President Franklin D. Roosevelt signing the Social Security Act.
Before 1935, most federal grants-in-aid to states were awarded for specific purposes and dispersed using an allocation formula based on population, per capita income, and extent of the problem. Apart from these federal categorical programs, health services for vulnerable populations were provided through philanthropic, and, occasionally, state and local clinics. Few, if any, federal clinics were available to support oral health care, and little funding was available for public oral health. Each state operated independently, and states varied significantly in the populations served and services provided. State health departments expended approximately $37,000 for oral health services in 1930. The large variation in state health services for individuals with low incomes and the inability of public agencies to cope with the widespread social and health problems caused by the Great Depression focused attention on the need to better organize health services and to control the cost of medical care to individuals. The Committee on the Cost of Medical Care, which was charged to study the delivery of health services and its increasing cost, played a critical role. The committee’s 1932 report set the stage for a protracted debate on social and health issues that resulted in the Social Security Act of 1935.
With the passage of the Social Security Act, the federal government, through the Title V Amendment (Public Law 90-248), pledged its support of state efforts to extend health and welfare services for mothers and children. This landmark legislation resulted in the establishment of state departments of health or public welfare in some states and facilitated the efforts of existing agencies in others. The goal of the legislation was to improve the health of all mothers and children, in particular those with low incomes or with limited access to health services.
Title V of the Social Security Act of 1935 authorized federal grants for maternal and child health services, services for crippled children, and child welfare services. Since funds were not earmarked under the act, oral health programs had to compete with other state health interests for funding, and state oral health programs grew slowly. Dental services were often part of divisions of maternal and child health in state health departments, but increasingly they became divisions of dental health. Thus Title V resulted in the rapid growth of administrative units responsible for dental health activities. In 1934, only 14 states had such units, and altogether they employed 8 full-time dentists. By 1941, 38 states had oral health units that employed 154 full-time dentists.
Albertini TF, Hillsman JT, Crawford BL. 1984. Federal financing of dental services. Journal of Dental Education 48(11):606–615.
Maternal and Child Health Bureau. 2000. Understanding Title V of the Social Security Act: A Guide to the Provision of the Federal Maternal and Child Health Block Grant. Rockville, MD: Maternal and Child Health Bureau.
Oettinger KB. 1960. Title V of the Social Security Act: What it has meant to children. Social Security Bulletin 23(8):39-50.
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