State Implementation of the Maternal and Child Health Block Grant

GAO discussed States' implementation of the Maternal and Child Health (MCH) services block grant. GAO stated that, although Federal appropriations for MCH services decreased as States implemented the block grant, most States were able to maintain total funding for MCH programs. However, only 5 of the 13 States reviewed experienced increases in total funding after adjustment for inflation. While States continued to support activities similar to those funded under prior MCH programs, some States altered program priorities and services offered. Many of the service providers visited by GAO experienced a wide variety of changes. Some changes were attributed to the block grant, but providers generally cited causes such as escalating costs, changes in other sources of funds, prevailing economic conditions, and changing client needs. GAO noted that States generally assigned block grant responsibilities to offices which administered prior MCH programs and made minimal changes to their organizations and service provider networks. Many State officials liked the block grant's increased flexibility and found it to be less burdensome than previous MCH programs. However, most interest groups perceived the block grant approach to be less desirable. Finally, GAO noted that both State officials and interest groups expressed concern about reduced Federal funding under the block grant.