---
kind: "section"
citation: "42 U.S.C. § 280c–6"
title: "42"
title_heading: "The Public Health and Welfare"
number: "280c–6"
heading: "Projects to improve maternal, infant, and child health"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/280c-6"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter II — General Powers and Duties"
  - "Part K — Health Care Services in the Home and Public Health Programs for Dementia"
  - "Subpart iii — grants for home visiting services for at-risk families"
---

# §280c–6. Projects to improve maternal, infant, and child health

- (a) **In general—**
  - (1) **Establishment of program—** The [Secretary](/usc/42/201.md?p=c), acting through the [Administrator](/usc/42/4005.md?p=1) of the Health Resources and [Services](/usc/42/201.md?p=a) Administration, shall make grants to eligible entities to pay the Federal share of the cost of providing the [services](/usc/42/201.md?p=a) specified in [subsection (b)](#b) to families in which a member is—
    - (A) a pregnant woman at risk of delivering an infant with a health or developmental complication; or
    - (B) a child less than 3 years of age—
      - (i) who is experiencing or is at risk of a health or developmental complication, or of child abuse or neglect; or
      - (ii) who has been prenatally exposed to maternal substance abuse.
  - (2) **Minimum period of awards; administrative consultations—**
    - (A) The [Secretary](/usc/42/201.md?p=c) shall award grants under [paragraph (1)](#a-1) for periods of at least three years.
    - (B) The [Administrator](/usc/42/4005.md?p=1) of the Administration for Children, Youth, and Families and the [Director](/usc/42/11851.md?p=5) of the National Commission to Prevent Infant Mortality shall be consulted regarding the promulgation of [program](/usc/42/274l–1.md?p=4) guidelines and funding priorities under this section.
  - (3) **Requirement of status as medicaid provider—**
    - (A) Subject to [subparagraph (B)](#a-3-B), the [Secretary](/usc/42/201.md?p=c) may make a grant under [paragraph (1)](#a-1) only if, in the case of any [service](/usc/42/201.md?p=a) under such paragraph that is covered in the [State plan](/usc/42/300d–31.md?p=2) approved under title XIX of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.] for the [State](/usc/42/201.md?p=f) involved—
      - (i) the entity involved will provide the [service](/usc/42/201.md?p=a) directly, and the entity has entered into a participation agreement under the [State plan](/usc/42/300d–31.md?p=2) and is qualified to receive payments under such plan; or
      - (ii) the entity will enter into an agreement with an organization under which the organization will provide the [service](/usc/42/201.md?p=a), and the organization has entered into such a participation agreement and is qualified to receive such payments.
    - (B)
      - (i) In the case of an organization making an agreement under [subparagraph (A)(ii)](#a-3-A-ii) regarding the provision of [services](/usc/42/201.md?p=a) under [paragraph (1)](#a-1), the requirement established in such subparagraph regarding a participation agreement shall be waived by the [Secretary](/usc/42/201.md?p=c) if the organization does not, in providing health or mental health [services](/usc/42/201.md?p=a), impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or [State](/usc/42/201.md?p=f) health benefits [program](/usc/42/274l–1.md?p=4).
      - (ii) A determination by the [Secretary](/usc/42/201.md?p=c) of whether an organization referred to in [clause (i)](#a-3-B-i) meets the criteria for a waiver under such clause shall be made without regard to whether the organization accepts voluntary donations regarding the provision of [services](/usc/42/201.md?p=a) to the public.
- (b) **Home visiting services for eligible families—** With respect to an eligible family, each of the following [services](/usc/42/201.md?p=a) shall, directly or through arrangement with other public or [nonprofit](/usc/42/300s–3.md?p=3) private entities, be available (as applicable to the [family member](/usc/42/300gg–91.md?p=d-15) involved) in each [project](/usc/42/13641.md?p=2) operated with a grant under [subsection (a)](#a):
  - (1) Prenatal and postnatal health care.
  - (2) Primary health care for the children, including developmental assessments.
