Association of Maternal & Child Health Programs

About Title V

Since its inception, the Maternal and Child Health (MCH) Services Block Grant (Title V of the Social Security Act) has provided a foundation for ensuring the health of our Nation’s mothers and children.

With the passing of the Social Security Act in 1935, the Federal Government, through Title V, pledged its support of State efforts to extend health and welfare services for mothers and children. This landmark legislation resulted in the estab-lishment of State departments of health or public welfare in some States, and facilitated the efforts of existing agencies in others.

Over the years, the achievements of Title V-supported projects have been inte-grated into the ongoing care system for children and families. Landmark projects have produced guidelines for child health supervision from infancy through adoles-cence; influenced the nature of nutrition care during pregnancy and lactation; recommended standards for prenatal care; identified successful strategies for the prevention of childhood injuries; and developed health safety standards for out-of-home child care facilities.

Although Title V has been frequently amended over the years, the underlying goal has remained constant: continued improvement in the health, safety, and well-being of mothers and children.¹

Title Accountability Title V Today... Leadership, Performance, Accountability

• Title V remains the only Federal program that focuses solely on improving the health of all mothers and children.
• Title V is a partnership with State Maternal and Child Health (MCH) and Children with Special Health Care Needs (CSHCN) programs, reaching across economic lines to support such core public health functions as resource development, capacity and systems building, population-based functions such as public informa-tion and education, knowledge development, outreach and program linkage, technical assistance to communities, and provider training.
• Title V makes a special effort to build community capacity to deliver such enabling services as care coordination, transportation, home visiting, and nutrition counsel-ing, which complement and help ensure the success of State Medicaid and SCHIP medical assistance programs. • Title V funds support programs for children with special health needs to facilitate the development of family-centered, community-based, coordinated systems of care.
• Title V-supported programs provide gap-filling prenatal health services 2 million women and primary and preventive health care to more than 17 million children, including almost 1 million children with special health needs.
• Special projects target underserved urban and rural areas with efforts at the commu-nity level that promote collaboration between public and private sector als, leaders, and health care providers. • A new cadre of trained pediatric emergency specialists, more emergency equip-ment suited to the special needs of children are available, and protocols to ensure that more young lives can be saved in emergency situations are in place.
• Today many historical legacies of Title V survive as key components of local and State systems of care. ¹

The Roots and Evolution of Title V

Back to the future - that's how current public health emphases on assessment and policy might be viewed from a Title V perspective. Because the roots of Title V of the 1935 Social Security Act date back to the dawn of the 20th century, and it grew from a focus on using data to affect policy.

The Federal Children's Bureau was created in 1912 "to investigate and report on the status of children and on their common as well as special needs" and on "the welfare of children and child life among all classes of our people." The bureau used these reports to stimulate action. Results included uniform birth registration, the school lunch program, child labor laws, maternal health standards and the basis for the…

Sheppard-Towner Maternity and Infancy Act of 1921, which provided the first federal grants to states for public health. The controversial act's support for an activist governmental role in health was viewed as "radical" and "socialistic." The American Medical Association, the Catholic Church and the Public Health Service were instrumental in the act's 1929 repeal. The American Academy of Pediatrics was born in 1930 from disagreement with AMA's position. During the eight years that it was on the books, this law fostered creation of child health units in 47 states, many of which remained in place after its repeal.

The Social Security Act of 1935 included Title V, again authorizing grants to states, this time to "extend and improve" services. The grants targeted maternal and child health (MCH), children with special needs (then known as "crippled children"), and child welfare services. While the MCH component continued to focus on prevention, the CSHCN component introduced grants for medical care. States were funded by formula to establish service units and were required to submit state plans to obtain funding.

Over the next six decades, special program emphases were added to Title V, as the program adapted to identified needs and to the enactment of other federal health programs. Maternity and Infant Care (MIC) and Children and Youth (C&Y) projects developed under Title V in the 1960s to respond to problems of mental retardation and poverty conditions, respectively. These projects proved to be effective comprehensive care models. Projects for neonatal intensive care, family planning and dental care were added by the 1970s. Later years brought programs on school health, genetic diseases, newborn screening, training and research. All of these made significant contributions in advancing the field of maternal and child health. At the same time, new federal programs, including community health centers and Medicaid, resulted in some loss of influence for the Title V federal and state program.

In 1981, Title V became a block grant but retained key features of the original legislation. These amendments established the groundwork for current aspects of the program, such as the needs assessment. However many critics, including those in Congress, decried the lack of accountability mechanisms and cited initial reductions in funding and decreased federal oversight as weakening programs in some states.

The 1989 amendments brought increased accountability for Title V while retaining flexibility. Although some now dub the Title V Block Grant a "blockagorical," the 1989 amendments were an attempt to retain the historic strength of the program in assessing, planning and responding flexibly to state specific needs, while introducing stronger national accountability. Advocates came together with state MCH programs and AMCHP to urge Congress to seek this balance in the law.

Recent years showed continued tension between flexibility and accountability. Over the course of the 1990s, Congress frequently proposed federal legislation to create more and larger block grants. Some proposals included recommendations to consolidate the MCH Block Grant program with others, such as WIC, family planning, immunizations and other public health programs. Some also proposed turning the Medicaid program into a block grant. As of 2003, Congress hasn't enacted any of these proposals. The State Children's Health Insurance Program (SCHIP) was enacted as a capped entitlement to the states, allowing states more flexibility than they have with Medicaid. At the same time, this decade saw passage of the Government Performance and Results Act (GPRA), which was one of the policy forces that drove development of performance measures under Title V. These policy tensions between block grant and categorical programs and flexibility and accountability are likely to continue.

Title V today gives states flexibility with accountability for systemic approaches to improve health access and outcomes for ALL women, children, youth and families. Title V has been dubbed the framework, the infrastructure and even the "glue" for states' and territories' overall strategies, policies and programs. Over the years, many strengths have evolved from Title V: flexibility, adaptability, broad mission focused on national health objectives, responsiveness to states' and territories' needs, and accountability for performance. While the dollars for Title V may be a relatively small proportion of a state's total budget for family health programs, used effectively they can have a big impact.

• This information is from AMCHP's publication Leading State Maternal and Child Health Programs: A Guide for Senior Managers

Additional Resources

• Leading State Maternal and Child Health Programs: A Guide for Senior Managers. This manual is organized into chapters dedicated to "the big picture," or the theoretical framework of maternal and child health, and "the ABC's," which delve into the day-to-day operational aspects of MCH programs.
  • Conceptual Frameworks of Title V
    • Essential Public Health Services
    • The Core MCH Services Pyramid
    • Systems of Care
  • Key Concepts of MCH
    • Systems Building
    • Family Involvement
    • Population Base
• MCH Timeline: History, Legacy and Resources for Education and Practice, traces the history of maternal and child health in the U.S., provides in-depth modules on topics such as MCH 101, MCH Systems of Care, Infant Mortality and MCH Performance and Accountability, and allows you to search for topical areas of interest.

1. Understanding Title V