The Title V program and the Title XIX Medicaid program are under the organizational structure of the Health Department. The health care for the low-income population, Medicaid and CHIP eligible are channel through the PRHIA that contract private Health Insurance Companies (HICs) to provide de clinical services needed and included in the State Plan submitted to CMS. It includes special coverage for CSHCN and ASD.

Services coordination isn’t mandatory by CMS and not included in the PR State Plan. That limitation has provided a good opportunity for TV MCAHD staff collaboration with Title XIX Medicaid program, especially with the Medical Assistance Office (MAO) which performs the eligibility evaluation.

The MCAHD CHWs and the HEs are in the community constantly looking for pregnant women to offer them education on health issues that can impact them and one specific task is the referral to the MAO for the evaluation of eligibility to the GHP to those without health insurance coverage and to other services needed as are identified. This contact with the population at the community level allows our personnel to refer for the HVP and to recruit for the Prenatal and Parenting courses, tools that increase the prevention and promotion of health. At the same time MAO personnel at their local offices refer to MCAHD staff the pregnant women that they certify as eligible for the GHP. This collaboration allows MCAHD a more extensive impact toward improving the overall health of the MCH population.

The HVP provide the education and support by nursing personnel, to high risk pregnant women for complications that complement the clinical services provided by the GHP.

The MCAHD began collecting data for the CDC collaborative project PRAMS on July 2017. This project provide data to respond to emerging issues that arise during the collection cycle, alongside with regular data, which help to guide our efforts toward healthier MCH population. During 2018-19, a Disaster Supplement was included in the regular PRAMS questionnaire, whose data helped to establish preventive measures on health care services. From 2019 to 2020, an Opioids Supplement was implemented due to the opioid misuse epidemic recognized as a nationwide crisis.  From 2020 to 2021, a COVID-19 Supplement has been implemented to compile a full-year of data.  A COVID-19 Vaccine supplement also started in 2021.

The Early Intervention (EI), IDEA Part C program is under the MCAHD which allows the direct access for the families’ referred from the HVP and other staff. The services provided under EI at the children natural environment increase those needed by the MCH population and not covered in the same way as in the GHP or other private health insurance.

MCAHD personnel is part of the MOD Program Committee, along with the Hospital Association, ACOG/PROGYN, Association of Primary Health Care of PR, Vita Health Care, and UPR University, among other organizations. The Hard Stop Policy, that specifically prohibits or denies payment for elective inductions, as well as the 17-P administration in pregnant women with a previous premature birth, are initiatives driven by this committee in order to decrease premature births.

The Pediatric Preventive Health Care Guidelines were developed as a public policy by the MCAHD in collaboration with members of the Academia, AAP, PR Health Insurance Administration, PR Children’s Hospital, Society of Pediatric Dentist of PR, Puerto Rican Society of Pediatrics and other experts in the field. These guidelines are according to Bright Future Guidelines and are distributed to the health care providers steer primary health care providers to deliver high-quality preventive health care that have an impact on child health and well-being.

The CSMND has collaborative agreements and partnerships, formal or informal, with key players at the public health care system and services level. Partnerships at this level involve data sharing, technical assistance, policy development, training activities and collaborations development for health-care services, among others. Below is a list of some, but not all, of the partners.

Federal agencies: CDC, HRSA, CMS, FEMA, WIC, Medicaid, and FQHCs. Jurisdictional agencies: Department of Education, Family Department, Demographic Registry, PR-HIA, ASEM, and the Office of the Ombudsman for People with Disabilities (OPPI, Spanish acronym), among others. Academic: Medical Science Campus of the University of PR, Albizu Campos University. Professional associations: PR-Psychology Association, PR Audiologists Academy, Puerto Rican Pediatric Society, West Region Pediatricians Association, East Region Pediatricians Association. Family associations and organizations: APNI, F2F, PR-PKU Association. Other community organizations: Association of Primary Health Care of PR, Oral health Program, MAVI, PR-Newborn Screening Program, Society of Education and Rehabilitation of PR (SER de PR, Spanish acronym), and the Spina Bifida and Hydrocephaly Association, among others.

Collaborations at the enabling services level are primarily related to the provision of enabling and direct services for CSHCN and their families including referrals to needed services, care coordination, family engagement and support, and eligibility assistance services. Partners at this level include community health care providers, Part C Early Intervention Services, audiology clinics, the Spina Bifida and Hydrocephaly Association, the Down Syndrome Association, SER de PR, Centro Margarita, Centro Espibi among others.