  - (3) Education for the parents concerning infant care and child development, including the development and utilization of parent and teacher resource networks and other family resource and support networks where such networks are available.
  - (4) Upon the request of a parent, providing the education described in [paragraph (3)](#b-3) to other individuals who have responsibility for caring for the children.
  - (5) Education for the parents concerning behaviors that adversely affect health.
  - (6) Assistance in obtaining necessary health, mental health, developmental, social, housing, and nutrition [services](/usc/42/201.md?p=a) and other assistance, including [services](/usc/42/201.md?p=a) and other assistance under maternal and child health [programs](/usc/42/274l–1.md?p=4); the special supplemental nutrition [program](/usc/42/274l–1.md?p=4) for women, infants, and children; [section 1786 of this title](/usc/42/1786.md); title V of the Social Security Act [[42 U.S.C. 701](/usc/42/701.md) et seq.]; title XIX of such Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.] (including the [program](/usc/42/274l–1.md?p=4) for early and periodic screening, diagnostic, and [treatment](/usc/42/11851.md?p=11) [services](/usc/42/201.md?p=a) described in section 1905(r) of such Act [[42 U.S.C. 1396d(r)](/usc/42/1396d.md?p=r)]); titles IV and XIX of the Social Security Act [[42 U.S.C. 601](/usc/42/601.md) et seq., 1396 et seq.]; housing [programs](/usc/42/274l–1.md?p=4); other food assistance [programs](/usc/42/274l–1.md?p=4); and appropriate alcohol and [drug](/usc/42/11851.md?p=4) dependency [treatment](/usc/42/11851.md?p=11) [programs](/usc/42/274l–1.md?p=4), according to need.
- (c) **Considerations in making grants—** In awarding grants under [subsection (a)](#a), the [Secretary](/usc/42/201.md?p=c) shall take into consideration—
  - (1) the ability of the entity involved to provide, either directly or through linkages, a broad range of preventive and primary health [care services](/usc/42/300z–1.md?p=a-7) and related social, family support, and developmental [services](/usc/42/201.md?p=a);
  - (2) different combinations of professional and lay home visitors utilized within [programs](/usc/42/274l–1.md?p=4) that are reflective of the identified [service](/usc/42/201.md?p=a) needs and characteristics of target populations;
  - (3) the extent to which the population to be targeted has limited access to health care, and related social, family support, and developmental [services](/usc/42/201.md?p=a); and
  - (4) whether such grants are equitably distributed among urban and rural settings and whether entities serving Native American communities are represented among the grantees.
- (d) **Federal share—** With respect to the costs of carrying out a [project](/usc/42/13641.md?p=2) under [subsection (a)](#a), a grant under such subsection for the [project](/usc/42/13641.md?p=2) may not exceed 90 percent of such costs. To be eligible to receive such a grant, an applicant must provide assurances that the applicant will obtain at least 10 percent of such costs from non-Federal funds (and such contributions to such costs may be in cash or in-kind, including facilities and personnel).
- (e) **Rule of construction regarding at-risk births—** For purposes of [subsection (a)(1)](#a-1), a pregnant woman shall be considered to be at risk of delivering an infant with a health or developmental complication if during the pregnancy the woman—
  - (1) lacks appropriate access to, or information concerning, early and routine prenatal care;
  - (2) lacks the transportation necessary to gain access to the [services](/usc/42/201.md?p=a) described in [subsection (b)](#b);
  - (3) lacks appropriate child care assistance, which results in impeding the ability of such woman to utilize health and related social [services](/usc/42/201.md?p=a);
  - (4) is fearful of accessing [substance abuse services](/usc/42/290cc–34.md?p=4) or child and family support [services](/usc/42/201.md?p=a); or
  - (5) is a minor with a low income.
- (f) **Delivery of services and case management—**
