A myriad of public health programs have been created over the years to improve the health of disadvantaged mothers, infants, and children, and to reduce disparities in health status and health care access. A few of the major programs are listed below.
MCH Block Grant Program. Title V of the Social Security Act (1935) authorized the use of federal monies for MCH programs. The biggest change to the Title V program came in 1981, when seven MCH programs were consolidated into the MCH block grant. Administration of MCH programs, which support direct delivery of MCH services in the public health setting, devolved to the state level, while state and federal governments share the costs.
Medicaid. Created by Title XIX of Social Security Act in 1965, the objective of Medicaid is to support the provision of health services to low-income Americans. The federal and state governments jointly administer the program and share its costs. Medicaid is really a financing program rather than a service delivery program. States are mandated to cover pregnant women and children six years of age and younger living at up to 133 percent of the federal poverty level, as well as all children up to age nineteen in families with incomes below the poverty level. Medicaid is by far the largest MCH program, funding prenatal and obstetrical care, the EPSDT program, and health services for children with special health care needs. Three out of four Medicaid recipients are women and children, though they consume only one-fourth of total Medicaid expenditures.
Community and Migrant Health Center Program. Created in 1965, the Community and Migrant Health Center Program provides basic primary care to medically underserved (largely rural) areas. It is funded by the federal government and administered at the community level. These centers place a high priority on reducing infant mortality and improving the health of mothers and children. One-third of individuals served by the program are children under age fifteen, and one in four are women of childbearing age.
The Special Supplemental Food Program for Women, Infants, and Children (WIC). Created in 1972, WIC provides supplemental food and nutritional education to low-income pregnant women, nursing mothers, and children diagnosed as being at nutritional risk. It is funded by the federal government and administered by the U.S. Department of Agriculture. Technically speaking, WIC is not a health care program, but evaluations have found WIC to be effective in reducing infant mortality, low birth weight, anemia, and other problems.
Head Start, Early Head Start, and Healthy Start. Project Head Start was created in 1965 to promote social and behavioral competence among preschool children from low-income families and to ensure that the children enter school with a similar foundation as their more economically advantaged peers. The program includes comprehensive health services, including preventive health services. Ten percent of Head Start enrollment is reserved for children with disabilities. Evaluations have shown reduced juvenile delinquency and increased school completion rates among children enrolled in the Head Start program. In 1994, Congress established the Early Head Start program for low-income families with infants and toddlers. Both programs are administered by the Head Start Bureau of the Department of Health and Human Services. The Healthy Start Initiative was created in 1991 to attack the causes of infant mortality and low birthweight using a broad range of community-based interventions in nearly one hundred communities across the United States. The Healthy Start Initiative is administered by the Maternal and Child Health Bureau.
Temporary Assistance for Needy Families (TANF) Program. In 1996, the U.S. Congress passed landmark welfare reform legislation (the Personal Responsibility and Work Opportunity Reconciliation Act) that replaced the Aid to Families with Dependent Children (AFDC) Program with the TANF Program. TANF was intended to give states new opportunities to develop and implement creative and innovative strategies and approaches to removing families from a cycle of dependency on public assistance and creating employment opportunities for them. While reviews of the impact of TANF on the health of women and children have been mixed, TANF has generated additional monies for MCH programs. For example, Los Angeles County created the Long-Term Family Self Sufficiency Plan with its TANF monies. The plan includes programs to help pregnant women gain access prenatal care, and to provide additional support services, such as parenting skills training.
State Children's Health Insurance Program (SCHIP). SCHIP was established in 1997 to provide insurance for children from families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. Of the over 10 million children in the United States who were uninsured in 1997, only 3 million were eligible for Medicaid prior to SCHIP. In its first three years, SCHIP has enrolled over 3 million children. Although enrollment was slow initially, states have responded with innovative strategies to reach out to uninsured children and families to increase enrollment. SCHIP is administered through the Health Care Financing Administration (HCFA).
State Programs. In addition to the programs described above, many state and local governments have developed additional MCH programs of their own. A notable example is the California Children and Families First Initiative, or Proposition 10. Passed in 1998, the initiative has raised approximately $700 million annually from a tobacco surtax to be used to improve early child development for children up to age five. The money will be used to support health care services for children and families, parental education and support services, and child-care programs. Because of the autonomy of its governance structure and its broadly defined goals, it is flexible enough to allow for different approaches that cross the traditional boundaries of MCH, a flexibility that is often not permitted under categorical funding and grant making. Proposition 10 has the potential for providing a model for the rest of the nation.
