Title V and Medicaid: Legislation

The summary of requirements for Title V and Title XIX coordination can be viewed within a broader overview of Federal legislation, regulations, and policy, outlined below:

Overarching Federal Legislation, Regulations, and Policy
Federal Legislation and Regulations
Title V
Title V of the Social Security Act (enacted 1935: amended by Omnibus Budget Reconciliation Acts (OBRAs))
OBRA-1981
  • Converted Title V into a block grant program.
  • Incorporated five other related programs into Title V.
  • Granted States increased spending flexibility.
OBRA-1989
  • Provided stricter application, spending, and reporting requirements.
  • Stressed the importance of State Title V agencies in meeting requirements set forth in Title XIX of the SSA, with a particular emphasis on coordination, accountability, and reporting requirements.
  • Required Title V agencies to:
    • Participate in developing and carrying out agreements on coordination of care and services (§1902(a)(11); §505(a)(5)(E)(ii)).
    • Coordinate activities with the EPSDT program (§505(a)(5)(E)(i)).
    • Assist in identifying and registering pregnant women and infants who are eligible for medical assistance (§505(a)(5)(F)(iv)).
    • Provide a toll-free telephone number to help parents obtain information about services under Title V and Title XIX (§505 (a)(5)(E)).
Title XIX
Title XIX of the Social Security Act (enacted 1965)
Amended
(1967, 1981)
  • Expanded requirements for cooperation with health agencies to include Title V (§1902(b)(11)(B)).
  • Required Medicaid agencies to act as the payer of first resort and to:
    • Use Title V-funded agencies to provide services for Medicaid-eligible clients if such services are included in the State plan (§1902(a)(11)(B)(i)).
    • Reimburse agencies for the cost of services provided to any individual for which payment would otherwise be made to the State (§1902(a)(11)(B)(ii)).
    • Coordinate information and education on pediatric vaccinations and delivery of immunization services (§1902(a)(11)(B)(iii)).
Title 42, Chapter IV, Code of Federal Regulations
§431.615(b)

Title V grantees may receive Federal payments for services including:

  • Maternal and child health services.
  • Children with Special Health Care Needs (CSHCN).
  • Maternal and infant care projects.
  • Children and youth projects.
  • Projects for the dental health of children.
§431.615(c)

Each State plan must:

  • Describe cooperative arrangements with Title V and other programs and grantees to maximize use of services.
  • Provide arrangements for Title V grantees to deliver services on behalf of the State Medicaid agency.
  • Ensure that all arrangements meet Federal requirements.
  • Ensure that the Medicaid agency reimburses the Title V grantee or provider for the cost of service (if requested by the grantee).
§431.615(d)

IAAs must specify, as appropriate:

  • The mutual objectives and responsibilities of each party to the arrangement.
  • The services each party offers and in what circumstances.
  • The cooperative and collaborative relationships at the State level.
  • The kinds of services to be provided by local agencies.
  • Methods for beneficiary identification, referrals, reimbursement, etc.
§431.615(e)
  • Federal financial participation (FFP) is available for expenditures for Medicaid services provided to beneficiaries under such cooperative arrangements.
Deficit Reduction Act (DRA) of 2005
 
  • Scheduled to reduce spending by $4.7 billion over the 2006-2010 period for provisions that cover Medicaid, SCHIP, and funding for health care costs in areas affected by Hurricane Katrina.
Federal Policy
Title V
MCHB's Title V Guidance
 
  • As part of their 5 year needs assessment, requires States to assess how local delivery systems (including regional areas) meet the population’s health needs by examining existing systems and collaborative mechanisms with Medicaid and other programs (Part II(II)(B)(4)(d): p. 29).
  • Requires States to report in four areas:
    • Coordination with other State human services agencies, including Medicaid.
    • Health Systems Capacity Indicators (HSCIs), including Medicaid data.
    • National and State Performance Measures (NPMs), often documenting a State’s partnership and coordination activities with Title XIX agencies and populations.
    • Program data, including individuals eligible and served by Title XIX.
Title XIX
CMS’s State Medicaid Manual
 
  • Issues mandatory, advisory, and optional Medicaid policies and procedures to State agencies for use in administering their Medicaid programs.
  • Serves as guidance to overarching coordination with Title V programs and with Title V grantees, with special emphasis on EPSDT coordination.
  • Requires that each State have in effect an IAA that:
    • Provides for care and services available under MCH programs.
    • Utilizes MCH grantees to develop more effective uses of Medicaid resources.
  • States that Medicaid agencies are responsible for reimbursing Title V providers for services provided to Medicaid beneficiaries even if these services are provided free of charge to low-income uninsured families.
  • Stresses the importance of including a detailed description of payment arrangements in the IAA.
  • Advises:
    • Limiting reimbursement of overhead costs under IAAs to those identifiable as supporting EPSDT services.
    • Specifying within the IAA the conditions under which private practitioners may bill through Title V for services provided to Medicaid beneficiaries.
    • Detailing the conditions under which services are covered (since services are often provided by professionals who are not physicians).