  - (1) **Case management model—** Home visiting [services](/usc/42/201.md?p=a) provided under this section shall be delivered according to a case management model, and a registered nurse, licensed social worker, or other licensed health care professional with experience and expertise in providing health and related social [services](/usc/42/201.md?p=a) in home and community settings shall be assigned as the case manager for individual cases under such model.
  - (2) **Case manager—** A case manager assigned under [paragraph (1)](#f-1) shall have primary responsibility for coordinating and overseeing the development of a plan for each family that is to receive home visiting [services](/usc/42/201.md?p=a) under this section, and for coordinating the delivery of such [services](/usc/42/201.md?p=a) provided through appropriate personnel.
  - (3) **Appropriate personnel—** In determining which personnel shall be utilized in the delivery of [services](/usc/42/201.md?p=a), the case manager shall consider—
    - (A) the stated objective of the [project](/usc/42/13641.md?p=2) to be operated with the grant, as determined after considering identified gaps in the current [service](/usc/42/201.md?p=a) delivery system; and
    - (B) the nature of the needs of the family to be served, as determined at the initial assessment of the family that is conducted by the case manager, and through follow-up contacts by other [providers](/usc/42/299b–21.md?p=8) of home visiting [services](/usc/42/201.md?p=a).
  - (4) **Family service plan—** A case manager, in consultation with a team established in accordance with [paragraph (5)](#f-5) for the family involved, shall develop a plan for the family following the initial visit to the home of the family. Such plan shall reflect—
    - (A) an assessment of the health and related social [service](/usc/42/201.md?p=a) needs of the family;
    - (B) a structured plan for the delivery of home visiting [services](/usc/42/201.md?p=a) to meet the identified needs of the family;
    - (C) the frequency with which such [services](/usc/42/201.md?p=a) are to be provided to the family;
    - (D) ongoing revisions made as the needs of [family members](/usc/42/300gg–91.md?p=d-15) change; and
    - (E) the continuing voluntary participation of the family in the plan.
  - (5) **Home visiting services team—** The team to be consulted under [paragraph (4)](#f-4) on behalf of a family shall include, as appropriate, other nursing professionals, physician assistants, social workers, child welfare professionals, infant and early childhood specialists, nutritionists, and laypersons trained as home visitors. The case manager shall ensure that the plan is coordinated with those physician [services](/usc/42/201.md?p=a) that may be required by the mother or child.
- (g) **Outreach—** Each grantee under [subsection (a)](#a) shall provide outreach and casefinding [services](/usc/42/201.md?p=a) to inform eligible families of the availability of home visiting [services](/usc/42/201.md?p=a) from the [project](/usc/42/13641.md?p=2).
- (h) **Confidentiality—** In accordance with applicable [State](/usc/42/201.md?p=f) law, an entity receiving a grant under [subsection (a)](#a) shall maintain confidentiality with respect to [services](/usc/42/201.md?p=a) provided to families under this section.
- (i) **Certain assurances—** The [Secretary](/usc/42/201.md?p=c) may award a grant under [subsection (a)](#a) only if the entity involved provides assurances satisfactory to the [Secretary](/usc/42/201.md?p=c) that—
  - (1) the entity will provide home visiting [services](/usc/42/201.md?p=a) with reasonable frequency—
    - (A) to families with pregnant women, as early in the pregnancy as is practicable, and until the infant reaches at least 2 years of age; and
    - (B) to other eligible families, for at least 2 years; and
  - (2) the entity will coordinate with public health and related social [service](/usc/42/201.md?p=a) [agencies](/usc/42/8262.md?p=1) to prevent duplication of effort and improve the delivery of comprehensive health and related social [services](/usc/42/201.md?p=a).
- (j) **Submission to Secretary of certain information—** The [Secretary](/usc/42/201.md?p=c) may award a grant under [subsection (a)](#a) only if the entity involved submits to the [Secretary](/usc/42/201.md?p=c)—
