Why It Matters
Federal funding for maternal and child health programs requires Congress to approve appropriations every year. The Title V Maternal and Child Health (MCH) Services Block Grant aims to improve the health of pregnant women, mothers, and children, especially those with low incomes or limited access to health services. States must match federal block grant funds at a ratio of at least three state dollars for every four federal dollars received. This creates a direct incentive for states to invest in maternal and child health alongside federal support.
The Big Picture
In fiscal year 2024, total MCH program funding across all sources reached $2.875 billion. The federal government contributed $550.1 million through the MCH Services Block Grant. States provided $1.255 billion. Additional funding came from program income ($621.5 million), other sources ($309.8 million), and local funds ($138.2 million).
The block grant has three main components. State MCH Block Grants received $593.3 million, representing 73 percent of the total. Special Projects of Regional and National Significance (SPRANS) received $210.1 million, representing 26 percent of the total. Community Integrated Service Systems (CISS) received minimal funding, representing 1 percent of the total.
Federal allotments to individual states vary based on a formula that considers historical funding levels and the proportion of low-income children in each state. In fiscal year 2024, allotments ranged from $155,078 to $41.1 million, with Palau receiving the minimum and California receiving the maximum.
Federal law requires states to dedicate 30 percent of their federal funds to preventive and primary care services for children. States must also dedicate an additional 30 percent to services for children and youth with special health care needs.
In practice, states directed the largest share of MCH expenditures toward enabling services (40.4 percent). Public health services and systems received 35.9 percent. Direct health care services received 23.8 percent.
Different populations received different shares of MCH spending in fiscal 2024. Children with special health care needs accounted for 34.6 percent of expenditures. Children aged 1 to 21 represented 33.3 percent. Pregnant women accounted for 12.9 percent. Infants under 1 year represented 12.9 percent.
The Bottom Line
States must report annual performance data using a three-tiered measurement framework. This framework includes National Outcome Measures (NOMs), National Performance Measures (NPMs), and Evidence-informed Measures (ESMs). These metrics help track whether the program is meeting its goals to improve maternal and child health outcomes.
Performance measurement serves a critical function in a block grant program. Because states have flexibility in how they spend federal funds, standardized metrics allow Congress and the public to assess whether the program is reaching vulnerable populations and delivering results. The three-tiered approach balances national accountability with state autonomy, enabling policymakers to identify which states are succeeding and which may need additional support or resources.
However, the program faces an important uncertainty. The CRS report notes that an announced restructuring plan within the Department of Health and Human Services could affect how the Maternal and Child Health Bureau administers the program. Any disruption to federal administration or further shifts in funding priorities could impact states' ability to maintain current service levels, particularly in rural or underserved areas where MCH services are often the backbone of maternal health infrastructure.
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