Oklahoma Title V has excellent relationships with partners throughout the state and this assists programs in assuring access to quality health care and needed services for the Oklahoma MCH population. A close working relationship with the State’s Medicaid Agency, the Oklahoma Health Care Authority (OHCA), is of high value to Title V to the degree that representation and involvement from OHCA can be found in most all Title V initiatives undertaken. Other system partners include: Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), Oklahoma Perinatal Quality Improvement Collaborative (OPQIC), Oklahoma Hospital Association, Oklahoma March of Dimes, Oklahoma American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) Chapters, Oklahoma State Medical Association (OSMA), Southern Plains Tribal Health Board, Indian Health Service, tribal nations, birthing hospitals, universities, county health departments, physicians, and other public health organizations and agencies. Examples of some of these collaborations include:

• AIM/Every Mother Initiative to reduce severe maternal morbidity and maternal mortality through evidence-based safety bundles;
• Focus Forward Oklahoma to reduce unintended pregnancies and teen births through education, counseling, and increased access to long acting reversible contraceptives;
• OPQIC Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Work Group to decrease maternal opioid use and infants affected with NAS;
• OPQIC Preterm Birth Initiative to promote best practices with providers to reduce preterm births;
• The Child Health Group to improve overall child health outcomes;
• Sooner SUCCESS Health Care Transition Team/Advisory Board to advise on services for CSHCN and transition to adult care services;
• Child Death Review Board, Fetal and Infant Mortality Review Teams, and Maternal Mortality Review Committee to review maternal, fetal, infant, and child deaths and make recommendations in relation to prevention and best practices;
• Choctaw Nation Medical Center pilot to improve breastfeeding and safe sleep practices;
• Child Safety Learning Collaborative involvement to improve teen driving safety;
• Preconception CoIIN to improve Women’s Health awareness and assessment during Preconception/Interconception phases; and the
• Oklahoma Family Network Advisory Committee to advise the Oklahoma Family Network in relation to services and resources for Oklahoma families.
• SoonerCare Member Advisory Task Force (Medicaid Member Advisory) to  provide perspectives and recommendations of SoonerCare members and their parents to the Oklahoma Health Care Authority for quality improvement and program development.

Other unique collaborative efforts between the OHCA and MCH are the Shared Data Work Group and analyst position. The OHCA and MCH have a leadership team that meets monthly to address shared MCH topics of interest through linked data. The analysis is accomplished by a shared analyst position (paid 50% from OHCA Medicaid and 50% from the MCH) that links both data systems and gathers critical data and information to further inform efforts to critical MCH areas of concern such as Neonatal Abstinence Syndrome and prenatal care.

The OHCA and DHS have an agreement to assure cooperation and collaboration in performance of their respective duties to provide health care to persons eligible under Titles V, XIX, XXI of the Social Security Act; including but not limited to state custody children and Title V recipients.

OHCA and DHS collaborate to provide both organizational and programmatic support to the other, as outlined in the MOU. An interagency steering committee comprised of executive management staff from both agencies meet to ensure coordination of responsibilities, including establishment of a strategic plan for both agencies.

Waivers or state plan amendments which influence health care delivery for the MCH population, particularly CSHCN, are the 1915 (c) home and community-based waivers and the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). DHS medical programs have the responsibility for the operation and allowable OHCA administrative activities of approved 1915 (c) home and community-based waivers. Developmental Disabilities Service Division, a division of DHS, serves individuals who are 3 years of age and older who have intellectual disabilities and certain persons with related conditions who would otherwise require placement in an intermediate care facility for individuals with intellectual disabilities. OHCA and DHS coordinate all mutual policy issues related to the operation of all waivers and state plan amendments.

TEFRA is a state plan option available for a certain population of CYSHCN. Under Section 134 of TEFRA, (P.L.97-248), states have the option to make Medicaid benefits available to children with physical or mental disabilities who would not ordinarily be eligible for Supplemental Security Income (SSI) benefits because of their parent's income or level of resources being too high. In these cases, only the child’s income and resources are used in determining financial eligibility. Under Oklahoma’s Medicaid program, TEFRA allows children who are eligible for institutional services to be cared for in their homes (they don’t have to be in an institution). The cost of care at home compared to the cost in an institutional setting is also used in determining eligibility. DHS determines the financial eligibility and OHCA establishes the medical eligibility for the TEFRA program.

