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2100 Program Authorization and Services
Revision 24-2; Effective Sept. 30, 2024
Title V Maternal and Child Health Fee-for-Services (TVFFS) Program Background
The purpose of the Maternal and Child Health (MCH) Services Title V Block Grant is to create federal and state partnerships. These partnerships provide direct services to low-income women and children not eligible for Medicaid, Children’s Health Insurance Program (CHIP), CHIP Perinatal, or another payor source that covers these same services. TVFFS grantees provide services:
- significantly reducing infant mortality;
- including comprehensive care for women before, during, and after pregnancy and childbirth; and
- including preventive and primary care services for infants, children and adolescents.
Legal Authority
Through Title V of the Social Security Act (SSA) of 1935, the federal government pledged to support state efforts to improve the health of all mothers and children. The MCH Block Grant Program under Title V of the SSA was created in 1981 to consolidate multiple programs. These programs support a more comprehensive, coordinated approach to meeting states’ individual needs consistent with the applicable health status goals and national health objectives now identified in Healthy People 2030.
Within Texas, TVFFS operates within a framework articulated by the Texas Legislature and Texas Health and Human Services Commission (HHSC).
States are required to use awarded federal funds as follows:
- 30% for preventive or primary care services for children
- 30% for services for children with Special Health Care Needs
- Up to 10% on administrative costs
- Remaining funds to support other MCH populations, such as pregnant women and mothers
Funding Sources
TVFFS program services are funded both by state general revenue and federal funds through the Title V MCH Block Grant. HHSC TVFFS funds are allocated through a competitive application process. After the funds are allocated, selected applicants negotiate contracts with HHSC to provide services.
2200 Definitions
Revision 25-3; Effective Sept. 1, 2025
The following terms, when used in this manual, mean the following:
Adjusted Gross Household Income – The gross household income – before taxes – minus any allowable deductions. The adjusted gross household income is used to calculate the Federal Poverty Level (FPL) percentage.
Barriers to Care – A factor that hinders a person from receiving health care. For example, distance, lack of transportation, documentation requirements and copayment amounts.
Case Management – Relating to pregnant women, this means services to assure access to quality prenatal, delivery and postpartum care. With respect to infants, children and adolescents, it means services to assure access to quality preventive and primary care services.
Children’s Health Insurance Program (CHIP) – A health insurance program for non-Medicaid eligible children with a family income up to 198% Federal Poverty Level (FPL).
CHIP Perinatal Program – An HHSC program that provides medical coverage for perinatal care of unborn children of non-Medicaid eligible women with an income up to 202% FPL.
Children and Adolescents – People from their first birthday through the 21st year of age.
Client – A person who has been screened and determined to be eligible for the program.
Confidentiality – The state of keeping information private and not sharing it without permission.
Consultation – A type of service provided by a health care provider with expertise in a medical or surgical specialty. These providers help with the evaluation or management of a patient when requested by another appropriate health care provider.
Copayment or Copay – Money collected directly from clients for services.
Dental Services – Diagnostic, preventive and therapeutic dental services provided to clients and performed in a dental office or clinic.
Department of State Health Services (DSHS) – The agency responsible for public health in the state of Texas.
Dependent Care Deduction – The expense of providing care for a dependent. This expense must be both necessary for employment and incurred by an employed person. Allowable deductions are actual expenses, up to $200 per month for each child younger than 2 years and $175 per month for each child 2 or older.
Diagnosis – The recognition of disease status determined by evaluating the history of the client and the disease process, and the signs and symptoms present. Determining the diagnosis may require some or all the following:
- microscopic – culture
- chemical – blood tests
- radiological examinations – X-rays
Diagnostic Services – Activities related to the diagnosis made by a physician or other health professional.
Family Planning Services – Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select how this may be achieved.
Federal Poverty Level (FPL) – The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. In the United States, the Department of Health and Human Services determines this level. FPL varies per family size. The number is adjusted for inflation and reported annually in the form of poverty guidelines. Public assistance programs, such as Medicaid, define eligibility income limits as some percentage of FPL.
Fee-for-Service (FFS) – Payment mechanism for services that are reimbursed on a set rate per unit of service, also known as unit rate.
Fiscal Year – The state fiscal year is Sept. 1 through Aug. 31. The federal fiscal year is Oct. 1 through Sept. 30.
Grantee – A non-state entity that receives an award directly from the state awarding agency to carry out an activity under a state program. The term grantee does not include subrecipient.
Gross Household Income – The total countable income of the household before taxes. Refer to Appendix I, Definition of Income.
Health and Human Services Commission (HHSC) – The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services.
Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 subject to Title XIX of the Social Security Act, 42 U.S.C. Section 1396, et seq. The program reimburses for health care services delivered to low-income clients who meet eligibility guidelines.
Minor – Per Texas Family Code, Section 101.003, a person younger than 18 who is not and has not been married, or who has not had the disabilities of minority removed for general purposes such as emancipated.
Nutritional Services – The provision of services to identify the nutritional status of a person and offer instruction. Instruction includes appropriate dietary information based on the client’s needs such as age, sex and health status. This may be provided to a person on a one-to-one basis or to a group of people.
Payor Source – Programs, benefits or insurance that pays for the service provided.
Prescription Drugs, Devices and Durable Supplies – Medically necessary pharmaceuticals and medical supplies that are capable of withstanding wear, which are needed for the treatment of a diagnosed condition.
Preventive Health Care – Services include immunizations, risk assessments, health histories and baseline physicals for early detection of disease and restoration to a previous state of health, and prevention of further deterioration or disability.
Program Income – Money collected directly by the grantee or provider for services provided under the grant award.
Promotores or Community Health Worker (CHW) – A person who, with or without compensation, helps connect people in their community with health care and social services. A certified CHW is someone with current certification issued by DSHS.
Provider – A clinician or group of clinicians who provide services.
Recertification – The process of rescreening and determining eligibility for the next state fiscal year.
Referral – The process of directing or redirecting, as a medical case or a person, to an appropriate specialist or agency for information, help or treatment.
Referral Agency – An agency that provides a service for a TVFFS client that the TVFFS grantee does not provide and is not a reimbursable TVFFS service.
Subrecipient – A non-state entity that receives a subaward from a pass-through entity to carry out part of a state program. It does not include a person that is a beneficiary of such a program. A subrecipient may also be a grantee of other state awards directly from a state awarding agency. A subgrantee may also be referred to as a subrecipient. Refer to Texas Grant Management Standards – Version 2.0, Appendix 2, Page 57.
Teledentistry – A health service delivered by a dentist or by a health professional acting under the delegation and supervision of a dentist. The providers act within the scope of the dentist's or health professional's license or certification to provide dental care to a patient at a different physical location than the dentist or health professional using telecommunications or information technology.
Telehealth – A health service, other than a telemedicine medical service or a teledentistry dental service, delivered by a health professional licensed, certified or otherwise entitled to practice in this state and acting within the scope of their license, certification or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology.
Telemedicine – A health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state and acting within the scope of the physician's or health professional's license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.
Texas Resident – A person who lives within the geographic boundaries of the state of Texas.
Transportation – Services that may be provided to transport a client to receive required health care services. Transportation could be provided by private vehicle, public transportation, project site vehicle or emergency medical vehicle.
Unduplicated Client – A client who is counted only one time during the program’s fiscal year for each Title V program they participate in, which includes: Prenatal Medical, Prenatal Dental, Child Health and Child Dental. If a client participates in more than one Title V program, only their first visit of the fiscal year will be counted as an unduplicated client for each program they participate in.