President Ronald Reagan signing the Omnibus Budget Reconciliation Act of 1981. Reproduced with permission from the Ronald Reagan Library.
The Omnibus Budget Reconciliation Act of 1981 (OBRA ’81) converted Title V into a block grant. As a block grant, each state must prepare and submit a standardized application to provide a mechanism for program planning, management, measurement of progress, and accounting for the costs of state efforts. Title V operates as a federal-state partnership. States must provide a 3-dollar match for every 4 federal dollars allocated.
Because Title V is a block grant, it does not create an individual federal entitlement to services. As a result, states may structure their Title V programs as broadly targeted services to qualified communities and entities (as defined by the state), rather than as a system of specified payments for certain classes of covered medical services for individuals who are eligible, as with Medicaid. Consequently, services that enhance child health through the provision of health care interventions aimed at parents and caregivers would be considered permissible Title V-assisted activities. The law contains very few prohibitions on states’ use of allotment funds; none of them would impede delivery or enhancement of child-development services.
Since 1960, oral health was a mandatory part of state Title V programs; however, when Title V was converted to a block grant, this changed. Starting in 1981, many state Title V programs no longer required an oral health component.
OBRA ’81 authorized a federal set-aside for Special Projects of Regional and National Significance (SPRANS) discretionary grants as part of the Title V block grant. This set-aside permits retention of 15 percent of the appropriation each fiscal year to support programs in the following categories:
Maternal and Child Health Bureau. 2000. Understanding Title V of the Social Security Act: A Guide to the Provisions of the Federal Maternal and Child Health Block Grant. Rockville, MD: Maternal and Child Health Bureau.
Rosenbaum S, Proser M, Schneider A, Sonosky C. 2002. Using the Title V Maternal and Child Health Services Block Grant to Support Child Development Services. New York, NY: Commonwealth Fund.
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