Section III.E.2.b.iv. Health Care Delivery System
According to the University of North Dakota’s Fifth Biennial Report on Health Issues for the State of North Dakota, health care in North Dakota is delivered through more than 300 ambulatory care clinics, 52 hospitals, 80 skilled-nursing facilities, 68 basic-care facilities, and 72 assisted-living facilities, supported by an array of EMS providers, trauma centers, 28 public health units, oral health providers, mental health providers, and pharmacies. Generally, the further the facility is from a metropolitan area, the more its operation is threatened by financial and other pressures, including staff recruitment and retention. Rural health organizations tend to be small but have a significant impact on both the health of individuals and the economic base of the community.
Title V programs in North Dakota use a collaborative systems-based approach to ensure access to quality health care and needed services for the maternal and child health population. Although Title V programs have a more limited role in activities that support overall health reform efforts, programs partner with others to address policy and health systems advocacy.
The Affordable Care Act (ACA) led to the provision of more services to populations that have previously struggled with access to health insurance: https://www.healthinsurance.org/. According to the summary:
- A total of 21,820 people enrolled in Qualified Health Plans (QHP) through the North Dakota exchange during 2019 open enrollment.
- This was almost a 3% lower enrollment than in 2018, when 22,486 people enrolled through the North Dakota exchange, although this is still higher that prior to implementation of the ACA.
- Accepting federal funds to expand Medicaid in North Dakota has been a key aspect of the law’s success there. All legal residents with incomes up to 138% of the federal poverty level (FPL) are now eligible for Medicaid. With North Dakota Medicaid Expansion underway in 2014, there were 35,000 people estimated to be newly eligible for coverage. However, as of September 2017, enrollment in Medicaid Expansion was under 20,000 people.
- The percentage of uninsured residents dropped from 10.4% in 2013 to 7% in 2016, according to United States (U.S.) Census data. The national uninsured rate fell from 14.5% to 8.6% during the same time.
There are still gaps that exist with the ACA in that some individuals need services that are not available through current benefit plans. Service limits also pose a challenge. Lower-income families aren’t always able to afford a plan that covers their needs or the associated co-payments for services.
North Dakota is one of 36 states that make up the Federally Facilitated Marketplace for the ACA. North Dakota is also a Medicaid Expansion state.
Title V staff collaborate with North Dakota Medicaid in day-to-day program implementation. The State Health Officer is a member of the North Dakota Medicaid Advisory Committee. Other Title V staff participate in workgroups with Medicaid staff that address services for the MCH population. The Medicaid Deputy Director and the Dental Consultant in the Medical Services Division are invited to attend the annual SHS Medical Advisory Council meeting. More recently, Title V staff-initiated meetings focused on updating the Title V/Medicaid agreement.
Title V programs monitor whether individuals served have a source of health care coverage and assess the “reach” of public insurance options. Located within the North Dakota Department of Human Services (NDDHS), Healthy Steps and Medicaid have been effective public programs in reducing the number of uninsured, low-income children in the state. A toll-free resource line is available (1-877-KIDS-NOW) that helps uninsured families learn about low-cost and free health coverage programs. In addition, a seamless eligibility process for health coverage programs helps assure coverage for North Dakota’s children.
Title V is the payer of last resort for services that are not covered or reimbursed through another provider. Medicaid reimbursement is available for a variety of public health services (e.g., children with special health care needs (CSHCN), oral health, and local public health claims). In a unique arrangement, Special Health Services (SHS) utilizes the North Dakota Health Enterprise Medicaid Management Information System located in the NDDHS for eligibility and claims payment activities on behalf of CSHCN and their families.
Title V programs continue to conduct outreach services and have an active role in providing consumer assistance services by providing families with information, referrals, linkages, and counseling aimed at increasing access to available sources of health care coverage. Examples of activities that are provided to directly support local staff and families follow:
- State Women, Infants and Children (WIC) staff share resource information with local WIC agency staff.
- Title V staff monitor legislation during legislative sessions or through interim legislative committees that impact health care financing (e.g., managed care, Medicaid waivers).
Additional information is detailed in Section III.B. Overview of the State.
To Top
Narrative Search