, to report having a regular source of care. Furthermore, individuals with Medicaid report getting recommended preventive care services at higher rates than did those who are uninsured.

When focusing specifically on how Medicaid insulates people from further impoverishment, evidence from the Commonwealth Fund shows that "adults with Medicaid were significantly less likely than either privately insured or uninsured individuals to report difficulty paying medical bills, being contacted by a collection agency about unpaid bills, having to change their way of life to pay medical bills, or paying off medical bills over time. Those with Medicaid were also significantly less likely to report skipping services because of the cost of care compared with adults who had spent time uninsured." In an era where high medical bills are the number one cause of personal bankruptcy, the importance of adequate health insurance is clear.

AMCHP leaders also are discussing how the Title V MCH Services Block Grant can provide tools to address poverty as one of the single largest determinants of health. One manifestation of this emerging is in the MCHB supported Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) where states have identified the need to implement evidence-based policies and programs and place-based strategies to improve social determinants of health and equity in birth outcomes. And at the individual state level, Minnesota is one of the leaders in the field creating a Center for Health Equity within the Department of Health. This center has published white papers on paid leave and health and income and health, and has made advancing health equity a central goal for the state. 

Other states are actively leading in this area, and at the federal level a bill has been introduced entitled the Child Poverty Reduction Act of 2015 (H.R. 2408), which seeks to create a national child poverty target, with the overall goal of halving child poverty in the United States in 10 years and completely eliminating it within 20. To help create a map on how this could be achieved, our partners at the Children's Defense Fund recently produced a report showing that these policy eight changes {see box) would create a 60 percent reduction in childhood poverty.

Policy Changes to Reduce Childhood Poverty

​Increasing employment and making work pay more for adults with children

  • Increase the Earned Income Tax Credit for lower-income families with children
  • Increase the minimum wage from $7.25 to $10.10
  • Create subsidized jobs for unemployed and underemployed individuals ages 16-64 in families with children
  • Make child care subsidies available to all eligible families below 150 percent of poverty
  • Make the Child and Dependent Care Tax Credit refundable with a higher reimbursement rate

Ensuring children's basic needs are met

  • Base SNAP benefits on USDA's Low-Cost Food Plan for families with children
  • Make the Child Tax Credit fully refundable
  • Make housing vouchers available to all households with children below 150 percent of poverty for whom fair market rent exceeds 50 percent of their income
  • Require child support to be fully passed through to TANF families, fully disregarded for TANF benefits, and partially disregarded for SNAP benefits

- See more at:

Navigating the intersection of health and poverty is not easy, but we at AMCHP have been encouraged that it is increasingly becoming part of the national policy dialogue in recent years.  We look forward to adding your voice to this discussion and continuing to support those policy and programs that will make a difference for all moms, children, families and communities.