Title V and Medicaid: Legislation
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,
|Federal Legislation and Regulations
V of the Social Security Act (enacted 1935: amended by Omnibus Budget Reconciliation
- Converted Title V into a block grant
- Incorporated five other related programs
into Title V.
- Granted States increased spending
- 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:
in developing and carrying out agreements
of care and services
activities with the EPSDT program (§505(a)(5)(E)(i)).
in identifying and registering pregnant women
who are eligible
a toll-free telephone number to help
parents obtain information about
Title V and
Title XIX (§505 (a)(5)(E)).
XIX of the Social Security Act (enacted 1965)
requirements for cooperation with health agencies
to include Title V (§1902(b)(11)(B)).
Medicaid agencies to act as the payer of first
resort and to:
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)).
agencies for the cost of services provided
to any individual for which payment
be made to the State (§1902(a)(11)(B)(ii)).
information and education on pediatric
vaccinations and delivery of immunization
|Title 42, Chapter IV, Code of Federal
Title V grantees may receive Federal payments
for services including:
- Maternal and child
- Children with Special Health
Care Needs (CSHCN).
- Maternal and infant care
- Children and youth projects.
- Projects for the
dental health of children.
State plan must:
cooperative arrangements with Title V and other
and grantees to maximize use of services.
arrangements for Title V grantees to deliver
services on behalf of the State Medicaid
that all arrangements meet Federal requirements.
that the Medicaid agency reimburses the Title
V grantee or provider for the cost
of service (if requested by the grantee).
IAAs must specify, as appropriate:
mutual objectives and responsibilities of
each party to the arrangement.
- The services each
party offers and in what circumstances.
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.
- Federal financial participation (FFP)
is available for expenditures for Medicaid services
provided to beneficiaries under such cooperative
|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.
|MCHB's Title V Guidance
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):
- Requires States to report in four areas:
with other State human services agencies,
- Health Systems Capacity Indicators (HSCIs),
including Medicaid data.
and State Performance Measures (NPMs), often
partnership and coordination activities
with Title XIX
- Program data, including individuals
eligible and served by Title XIX.
State Medicaid Manual
- Issues mandatory, advisory, and optional Medicaid
policies and procedures to State agencies for
use in administering their Medicaid programs.
as guidance to overarching coordination with
Title V programs and with Title V grantees,
with special emphasis on EPSDT coordination.
that each State have in effect an IAA that:
for care and services available under MCH
MCH grantees to develop more effective uses
of Medicaid resources.
- States that Medicaid agencies
are responsible for reimbursing Title V providers
provided to Medicaid beneficiaries even if these services
are provided free of charge to low-income
- Stresses the importance of including a detailed
description of payment arrangements in the IAA.
- Limiting reimbursement of overhead costs
under IAAs to those identifiable as supporting
- 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
who are not physicians).