MCH Student:
Vidya Venkataraman
Date of Defense:
April 20, 2018
Abstract:
Introduction
Title V of the Social Security Act (SSA), the Maternal and Child (MCH) Health Block Grant is the longest standing public health legislation in American History.[1] The MCH block grant is a federal-state partnership that caters to a wide range of programs related to maternal and child health. By serving pregnant women, infants, families, children, and children and youth with special health care needs (CYSHCN), the MCH block grant has been instrumental in reducing infant mortality, increasing immunization, and improving access to preventive care, among others.1 Although programs funded by the block grant have been shown to be cost saving, every year, appropriating funds for Title V comes with uncertainty and has required effective advocacy.[2] Furthermore, with the passage of the Affordable Care Act’s (ACA) provision for improved preventive and other MCH sanctions, the block grant was potentially facing not just decreased funding, but also new challenges for states to learn to link their existing block grant MCH programs with new federal ones. 2,[3]
Title V lies at the core of MCH policy and advocacy and is instrumental in improving the health of women, children, and families over the life course.3 My goal with this field experience was twofold – (i) to understand the systems, structures, processes of Title V, especially during the implementation period of the ACA and, (ii) to advocate for women and children, not just in the state of Minnesota, but in the entire United States.
Experience
As an intern with the division of Policy and Government Affairs, my work at the Association of Maternal and Child Health Programs (ACMHP) in Washington D.C., involved working in three distinct areas:
(a) With the Director of the Division: I worked on understanding the MCH budget using the Title V Information System (TVIS) and AMCHP compiled MCH budget reports. I tracked the block grant budget over the last five years and tabulated the amount and percentage of funding received by each state and the programs it went towards for 2012. This was important lobbying material for future Title V funding.
(b) With the Associated Director of the Division: I worked on understanding the process of lobbying and advocacy in Washington D.C. I prepared a dossier documenting statements made by members of congress (from news reports, press releases, and thomas.loc.gov) and positions they had taken in the past (bills they had proposed, signed, supported, or not) on matters related to MCH. This was used to more effectively advocate for the block grant when meeting with policymakers. I also attended advocacy meetings with congressional staff and hearings in both the House and the Senate.
(c) With the Senior Policy Manager of the division: I tracked the progress of the ACA. I maintained an ongoing and living document where I updated the stance of each state/governor on the status of the Medicaid Expansion and the status of Health Insurance Exchanges. I did this by monitoring press releases, governors’ statements, calling governors’ staff members, attending hearings, and by hearing from other policymakers in the states.
My learning objectives from this field experience were to get a better understanding of the MCH Block Grant, to understand federal level policymaking, and to understand the advocacy and lobbying in Washington D.C. I achieved these objectives during my field experience through the projects I worked on and the interactions I had with my colleagues, with people working in MCH, and with policymakers.
Organization
The Association of Maternal and Child Health Programs (AMCHP), located in Washington D.C., is a membership based national resource, partner, and advocate for public health leaders and workers in all the states and jurisdictions of the United States.[4] AMCHP’s members work on improving the health of women, children, youth, and families and are at extremely high levels of state government. Other members of AMCHP include academic, advocacy, and community based family health professionals, and families themselves. 4
Results
Although this field experience did not explicitly involve any form of data analysis, I did prepare tangible deliverable for each of the projects that I worked on.
Lessons Learned
Through this field experience, there were two different kinds of lessons learned – (a) I got the opportunity to learn not just about Title V, but also about the ACA, and MCH through the life course; (b) I got the opportunity to apply what I had studied about health policy and advocacy, on the field. There was a steep learning curve and I spent a significant portion of the field experience reading articles, reports, and AMCHP publications about Title V and health policy in general. AMCHP is an important resource to MCH policymakers and organizations, so knowing about policy was not only necessary, but also became easy to understand as I kept applying it. By attending hearings and meetings on Capitol Hill, I got a close look at policymaking at the federal level. What stood out to me was that I learned about finer aspects of bills and policies (through testimonies, debates, comments) that were being discussed – matter that never makes it to final bills or reports – and it helped me understand different aspects of the same policy and different schools of thought. As someone interested in data analysis, analyzing the title V budget was of particular interest to me. However, as AMCHP is less involved in research, the “data analysis” was not particularly difficult and I did not get the chance to apply my biostatistics knowledge or skills.
Although I was given three distinct projects to do, the projects did not require 12 weeks of work (the length of my field experience). However, a less stringent and more spread-out timeline gave me the opportunity to learn more by spending my time reading and interacting with colleagues, members, and policymakers, which AMCHP encouraged.
Recommendations
Although, AMCHP has multiple divisions that cover the whole MCH life course, I believe it would be more beneficial if the divisions and the work overlapped and/or interacted more, as they largely existed in silos. For example, the policy team did not work closely with any particular division or MCH sub-population and I, for example, would have enjoyed working on specific policies related to infant health programs. AMCHP is not a research heavy organization so I felt like some of the work and projects of the organization lacked a more analytical approach and I would have benefitted with being able to apply my analytical skills at a higher level. At AMCHP, I learned that to understand policy, I couldn’t just go to Capitol Hill, but had to read the latest research, closely follow the news, and even follow Twitter and C-Span! It was an approach that was unique but also multi-faceted and I would recommend it to other similar policy internships.
Conclusion
My time with AMCHP gave me valuable insight into Title V, the ACA, policymaking, and advocacy. This field experience was also an opportunity to apply, and enhance, what I had learned in my MPH coursework.
References
[1] US Department of Health and Human Services, Health Resources and Services Administration (HRSA), & Maternal and Child Health Bureau (MCHB). (2000). Understanding Title V of the Social Security Act(Rep.). Rockville, MD.
[2] Association of Maternal and Child Health Programs (AMCHP). (2010). Celebrating the Legacy, Shaping the Future: 75 years of the Title V Maternal and Child Health Services Block Grant. Washington, D.C.
[3] AMCHP Board of Directors. (2013). Memorandum: Preliminary Recommendations for the Future of the Title V Maternal and Child Health Services Block Grant.
[4] Association of Maternal and Child Health programs (AMCHP). (2017). About AMCHP. Washington, D.C. Source: http://www.amchp.org/AboutAMCHP/Pages/default.aspx