Additionally, Oklahoma has a Family Planning State Planning Amendment (SPA) in place which covers family planning services for males and females including examination, lab, contraceptive supplies, sterilizations, and Gardasil. Funds received from the SPA are matched funds used to pay for staff, contraceptive supplies, and medications under the program name SoonerPlan. These funds assist in reducing unintended pregnancies and teen births by sustaining access to the family planning program for priority populations.

The Oklahoma Family Network (OFN) is a contracted provider of the OSDH and DHS and assists in obtaining valuable family input on how best to provide Title V services to families in need. OFN outreach services include:

• Assisting and informing families regarding online SoonerCare (Medicaid) enrollment and connecting them with their local DHS office in cases of CYSHCN;
• Hosting statewide parent conference to help equip parents regarding such issues and/or programs as TEFRA, Special Education Services, Healthcare Transition, Becoming a Parent Advocate, and sessions for Spanish-speaking families (115 family members from across the state were in attendance);
• Hosting the 12th Annual Joining Forces: Supporting Family Professional Partnerships conference. One hundred and seventy-two participants enjoyed sessions providing family and community voice to agencies’ programs such as the Title V Needs Assessment, OKDHS CYSHCN, Department of Rehabilitation Services, OK Department of Mental Health and Substance Abuse Services and DDS Waitlist. This conference continued to provide agencies with valuable family and community insight with face-to-face connections;
• Hosting booths at conferences, trainings, health fairs, etc. to share information regarding access to Medicaid and other services – events such as the Women and Children’s Health Day at the Capitol, Child Advocacy Day, National Association for Medicaid Directors’ Conference, National Federation of Families Conference, Mental Health Awareness Day at the Capitol, Southern Plains Tribal Health Board Conference, Heartland Regional Genetics Network Conferences, and other MCH-related events;
• Continuing to provide SoonerCare, TEFRA and private duty nursing information and how to access by sharing on social media Facebook pages (public and private), in quarterly OFN newsletters (fulfilled in Fall 2018 Newsletter), by hosting focus group and in Joining Forces: Supporting Family Professional Partnerships Conferences (March 2019);
• Serving as a family voice regarding Preparing for a Lifetime: It’s Everyone’s Responsibility events and programming;
• Providing training and supporting families attempting to fill out TEFRA applications;
• Partnering with OHCA to assist in identifying barriers and improving access to TEFRA via the OHCA Member Advisory Task Force;
• Conducting family listening sessions with new incoming private duty nursing service to address concerns in Oklahoma with private duty nursing access;
• Promoting and sharing information to families and policy makers regarding financing of waivers and state plan services; and
• Hosting Coffee Chats at the Capitol for legislators and their staff to increase awareness of need for services for CYSHCN including behavioral health.

Other services relating to financing and policy decision-making include items such as promoting and attending Medicaid Matters Day and other disability awareness days to share information with families and policy makers regarding the importance of services for CYSHCN and providing Telling Your Story and Sitting on Boards and Committees Trainings at Family Leadership Institutes and individually to ensure the family voice and experience is available and valued to improve financing of essential services and better access to health care for CYSCHN and their families. OFN Family Leaders serve as members of the OKDHS Developmental Disability Services Policy Committee, OHCA Member Advisory Task Force, OSDH Preparing for a Lifetime and other Maternal and Child Health committees, Screening and Special Services committees, and Mental Health and Substance Abuse Services State Advisory Team for Systems of Care, to name a few. The OFN also provides stipends to family leaders for their involvement in these important decision-making groups.

Finally, two new Medicaid Health Service Initiatives were initiated in October 2018. These will impact two MCH Title V priority areas over the next few years, unintended pregnancy and infant safe sleep. The OHCA is paying for 87-97% of the costs for these projects and MCH is funding the remainder. One project would provide additional long acting reversible contraceptive methods to reduce unintended pregnancies and teen births in the counties and the other will expand the Cribs Project to reduce infant deaths and racial disparities through improvements in infant safe sleep practices with culturally approved race/ethnic specific educational materials, along with tools to carry through best infant safe sleep practices with portable cribettes and sleep sacks for those who do not have a safe sleep space for their infant.