  - (1) a description of the population to be targeted for home visiting [services](/usc/42/201.md?p=a) and methods of outreach and casefinding for identifying eligible families, including the use of lay home visitors where appropriate;
  - (2) a description of the types and qualifications of home visitors used by the entity and the process by which the entity will provide continuing training and sufficient support to the home visitors; and
  - (3) such other information as the [Secretary](/usc/42/201.md?p=c) determines to be appropriate.
- (k) **Limitation regarding administrative expenses—** Not more than 10 percent of a grant under [subsection (a)](#a) may be expended for administrative expenses with respect to the grant. The costs of training individuals to serve in the [project](/usc/42/13641.md?p=2) involved are not subject to the preceding sentence.
- (l) **Restrictions on use of grant—** To be eligible to receive a grant under this section, an entity must agree that the grant will not be expended—
  - (1) to provide inpatient [hospital](/usc/42/300s–3.md?p=1) [services](/usc/42/201.md?p=a);
  - (2) to make cash payments to intended recipients of [services](/usc/42/201.md?p=a);
  - (3) to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
  - (4) to satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds; or
  - (5) to provide financial assistance to any entity other than a public or [nonprofit](/usc/42/300s–3.md?p=3) private entity.
- (m) **Reports to Secretary—** To be eligible to receive a grant under this section, an entity must agree to submit an annual report on the [services](/usc/42/201.md?p=a) provided under this section to the [Secretary](/usc/42/201.md?p=c) in such manner and containing such information as the [Secretary](/usc/42/201.md?p=c) by regulation requires. At a minimum, the entity shall report information concerning eligible families, including—
  - (1) the characteristics of the families and children receiving [services](/usc/42/201.md?p=a) under this section;
  - (2) the usage, nature, and location of the [provider](/usc/42/299b–21.md?p=8), of preventive health [services](/usc/42/201.md?p=a), including prenatal, primary infant, and child health care;
  - (3) the incidence of low birthweight and premature infants;
  - (4) the length of [hospital](/usc/42/300s–3.md?p=1) stays for pre- and post-partum women and their children;
  - (5) the incidence of substantiated child abuse and neglect for all children within participating families;
  - (6) the number of emergency room visits for routine health care;
  - (7) the source of payment for health [care services](/usc/42/300z–1.md?p=a-7) and the extent to which the utilization of health [care services](/usc/42/300z–1.md?p=a-7), other than routine screening and [medical care](/usc/42/300gg–91.md?p=a-2), available to the individuals under the [program](/usc/42/274l–1.md?p=4) established under title XIX of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.], and under other Federal, [State](/usc/42/201.md?p=f), and local [programs](/usc/42/274l–1.md?p=4), is reduced;
  - (8) the number and type of referrals made for health and related social [services](/usc/42/201.md?p=a), including alcohol and [drug](/usc/42/11851.md?p=4) [treatment](/usc/42/11851.md?p=11) [services](/usc/42/201.md?p=a), and the utilization of such [services](/usc/42/201.md?p=a) provided by the grantee; and
  - (9) the incidence of developmental disabilities.
- (n) **Requirement of application—** The [Secretary](/usc/42/201.md?p=c) may make a grant under [subsection (a)](#a) only if—
  - (1) an application for the grant is submitted to the [Secretary](/usc/42/201.md?p=c);
  - (2) the application contains the agreements and assurances required in this section, and the information required in [subsection (j)](#j);
  - (3) the application contains evidence that the preparation of the application has been coordinated with the [State agencies](/usc/42/300s–3.md?p=12) responsible for maternal and child health and child welfare, and coordinated with [services](/usc/42/201.md?p=a) provided under part C of the Individuals with Disabilities Education Act [[20 U.S.C. 1431](/usc/20/1431.md) et seq.]; and
  - (4) the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the [Secretary](/usc/42/201.md?p=c) determines to be necessary to carry out this section.
