[Federal Register Volume 87, Number 121 (Friday, June 24, 2022)]
[Notices]
[Pages 37873-37874]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-13475]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Proposed Temporary Changes in State Title V Maternal and Child 
Health Block Grant Allocations

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services.

ACTION: Notice.

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SUMMARY: This notice seeks comments on proposed temporary changes to 
the method of calculating poverty-based allocations under Title V of 
the Social Security Act for HRSA's State Title V Maternal and Child 
Health (MCH) Block Grant. Since Fiscal Year (FY) 2017, the poverty-
based allocation has been based on the U.S. Census Bureau's 3-year 
American Community Survey (ACS) estimates using three pooled 1-year 
estimates. However, due to the COVID-19 pandemic, there were 
disruptions in the ACS data collection in 2020 resulting in data 
quality issues that prevented the Census Bureau from releasing standard 
1-year ACS estimates; instead, the Census Bureau released experimental 
estimates. HRSA proposes that the ACS 2020 experimental estimates be 
excluded from calculating MCH block grant allocations and that the FY 
2023 funding allocation be based on the same poverty data used in the 
FY 2022 allocation (i.e., pooled 1-year estimates for 2017, 2018, and 
2019 ACS). Funding allocations for FY 2024 and FY 2025 would continue 
to incorporate the latest 1-year ACS data while skipping 2020 (i.e., 
for FY 2024, the 2018, 2019, and 2021 ACS data will be used; for FY 
2025, the 2019, 2021, and 2022 ACS data will be used). In FY 2026, the 
temporary change to the method for calculating allocations will no 
longer be necessary, and HRSA will resume pooling of three consecutive 
1-year estimates (2021-2023).

DATES: Interested persons are invited to comment on this proposed 
change. Submit written comments no later than July 25, 2022. All 
comments received on or before this date will be considered.

ADDRESSES: All written comments concerning this notice should be 
submitted to Christopher Dykton, Acting Director of the Division of 
State and Community Health, at the contact information below.

FOR FURTHER INFORMATION CONTACT: Christopher Dykton, Acting Director of 
the Division of State and Community Health, Maternal and Child Health 
Bureau (MCHB), HRSA, Room 18N35, 5600 Fishers Lane, Rockville, Maryland 
20857; telephone: (301) 433-2204; email: <a href="/cdn-cgi/l/email-protection#9bd6d8d3d9f7f4f8f0dce9faf5efdbf3e9e8fab5fcf4ed"><span class="__cf_email__" data-cfemail="9cd1dfd4def0f3fff7dbeefdf2e8dcf4eeeffdb2fbf3ea">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: The purpose of the Title V MCH Block Grant, 
administered by HRSA's MCHB, is to improve the health of the nation's 
mothers, infants, children, including children with special health care 
needs, and their families by creating federal/state partnerships that 
provide each state/jurisdiction with needed flexibility to respond to 
its individual MCH population needs. Pursuant to section 502(c) of 
Title V of the Social Security Act (42 U.S.C. 702(c)), for any 
available funding in excess of 1983 levels ($406,649,394), Title V MCH 
Block Grant funds are allocated to States and the District of Columbia 
based on the number of children living in poverty in an individual 
state as a proportion of the total number of children living in poverty 
in the U.S., using data for the number of children in poverty in each 
State from the U.S. Census Bureau's ACS. Incorporating the proportion 
of total number of children living in poverty into the state funding 
formula for the Title V MCH Block Grant ensures that a portion of the 
funding is distributed according to greatest need.
    Beginning in FY 2013, data for the number of children in poverty in 
each state has been based on the U.S. Census Bureau's ACS.\1\ In FY 
2013, the allocation was based on 3-year rolling ACS estimates instead 
of 1-year or 5-year ACS estimates also produced at that time to strike 
a balance between reliability and currency of data. See 77 FR 65693 
(October 30, 2012). However, since 2014 (for FY 2017), when the Census 
Bureau discontinued the release of 3-year ACS estimates, HRSA has been 
using three pooled ACS 1-year estimates for this purpose.
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    \1\ Prior to this, the formula was based on poverty data from 
the decennial Census long-form, which was replaced with the American 
Community Survey.
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    In 2020, due to the COVID-19 pandemic, there were disruptions in 
the ACS data collection that prevented the Census Bureau from releasing 
standard 1-year ACS estimates for 2020. According to the Census Bureau 
report, ``An Assessment of the COVID-19 Pandemic's Impact on the 2020 
ACS 1-Year Data,'' \2\ both survey administration methods (mailed 
questionnaires and interviewing in-person) were impacted beginning in 
March 2020. For example, no mailings were completed from April through 
June 2020, and when they resumed, they did not include the mailing of 
most of the reminder letters and postcards. Similarly, there was an 
abrupt switch from in-person to telephone-only interviews from March 
2020 through June 2020, and the universe of addresses for which 
telephone numbers can be obtained is likely different than the universe 
of addresses obtained through in-person methods, over-representing 
certain types of addresses. In May, the option to complete the 
interview online became available. In-person

