Adequate Insurance – 2020 Annual Report Narrative (October 1, 2019 – September 30, 2020):

Access to quality health care is essential to increase the likelihood of a healthy life for the maternal and child health (MCH) population. In addition to influencing overall physical, dental, mental, and social health status, access to quality health care impacts prevention, detection, and treatment of health conditions. In addition to efforts that reduce the number of uninsured, challenges remain with adequacy of coverage. Those who are inadequately insured are more likely to have delayed or forgone care, lack a medical home, are less likely to receive needed referrals and care coordination, and/or receive family-centered care. Problems with adequacy include cost-sharing requirements that are too high, benefit limitations and inadequate coverage of needed services.

Census Bureau Health Insurance statistics break the population into major age cohorts: children under age 18, workforce age (18 through 64) and those age 65 and above. Data on health insurance for these population groups is in cited section III.B. Overview of the State.

Efforts to address these issues focused on the following strategies and activities for quality improvement. Staff continued to monitor the status of health care coverage for the MCH population using a variety of data sources. When available, this can be used to inform partners and stakeholders about the state’s progress in addressing adequacy of insurance. Health systems advocacy continued through partnerships between Title V and other departments, or organizations involved in insurance, financing, and navigation support (e.g., North Dakota Medicaid, North Dakota Insurance Department, health system coaches, etc. Gap-filling coverage continued to be provided for necessary safety net services (e.g., Family Planning, Diagnostic and/or Treatment services for children with special health care needs, etc.).

Bimonthly meetings were held between the North Dakota Department of Health and the North Dakota Department of Human Services to update the existing Memorandum of Understanding between North Dakota Medicaid and Title V. State Title V and its partners such as Family Planning, Women, Infants and Children (WIC), families, school nurses, county social service staff, human service center zone staff, local public health, childcare providers, etc. stayed informed of current health insurance options for the MCH population, distributed information through a variety of strategies, and made referrals as appropriate. This document was finalized in July 2020, which was a major collaborative accomplishment for the two agencies.

State Mandates– 2020 Annual Report Narrative (October 1, 2019 – September 30, 2020):

Priorities are often influenced by state mandates, which in turn, are generally reflective of expressed need within the state over time. Inclusion of these mandates epitomizes the successful federal/state partnership by honoring a state’s unique priorities. North Dakota has several mandates addressing the health of the maternal and child health (MCH) population that direct Title V work efforts and require use of significant resources for successful implementation. A list of these mandates can be found in the Supporting Document – North Dakota Title V/Maternal and Child Health State Mandates.

As part of the N.D.C.C. Chapter 14-02.1, Abortion Control Act, Section 14-02.1-02.1, the North Dakota Department of Health (NDDoH) is responsible for creating geographically indexed materials designed to inform the woman of public and private agencies and services available to assist a woman through pregnancy, upon childbirth, and while the child is dependent, including adoption agencies. The materials must include a comprehensive list of the agencies available, a description of the services they offer and a description of the manner, including telephone numbers, in which they might be contacted. In 2016, these materials were transferred from hard copy to an on-line map of services. As a quality improvement effort, Title V is working with First Link to further enhance and expand the list of services available. First Link is an on-line data base that assists people to identify, access, and make effective use of community and volunteer resources 24 hours a day. It is North Dakota’s first link to connect people to resources.    

A mandate from the 2019 Legislative Session (House Bill 1285) requires the NDDoH, in coordination with the North Dakota Department of Human Services (NDDHS), to develop and implement a public awareness campaign to provide information, public service announcements, and educational materials regarding abandoned infants to the public, including medical providers, law enforcement, and social service agencies (North Dakota Century Code 50-25.1-15. Abandoned infant - Approved location procedure - Reporting immunity). Title V is taking the lead to implement this mandate. The Title V Director and Grant Coordinator have participated in meetings organized by the NDDHS to discuss this mandate. The law allows the expansion of approved location sites beyond hospitals. The Title V Director received approval from local public health to be included as an approved location. To ensure approved locations are available in communities, additional sites have been explored (e.g., long-term care, family planning clinics), along with the ability to utilize law enforcement and first responders.

The Title V Director, CSHCN Director and the Title V Grant Coordinator assured compliance for these state mandates and oversaw staff assigned to carry out the roles and responsibilities related to the mandates. Additional detail on state mandates is discussed in Section III.E.2.c., Cross-Cutting/Systems Building Application Year (Annual Plan) – Implement all North Dakota State Mandates for the Maternal Child Health Population.