- (o) **Peer review—**
  - (1) **Requirement—** In making determinations for awarding grants under [subsection (a)](#a), the [Secretary](/usc/42/201.md?p=c) shall rely on the recommendations of the peer review panel established under [paragraph (2)](#o-2).
  - (2) **Composition—** The [Secretary](/usc/42/201.md?p=c) shall establish a review panel to make recommendations under [paragraph (1)](#o-1) that shall be composed of—
    - (A) national experts in the fields of maternal and child health, child abuse and neglect, and the provision of community-based primary health [services](/usc/42/201.md?p=a); and
    - (B) representatives of relevant Federal [agencies](/usc/42/8262.md?p=1), including the Health Resources and [Services](/usc/42/201.md?p=a) Administration, the Substance Abuse and Mental Health [Services](/usc/42/201.md?p=a) Administration, the Administration for Children, Youth, and Families, the U.S. Advisory Board on Child Abuse and Neglect, and the National Commission to Prevent Infant Mortality.
- (p) **Evaluations—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c) shall, directly or through contracts with public or private entities—
    - (A) conduct evaluations to determine the effectiveness of [projects](/usc/42/13641.md?p=2) under [subsection (a)](#a) in reducing the incidence of children born with health or developmental complications, the incidence among children less than 3 years of age of such complications, and the incidence of child abuse and neglect; and
    - (B) not less than once during each 3-year period, prepare and submit to the appropriate committees of Congress a report concerning the results of such evaluations.
  - (2) **Contents—** The evaluations conducted under [paragraph (1)](#p-1) shall—
    - (A) include a summary of the data contained in the annual reports submitted under [subsection (m)](#m);
    - (B) assess the relative effectiveness of [projects](/usc/42/13641.md?p=2) under [subsection (a)](#a) in urban and rural areas, and among [programs](/usc/42/274l–1.md?p=4) utilizing differing combinations of professionals and trained home visitors recruited from the community to meet the needs of defined target [service](/usc/42/201.md?p=a) populations; and
    - (C) make further recommendations necessary or desirable to increase the effectiveness of such [projects](/usc/42/13641.md?p=2).
- (q) **Definitions—** For purposes of this section:
  - (1) The term “eligible entity” includes public and [nonprofit](/usc/42/300s–3.md?p=3) private entities that provide health or related social [services](/usc/42/201.md?p=a), including community-based organizations, visiting nurse organizations, [hospitals](/usc/42/300s–3.md?p=1), local health departments, community health centers, Native Hawaiian health centers, nurse managed clinics, family [service](/usc/42/201.md?p=a) [agencies](/usc/42/8262.md?p=1), child welfare [agencies](/usc/42/8262.md?p=1), developmental [service](/usc/42/201.md?p=a) [providers](/usc/42/299b–21.md?p=8), family resource and support [programs](/usc/42/274l–1.md?p=4), and resource mothers [projects](/usc/42/13641.md?p=2).
  - (2) The term “eligible family” means a family described in [subsection (a)](#a).
  - (3) The term “health or developmental complication”, with respect to a child, means—
    - (A) being born in an unhealthy or potentially unhealthy condition, including premature birth, low birthweight, and prenatal exposure to maternal substance abuse;
    - (B) a condition arising from a condition described in [subparagraph (A)](#q-3-A);
    - (C) a physical disability or delay; and
    - (D) a developmental disability or delay.
  - (4) The term “home visiting [services](/usc/42/201.md?p=a)” means the [services](/usc/42/201.md?p=a) specified in [subsection (b)](#b), provided at the residence of the eligible family involved or provided pursuant to arrangements made for the family (including arrangements for [services](/usc/42/201.md?p=a) in community settings).
  - (5) The term “home visitors” means [providers](/usc/42/299b–21.md?p=8) of home visiting [services](/usc/42/201.md?p=a).
- (r) **Authorization of appropriations—** For the purpose of carrying out this section, there is authorized to be appropriated $30,000,000 for each of the fiscal years 1993 and 1994.

