The Maternal and Child Health (MCH) Services Block Grant is administered by the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) in the Department of Health and Human Services (HHS). This block grant is intended to improve the well-being of the low-income maternal and child population. According to HRSA, the MCH Services Block Grant serves as a "safety-net provider for the [maternal and child health] population by providing gap-filling health care services, as well as essential public health services, to the [maternal and child health] population." Generally, these services are provided to pregnant women, mothers, children, and children with special health care needs (CSHCNs), some of whom are also eligible for and receive services from Medicaid or the State Children's Health Insurance Program (CHIP). The MCH Services Block Grant is composed of three funding programs. The first is a block grant and is the largest of the three funding programs. It is provided to states and territories (referred to collectively as states in this report) to enable them to coordinate programs, develop systems, and provide a broad range of health services. The second funding program is the Special Projects of Regional and National Significance (SPRANS) program. SPRANS is a competitive grant program that funds research and training projects that focus on low-income pregnant women, mothers, and children, including CSHCNs. The third funding program is the Community Integrated Service Systems (CISS) program. CISS is a competitive grant program that funds projects that support the development and expansion of integrated services at the community level. The MCH Services Block Grant is the oldest federal-state partnership program. A federal-state partnership is a program that joins a federal agency with a state or jurisdiction, in order for the two to address a certain issue. Under this federal-state partnership, states make available federal and nonfederal funds to provide health care services to their maternal and child health populations (see the " Requirements of Block Grant Allocation and Distribution " section of this report). The FY2015 dollar amounts from these sources, the latest available, are presented in Table A-1 . Congress established this block grant under Title V of the Social Security Act (SSA, P.L. 74-271, as amended). The MCH Services Block Grant was established to serve as a single block grant under the previous SSA statutory heading, "Title V – Grants to States for Maternal and Child Welfare"; which was referred to as "Title V." In 1981, Congress combined the MCH Services Block Grant with other maternal and child health services and programs. Such services and programs aimed to improve the health of mothers and children, particularly those in low-income households. They included maternal and child health services, services for disabled children, child welfare services, and vocational rehabilitation services. Title V services included activities related to abstinence, postpartum depression, and personal responsibility educational services and programs. The 97 th Congress named this consolidation the MCH Services Block Grant and renamed it in statute as the "Title V MCH Services Block Grant," which is commonly referred to as "Title V." This change was implemented by the Omnibus Budget Reconciliation Act (OBRA) of 1981 ( P.L. 97-35 ), as amended. The 1981 OBRA gave states more flexibility in determining how to use federal funds to address maternal and child health needs. In addition, the 1981 OBRA required that each state receive, at a minimum, the combined funding of the programs consolidated under it. Congress made additional changes to the MCH Services Block Grant under the Omnibus Budget Reconciliation Act of 1989 ( P.L. 101-239 ). These changes increased the authorization of appropriations; called for greater accountability; and created stricter rules for application and reporting requirements for states, including a statewide needs assessment requirement. Over time, additional programs targeting CSHCNs and low-income women and children were added to the SSA and the Public Health Service Act (PHSA). Title V also supports services that are offered by the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program and the state-based CSHCNs program. The MCH Services Block Grant program creates partnerships between the federal government and states. The aim of the federal-state partnerships is to give attention to the health care needs of the maternal and child health populations. The MCH Services Block Grant enables states to ensure that quality health care is provided to mothers and children, particularly to those with low incomes or limited availability of care; reduce the number of infant deaths, preventable diseases, and handicapping conditions among children; reduce hospital inpatient and long-term care services; increase the number of low-income children who receive health assessments and follow-up diagnostic and treatment services; provide perinatal care to low-income, at-risk women and provide preventive and primary care services to low-income children; provide rehabilitation services that are not under subchapter XIX of the SSA to blind and disabled children who are under the age of 16 and who are beneficiaries under subchapter XVI of the SSA; provide family-centered, community-based, and care-coordinated services; and enable the development of community-based systems for CSHCNs. The population served by the MCH Services Block Grant consists of pregnant women, infants, children, CSHCNs, and others. HRSA defines these as follows: Pregnant W omen. Pregnant women are served from the date of conception to 60 days after the child or fetus is delivered or "expulsion of the fetus" happens. Expulsion may occur, for example, when a miscarriage takes place. Infants . Infants are babies aged one year and less. Children . Children are served from the age of one year, up to the day before their 22 nd birthday. If a female child becomes pregnant, HRSA classifies her as a pregnant woman rather than as a child. Children with Special Health Care Needs . CSHCNs are infants and children who have or are at risk of having a disability, chronic illness/condition, or educational/behavioral issue. Others . This category includes women who are over 21 years of age (referred to by HRSA as child-bearing age) and other individuals who are not defined by a state as being in one of the categories above. In FY2015 (the year in which the most recent data are available), 57,064,187 individuals were served by programs funded by the MCH Services Block Grant (see Figure 1 ). Of the total served, 2,640,078 were pregnant women, 3,891,644 were infants, 37,797,789 were children, 4,195,464 were CSHCNs, and 8,539,212 were "others" (women of childbearing age and any others who are not classified by the state). The primary use of funds under the MCH Services Block Grant, including formula grants to states, competitive grants for Special Projects of Regional and National Significance (SPRANS), and competitive grants for projects through the Community Integrated Services Systems (CISS) program, is to provide core public health services for low-income mothers and children. Projects funded by SPRANS include maternal and child health workforce development, genetic services, and diagnostic and treatment services for hemophilia. CISS grants fund projects that support integrated maternal and child health services at the community level. Block grant funds are to be used by the states "to provide and to assure mothers and children (in particular those with low income or with limited availability of health services) access to quality maternal and child health services." States determine the actual services provided under the block grant. For example, such services may include counseling services, dental care, family planning, immunization, inpatient services, prenatal care, screening services for lead-based poisoning, support for community health centers, vision and hearing screening services, and well-child care. All 50 states and nine jurisdictions may apply for the MCH Services Block Grant. In FY2015 (the year in which the most recent data are available), block grant funding to each of the states and nine jurisdictions ranged from $154,000 to $38,909,810 (see Table A-1 ). According to HRSA, "within each state, the state health agency is responsible for the administration (or supervision of the administration) of programs carried out with Title V allotments." States are organized within the 10 general regions of HHS (see Figure 2 ). There are four types of funded services: (1) direct health care services, (2) enabling services, (3) population-based services, and (4) infrastructure building services. Generally, these core services are presented as a four-level pyramid (see Figure 3 ). Although states deliver four types of services, direct health care services incurred the largest proportion (57.62%) of expenditures under the MCH Services Block Grant program in FY2015. Direct health care services are intended to fill the gaps in primary and preventive health care that are not otherwise available through other funding sources or providers, such as private insurance, Medicaid, or CHIP. In FY2015, approximately $3.87 billion went to direct services. In that same fiscal year, the MCH Services Block Grant program incurred $6.29 billion in expenditures (see Table A-1 in Appendix A ). Other federal and nonfederal funds combine with the actual (appropriated) funding level of the block grant to yield the larger figure, reflecting the nature of the grant's federal-state partnership. States may use their block grants "to provide and to assure [that] mothers and children (in particular those with low income or with limited availability of health services) [have] access to quality maternal and child health services." States determine the actual services provided under the block grant.