Tuesday, October 3, 2017

Child Health Day — words and actions

President Trump proclaimed Monday, October 1st, as Child Health Day. Child Health Day was passed into law in 1928 under TITLE 36 — PATRIOTIC AND NATIONAL OBSERVANCES, CEREMONIES, AND ORGANIZATIONS, including the request that a presidential proclamation be issued annually:

§ 105. Child Health Day

The President is requested to issue each year a proclamation — 

(1) designating the first Monday in October as Child Health Day; and

(2) inviting all agencies and organizations interested in child welfare to unite on Child Health Day in observing exercises that will make the people of the United States aware of the fundamental necessity of a year-round program to protect and develop the health of the children of the United States.

Trump's proclamation was issued the same day that Congress allowed two crucial health programs to expire through inaction:

  • CHIP, the Children’s Health Insurance Program, which provides for medical care for some 9 million children, and
  • DSH, Disproportionate Share Hospital funding, which supports community health centers and hospitals serving primarily the uninsured, working poor, and (legal) migrant workers, many of those families with children.

However, it's not as simple as a presidential proclamation highlighting Congress' failure to live up to a priority it enshrined into law ninety years ago.

The Presidential proclamation


As a father, I know the hope and joy children bring to our lives. They are society's most precious treasures and our most vulnerable population. We all share the moral responsibility to protect the health of our children, born and unborn, so they have the chance to achieve their potential.

To these ends, my Fiscal Year 2018 Budget provides a $30 million increase for the Maternal and Child Health Services Block Grant program, which enhances access to critical health services for 57 million women and children. In close partnership with States and communities, this program helps ensure mothers receive critical prenatal care and nutrition, provides aid for children with disabilities, and opens access to other vital health services. The program also addresses emerging issues that painfully affect our children, such as mental health disorders and our Nation's devastating opioid epidemic. The number of infants born physically dependent on opioids has more than quadrupled over the past decade. In addition, during the past 2 years, many States have experienced dramatic increases in the number of children in their foster care systems, as parents have struggled with addiction and its terrible consequences. I am committed to aggressively combating the scourge of opioid abuse, so that children do not bear the burden of its devastation.

The Maternal and Child Health Services Block Grant program and a number of related programs are administered by the Maternal and Child Health Bureau (MCHB) within the Health Resources and Services Administration (HRSA) within the Health and Human Services (HHS). The MCHS program is actually a federal-state partnership of which federal funding is a portion. For the most recent year of available data[1]:

Funding SourceDollars
Federal Allocation$525,951,754
State MCH Funds$2,614,069,562
Local MCH Funds$506,225,769
Other Funds$326,517,966
Program Income$2,314,110,617
TOTAL Expenditure      $6,286,875,668

The President's $30 million represents a 4.7% increase in MCHB's federal block grant funding. But that is only part of the story:[2]:

Program FY 2016
FY 2017
FY 2018
FY 2018
FY 2017
MATERNAL & CHILD HEALTH: [figures in $thousands]
Maternal and Child Health Block Grant 638,200 636,987 666,987 +30,000
Autism and Other Developmental Disorders 47,099 47,009 - -47,009
Sickle Cell Service Demonstrations 4,455 4,447 - -4,447
James T. Walsh Universal Newborn Hearing Screening 17,818 17,784 - -17,784
Emergency Medical Services for Children 20,162 20,124 - -20,124
Healthy Start 103,500 118,303 128,303 +10,000
Heritable Disorders 13,883 13,857 - -13,857
Family-to-Family Health Information Centers Mandatory 5,000 4,655 - -4,655
Family-to-Family Health Information Centers Proposed Mandatory - - 5,000 +5,000
Maternal, Infant and Early Childhood Home Visiting Program Mandatory 400,000 372,400 - -372,400
Maternal, Infant and Early Childhood Home Visiting Program Proposed Mandatory - - 400,000 +400,000
Subtotal, Maternal and Child Health Bureau (MCHB) 1,250,117 1,235,566 1,200,290 35,276
Subtotal, Discretionary MCHB (non-add) 845,117 858,511 795,290 -63,221
Subtotal, Mandatory MCHB (non-add) 405,000 377,055 405,000 +27,945

The President's proclamation states the administration is providing $30 million additional MCHB funding for maternal and child health care to meet a growing need for crises such as the opioid epidemic. But when you read the Trump budget:

  • All specialized MCHB programs have been defunded. That means no specific money for autism, developmental disorders, universal newborn hearing screening, emergency health care, sickle cell disease,....
  • Funding for general programs (information centers, visiting services) is kept at 2016 levels. Healthy Start receives an increase.
  • We suspect that the rationale is that the block grant increase replaces specialized programs, giving states full discretion on how MCHB funds are spent.
  • However, the autism and developmental disability program defunding alone — a loss of $47 million — is far more than the block grant increase.
  • Overall, the Trump budget slashes $35 million from maternal and child health programs administered under the MCHB.
  • Therefore President Trump's statement that his budget increases funding to improve access to "critical health services" for mothers and children in response to growing needs is a misdirection at best.
FAILS Working America

We will examine expiration of CHIP funding and revisit the expiration of DSH funding in a future article.

Read more

  • President Donald J. Trump Proclaims Monday, October 2, 2017, as Child Health Day, White House, 30 September 2017. LINK
  • Maternal and Child Health Bureau FACT SHEET, HHS Health Resources and Services Administration. LINK
  • Explore the Title V Federal-State Partnership, Maternal and Child Health Bureau. LINK

[1]Funding by Source, Maternal and Child Health Bureau. LINK
[2]DEPARTMENT of HEALTH and HUMAN SERVICES Fiscal Year 2018 — Justification of Estimates for Appropriations Committees, Health Resource and Services Administration. LINK

Updated: October, 2017

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