## Source credit

(July 1, 1944, ch. 373, title III, § 399, as added Pub. L. 102–321, title V, § 502(2), July 10, 1992, 106 Stat. 427; amended Pub. L. 103–448, title II, § 204(w)(2)(D), Nov. 2, 1994, 108 Stat. 4746; Pub. L. 108–446, title III, § 305(i)(2), Dec. 3, 2004, 118 Stat. 2806.)

## Notes

### Editorial Notes

### References in Text

The Social Security Act, referred to in subsecs. (a)(3)(A), (b)(6), and (m)(7), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles IV, V, and XIX of the Act are classified generally to subchapters IV (§ 601 et seq.), V (§ 701 et seq.), and XIX (§ 1396 et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

The Individuals with Disabilities Education Act, referred to in subsec. (n)(3), is title VI of Pub. L. 91–230, Apr. 13, 1970, 84 Stat. 175. Part C of the Act is classified generally to subchapter III (§ 1431 et seq.) of chapter 33 of Title 20, Education. For complete classification of this Act to the Code, see section 1400 of Title 20 and Tables.

### Prior Provisions

A prior section 399 of act July 1, 1944, was renumbered section 398A by section 502(1) of Pub. L. 102–321 and is classified to section 280c–4 of this title.

Another prior section 399 of act July 1, 1944, ch. 373, title III, formerly § 399b, as added Oct. 22, 1965, Pub. L. 89–291, § 2, 79 Stat. 1066; renumbered § 399a and amended Mar. 13, 1970, Pub. L. 91–212, § 10(c)(3), (d)(2)(A), 84 Stat. 67; renumbered § 399, July 23, 1974, Pub. L. 93–353, title II, § 204, 88 Stat. 373; Oct. 17, 1979, Pub. L. 96–88, title V, § 509(b), 93 Stat. 695, which related to the maintenance of records by recipients of grants and audits thereof by the Secretary of Health and Human Services and the Comptroller General of the United States, was classified to section 280b–11 of this title, prior to repeal by Pub. L. 99–158, § 3(b), Nov. 20, 1985, 99 Stat. 879.

### Amendments

2004—Subsec. (n)(3). Pub. L. 108–446 substituted “part C” for “part H”.

1994—Subsec. (b)(6). Pub. L. 103–448 substituted “special supplemental nutrition program” for “special supplemental food program”.

### Statutory Notes and Related Subsidiaries

### Effective Date of 1994 Amendment

Amendment by Pub. L. 103–448 effective Oct. 1, 1994, see section 401 of Pub. L. 103–448, set out as a note under section 1755 of this title.

### Effective Date

Section effective July 10, 1992, with programs making awards providing financial assistance in fiscal year 1993 and subsequent years effective for awards made on or after Oct. 1, 1992, see section 801(b), (d)(1) of Pub. L. 102–321, set out as an Effective Date of 1992 Amendment note under section 236 of this title.

### Reference to Community, Migrant, Public Housing, or Homeless Health Center Considered Reference to Health Center

Reference to community health center, migrant health center, public housing health center, or homeless health center considered reference to health center, see section 4(c) of Pub. L. 104–299, set out as a note under section 254b of this title.

### Purpose

Pub. L. 102–321, title V, § 501, July 10, 1992, 106 Stat. 426, provided that: “The purpose of this title [enacting this section] is— to increase the use of, and to provide information on the availability of early, continuous and comprehensive prenatal care; to reduce the incidence of infant mortality and of infants born prematurely, with low birthweight, or with other impairments including those associated with maternal substance abuse; for pregnant women and mothers of children below the age of 3 whose children have experienced or are at risk of experiencing a health or developmental complication, to provide assistance in obtaining health and related social services necessary to meet the special needs of the women and their children; to assist, when requested, women who are pregnant and at-risk for poor birth outcomes, or who have young children and are abusing alcohol or other drugs, in obtaining appropriate treatment; and to reduce the incidence of child abuse and neglect.”