Adequate Insurance – 2019 Annual Report Narrative (October 1, 2018 – September 30, 2019):

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 the 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 necessary 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 aged 65 and above. Data on health insurance for these population groups are cited in 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 insurance's adequacy. 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 navigators, 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.).

During the 2019 Legislative Session, new legislation was tracked, and changes in policies were monitored that had the potential to impact health care coverage for the MCH population.

• SB 2094 ensures that physicians can use telemedicine for FDA-approved opioid prescribing medication-assisted treatment (MAT), an important tool in a rural state like North Dakota where MAT programs are being launched.
• SB 2106 transferred the Children’s Health Insurance Program (CHP) from a managed care arrangement with Blue Cross Blue Shield of North Dakota and Delta Dental to being covered under the North Dakota Medicaid plan. This results in children receiving traditional Medicaid coverage rather than a private insurance plan, starting January 1, 2020.

• SB 2155 allows an exemption from the practice of pharmacy. A registered nurse working in a Title X clinic (family planning program) may now dispense contraceptives after receiving an order from a clinician.
• SCR 4002 is a concurrent resolution urging Congress to address the rising costs and availability of medications and healthcare for individuals with diabetes and coverage of those costs.
• SCR 4014 is a concurrent resolution directing the Legislative Management to consider studying the implementation of the recommendations of the Human Services Research Institute’s study of North Dakota’s behavioral health system.  

Efforts to inform and refer to healthcare coverage and other financing options available for the MCH population continued. Primary activities included disseminating information on insurance or other or coverage options and providing referral training and education opportunities for families, local staff, and partners. In addition, benefits counseling and care coordination services were provided for children with special health care needs and their families by state and county social service staff.

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, 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.

State Mandates– 2019 Annual Report Narrative (October 1, 2018 – September 30, 2019):

Priorities are often influenced by state mandates, which in turn, are generally reflective of expressed need within the state over time. The 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 the 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 available list of services. First Link is an online database that assists people in identifying, accessing, and making effective use of community and volunteer resources 24 hours a day. It is North Dakota's first link to connect people to resources.    

A new 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 several 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 are being explored (e.g., long-term care, family planning clinics) and the ability to utilize law enforcement and first responders. While there are many details to work through (e.g., parental rights, child support), a public service announcement that will be broadcasted through the North Dakota Health Network is being developed to educate the public. The North Dakota Health Network is a service of KAT Marketing designed to intersect the efforts of health providers and agencies with a mission to improve the health and wellness of North Dakotans. The Health Network plays health programming in almost 80 different venues (e.g., LPH, Indian Health Services, community health centers) throughout North Dakota.             

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 details on state mandates are 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.