Revision 23-2; Effective Sept. 8, 2023

2100 Program Authorization and Services

Revision 23-2; Effective Sept. 8, 2023

Title V Maternal and Child Health Fee-for-Services Program Background

The purpose of the Maternal and Child Health (MCH) Services Title V Block Grant is to create federal and state partnerships to provide direct services to low-income women and children not eligible for Medicaid Children’s Health Insurance Program (CHIP), CHIP Perinatal or another payor source that covers these same services. Title V MCH Fee-for-Service grantees provide services:

  • significantly reducing infant mortality;
  • including comprehensive care for women before, during, and after pregnancy and childbirth; and
  • including preventive and primary care services for infants, children and adolescents.

Legal Authority

Through Title V of the Social Security Act (SSA) of 1935, the federal government pledged to support state efforts to improve the health of all mothers and children. The MCH Block Grant Program under Title V of the SSA was created in 1981 to consolidate multiple programs to support a more comprehensive, coordinated approach to meeting states’ individual needs consistent with the applicable health status goals and national health objectives now identified in Healthy People 2030.

Within Texas, Title V operates within a framework articulated by the Texas Legislature and Texas Health and Human Services Commission (HHSC).

States are required to use federal funds awarded as follows:

  • at least 30% for preventive or primary care services for pregnant women, mothers, infants up to age one and children;
  • at least 30% for services for children with special health care needs; and
  • no more than 10% on administration.

Funding Sources

Title V MCH FFS program services are funded both by state general revenue and federal funds through the Title V MCH Block Grant. HHSC Title V MCH FFS funds are allocated through a competitive application process, after which selected applicants negotiate contracts with HHSC to provide services.

2200 Definitions

Revision 23-2; Effective Sept. 8, 2023

The following words and terms, when used in this manual, have the following meanings:

Barriers to Care – A factor that hinders a person from receiving health care. For example, distance, lack of transportation, documentation requirements and copayment amounts.

Case Management – With respect to pregnant women: services to assure access to quality prenatal, delivery, and postpartum care; and with respect to infants, children, and adolescents: services to assure access to quality preventative and primary care services.

Children’s Health Insurance Program (CHIP) – A health insurance program for non-Medicaid eligible children with a family income up to 198% Federal Poverty Level (FPL).

CHIP Perinatal Program – An HHSC program that provides medical coverage for perinatal care of unborn children of non-Medicaid eligible women with an income up to 202% FPL.

Children and Adolescents – Persons from their first birthday through the 21st year of age.

Client – A person who has been screened and determined to be eligible for the program. The term client and patient may be used interchangeably in other sources.

Confidentiality – The state of keeping information private and not sharing it without permission.

Consultation – A type of service provided by a health care provider with expertise in a medical or surgical specialty and who, upon request of another appropriate health care provider, assists with the evaluation or management of a patient.

Copayment or Copay – Money collected directly from clients for services.

Dental Services – Diagnostic, preventive and therapeutic dental services that are provided to eligible individuals and are performed in a dental office or clinic. 

Department of State Health Services (DSHS) – The agency responsible for administering physical and mental health-related prevention, treatment and regulatory programs for the state of Texas.

Dependent Care Deduction – The expense of providing care of a dependent. This expense must be both necessary for employment and incurred by an employed person. Allowable deductions are actual expenses, up to $200 per month for each child under age 2 and $175 per month for each child age 2 or older.  

Diagnosis – The recognition of disease status determined by evaluating the history of the client and the disease process, and the signs and symptoms present. Determining the diagnosis may require some or all the following: Microscopic (culture); Chemical (blood tests); Radiological examinations (X-rays).

Diagnostic Services – Activities related to the diagnosis made by a physician or other health professional.

Family Planning Services – Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select how this may be achieved. 

Federal Poverty Level (FPL) – The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. In the United States, this level is determined by the Department of Health and Human Services. FPL varies according to family size. The number is adjusted for inflation and reported annually in the form of poverty guidelines. Public assistance programs, such as Medicaid, define eligibility income limits as some percentage of FPL.

Fee-for-Service (FFS) – Payment mechanism for services that are reimbursed on a set rate per unit of service (also known as unit rate). 

Fiscal Year – The state fiscal year is from Sept.  1 through Aug. 31. The federal fiscal year is from Oct. 1 through Sept. 30.

Grantee – A non-state entity that receives an award directly from the state awarding agency to carry out an activity under a state program. The term grantee does not include subgrantees.

Health and Human Services Commission (HHSC) – The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services. 

Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 subject to Title XIX of the Social Security Act, 42 U.S.C. Section 1396, et seq., reimburses for health care services delivered to low-income clients who meet eligibility guidelines.

Minor – In accordance with Texas Family Code, a person under 18 years old who is not and has not been married or who has not had the disabilities of minority removed for general purposes (i.e., emancipated). In this policy manual, “minor” and “child” may be used interchangeably.

Nutritional Services – The provision of services to identify the nutritional status of an individual and instruction which includes appropriate dietary information based on the client’s needs, i.e., age, sex, health status, culture. This may be provided to an individual on a one-to-one basis or to a group of individuals.

Payor Source – Programs, benefits or insurance that pays for the service provided.

Prescription Drugs, Devices and Durable Supplies – Medically necessary pharmaceuticals and medical supplies (capable of withstanding wear) which are needed for the treatment of a diagnosed condition.

Preventive Health Care – Services include, but are not limited to the following: immunizations, risk assessments, health histories and baseline physicals for early detection of disease and restoration to a previous state of health, and prevention of further deterioration and/or disability.

Program Income – Money collected directly by the grantee or provider for services provided under the grant award.

Promotores or Community Health Worker (CHW) – A person who, with or without compensation, is a liaison and provides cultural mediation between health care and social services and the community. A certified CHW is an individual with current certification as a CHW issued by DSHS.

Provider – An individual clinician or group of clinicians who provide services.

Recertification – The process of rescreening and determining eligibility for the next state fiscal year.

Referral – The process of directing or redirecting (as a medical case or a person) to an appropriate specialist or agency for information, help or treatment. 

Referral Agency – An agency that will provide a service for the Title V MCH FFS client that the Title V MCH FFS grantee does not provide, and it is not a reimbursable Title V MCH FFS service.

Subgrantee – A non-state entity that receives a subaward from a pass-through entity to carry out part of a state program; but does not include an individual that is a beneficiary of such a program. A subgrantee may also be a grantee of other state awards directly from a state awarding agency. A subgrantee may also be referred to as a subrecipient. 

Telehealth Service – A health service, other than a telemedicine medical service, delivered by a health professional licensed, certified or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology.

Telemedicine Medical Service – A health care service delivered to a patient at a different physical location than the physician or health professional using telecommunications or information technology by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state and acting within the scope of the physician’s or health professional’s license.

Texas Resident – An individual who resides within the geographic boundaries of the state of Texas.

Transportation – Services that may be provided to transport a client for receiving required health care services. Transportation could be provided via private vehicle, public transportation, project site vehicle or emergency medical vehicle.

Unduplicated Client – An individual counted only one time during the program’s fiscal year for each Title V program they participate in: Prenatal Medical, Prenatal Dental, Child Health, and Child Dental. If a client participates in more than one Title V program, only their first visit of the fiscal year will be counted as an unduplicated client for each program they participate in.