[[Page 37874]]

interviewing resumed in July, but not for all areas.
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    \2\ https://www.census.gov/library/working-papers/2021/acs/2021_CensusBureau_01.html.
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    All of these changes affected response rates, in terms of who was 
most likely to complete the mailed surveys or participate in 
interviews, etc. The Census Bureau concluded that the 2020 ACS 1-year 
data were not ``reasonable'' as respondents disproportionately ``had 
higher levels of education, had more married couples and few never 
married citizens, had less Medicaid coverage, had higher median 
household incomes, and fewer non-citizens, and were more likely to live 
in single-family housing units'' than respondents in previous years. 
Therefore, the Census Bureau decided not to release standard 2020 ACS 
1-year estimates. The Census Bureau is providing only ``experimental 
estimates'' for 2020 ACS 1-year data.\3\ The Census Bureau indicated 
that the experimental 2020 estimates were released in an attempt to 
account for the differential response from more educated, higher 
income, single-family households, but also acknowledged the approach 
has not been thoroughly investigated.\4\
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    \3\ The Census Bureau defines experimental data products as 
``innovative statistical products created using new data sources or 
methodologies that benefit data users in the absence of other data 
products . . . Census Bureau experimental data may not meet all of 
HRSA's data quality standards. Because of this, HRSA clearly 
identifies experimental data products and includes methodology and 
supporting research with their release.'' https://www.census.gov/data/experimental-data-products.html.
    \4\ https://www.census.gov/programs-surveys/acs/data/experimental-data.html.
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    Upon their release, HRSA examined the 2020 ACS experimental 
estimates and compared the change in poverty share using a 3-year 
estimate incorporating the 2020 experimental estimate with prior year-
to-year changes since 2014--the first year of annual updates to poverty 
share data using 3-year ACS estimates. Using the 2020 experimental 
estimates, HRSA noted an increase in the variability, with 12 states 
having their largest observed relative percentage change, 9 states 
having large (>5 percent) relative percentage changes, and 6 states 
having large (>5 percent) relative decreases in poverty share from the 
prior year. Moreover, in years prior, large relative percentage changes 
were most often increases, but the opposite occurred in 2020 using the 
experimental estimates, i.e., six states would have a large decrease 
vs. three states would have a large increase. Thus, due to the greater 
observed data variability and number of states that would experience 
large decreases in their poverty share, HRSA has concerns about the 
accuracy of the 2020 experimental estimates as applied to the MCH 
allocation. For smaller states, in particular, large relative decreases 
in poverty share can result in meaningful absolute decreases in the 
poverty-based allocation. As state budgets are impacted by the COVID-19 
pandemic, HRSA proposes a conservative approach that limits such 
decreases based on uncertain experimental estimates to the extent 
possible.
    In order to ameliorate these concerns and because of the nature of 
the data, HRSA proposes that the ACS 2020 experimental estimates not be 
used in calculating MCH block grant allocations. Instead, HRSA proposes 
that the FY 2023 funding allocation be based on the same poverty data 
used in the FY 2022 allocation (i.e., pooled 1-year estimates for 2017, 
2018, and 2019 ACS). Funding allocations for FY 2024 and FY 2025 would 
continue to incorporate the latest 1-year ACS data while skipping the 
2020 experimental data (i.e., for FY 2024, the 2018, 2019, and 2021 ACS 
data will be used; for FY 2025, the 2019, 2021, and 2022 ACS data will 
be used). In FY 2026, the temporary change to the method for 
calculating allocations will no longer be necessary, and HRSA will 
resume pooling of 3 consecutive 1-year estimates (2021-2023). HRSA's 
proposal to temporarily change the method of calculating allocations 
continues to support the objective of distributing funding according to 
greatest need. In so doing, HRSA will avoid the use of lower quality 
and potentially inaccurate poverty data for 2020 that would result in 
larger funding fluctuations than observed in previous years, and will 
continue to use the latest available data in future years. With this 
approach, no state will see a decrease in its poverty-based allocation 
of funding in FY 2023.
    If the poverty data used for the FY 2022 allocation is used again 
for the FY 2023 allocation, all states will receive the same proportion 
of poverty-based funding as they received in FY 2022, which will 
prevent potentially inaccurate changes in allocations. HRSA recognizes 
the possibility that the changes seen with 2020 ACS experimental 
estimates may actually reflect real changes in the distribution of 
children in poverty which may be seen when the 2021 ACS 1-year 
estimates (to be released in Fall 2022) are incorporated. If that is 
the case, then the difference in FY 2024 allocations as compared to the 
FY 2023 allocations will accurately reflect those changes by 
incorporating the 2021 data.

Diana Espinosa,
Deputy Administrator.
[FR Doc. 2022-13475 Filed 6-23-22; 8:45 am]
BILLING CODE 4165-15-P


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