This section puts into context the Title V Maternal and Child Health (MCH) program within the State's health care delivery environment and provides an understanding of the State Health Agency's current priorities/initiatives and the Title V role.

 

Kansas MCH Population

 

 

 

 

 

Overview & Authority

 

The Kansas Department of Health and Environment (KDHE) is responsible for administration of programs carried out with allotments under Title V. The Bureau of Family Health (BFH), one of six Bureaus in the Division of Public Health, administers the Title V MCH Services Block Grant program. The mission of the Bureau is to “provide leadership to enhance the health of Kansas women and children through partnerships with families and communities.”

 

Kansas Law mandates financial supports for health care services for CSHCN pursuant to K.S.A. 65-5a01,

Kansas statutes do not mandate comprehensive services for MCH populations except for children with special health care needs (CSHCN). Pursuant to K.S.A. 65-5a01, a "child with special health care needs” means “a person under 21 years of age who has a disease, defect or condition which may hinder normal physical growth and development." Statutes and regulations detail program requirements related to direct health services, in which services and supports are available to individuals ages birth to 21 with eligible medical conditions, and all ages with conditions diagnosed through the state's newborn screening program. Kansas provides direct services for state-mandated eligibility criteria through the Kansas Special Health Care Need Program (KS-SHCN) and care coordination and other enabling and population health services through community partnerships to the broader CSHCN population, as defined by MCHB/HRSA.

 

Within the population of women of reproductive age, maternal mortality (death of a woman during pregnancy or up to one year after pregnancy) is an indicator that is monitored by KDHE pursuant to K.S.A. 65-177. Kansas maternal mortality data are closely aligned with national trends, as there are clear patterns that can be identified within the data. The following Kansas women are at greater risk of maternal death and therefore remain target populations for prevention efforts: advanced maternal age (35 years or older); Non-Hispanic black women; and women who have lower levels of education, are unmarried (separated, divorced, widowed, or never married), those that have Medicaid or are uninsured, and live in rural areas. Severe maternal morbidity is also monitored by Title V. It is critical to understand the patterns and contributing factors considering these are situations that result in lifelong challenges or death.

 

Over the past decade, significant investments have been made in building a collaborative environment and in supporting at-risk communities to improve child and family health and well-being. Title V convenes the Kansas Maternal and Child Health Council (KMCHC) and the Family Advisory Council (FAC) to ensure ongoing stakeholder engagement, monitoring of Title V performance and outcomes, and to provide opportunities to obtain input from subject matter experts to support innovation and early adoption of new strategies or initiatives on emerging needs, issues, or trends.

 

Kansas Demographics

 

Geography: Kansas, spanning 82,278 sq. miles, is divided into 105 counties with 627 cities.1 The U.S. Census Bureau estimated that there were 2,913,805 residents living in the state on July 1, 2020.2 Kansas has a unique geographic layout, ranging from urban to frontier counties. Within each of its regions, few populous cities are intermixed with multiple rural areas. For example, the South-Central region includes Wichita with a population of 391,731. Within that same region also lies Pratt with a population of 6,463. This is a good example of Kansas’ diversity where rural communities are influenced by mid-sized cities, and mid-sized cities are influenced by rural communities. This diversity provides challenges to service delivery but also presents an opportunity for sharing resources.

 

Population Growth/Change: Kansas’ total population increased by 8.1% between 2001 and 2020, including a 9.0% increase for males and a 7.3% increase for females.2 The population increased from 2,913,314 residents in 2019 to 2,913,805 in 2020, a 0.02% increase. In 2020, there were an estimated 35,281 infants living in Kansas or about 1.2% of the total population (2,913,805). Women of reproductive age 15-44 accounted for 19.3% (562,644) of the population.

 

In 2020, there were 829,513 children and adolescents ages 1-21 years living in Kansas, which represents 28.5% of the population.3 Based on five-year estimates from the American Community Survey (ACS) for 2016-2020, among children under 18 in households (excluding householders, spouses, and unmarried partners), 71.1% lived in a married-couple household, 7.9% lived in a cohabitating couple household, and for 21.0%, there was no spouse/partner present in the household.4 According to the 2019-2020 National Survey of Children’s Health (NSCH), 20.7% of Kansas children ages 0 to 17 years (est. 144,547) were identified as having special health care needs (SHCN).5 The prevalence of SHCN in boys and girls under 18 years was about the same, 20.8% (est. 69,868) and 20.6% (est. 74,679), respectively.

 

Population Density & Peer Groups (Urban, Semi-Urban, Densely-Settled Rural, Rural, Frontier): The population density of Kansas was 35.9 inhabitants per square mile in 2020,6 based on data from the 2020 Census. Most counties in Kansas were classified as either frontier counties (less than 6.0 persons per square mile) or rural counties (between 6.0 and 19.9 persons per square mile). Urban counties were considered as those having 150.0 or more persons per square mile, and included six counties (Douglas, Leavenworth, Johnson, Shawnee, Wyandotte, and Sedgwick).

 

Image Credit: University of Kansas Institute for Policy & Social Research

 

Age: The median age of Kansans in 2020 was 37.3 years, a 5.4% increase from the median age of 35.4 in 2001.2 The median ages of males and females in 2020 were 36.0 and 38.5, respectively. Shifts in the population distribution by age from 2001 to 2020 included decreases in the 0-4 age group (by 2.1%), 35-44 age group (by 11.6%), and 45-54 age group (by 12.5%). Increases were observed in the 5-14 age group (by 0.7%), 15-24 age group (by 0.7%), 25-34 age group (by 9.6%), 55-64 age group (by 60.8%), 65-74 age group (by 63.1%), and 75 and over age group (by 12.7%). These changes are likely due at least partially to the aging of the baby boomer population, as well as recent declines in the birth rate. In 2019-2020, the prevalence of SHCN increased with age, from about 9.1% among children 0-5 years old, to about 23.9% among those 6-11 years old, to 27.4% among those 12-17 years old.5 The higher prevalence of SHCN among older children is likely attributable to conditions that are not diagnosed or do not develop until later in childhood.

 

Race/Ethnicity: Kansas’ population is becoming more racially and ethnically diverse. Based on Census Bureau data for 2020, 75.1% of Kansans were of non-Hispanic White race, 5.7% were of non-Hispanic Black race, and 12.4% were of Hispanic ethnicity.2 Among women of childbearing age (ages 15-44), 71.1% were of non-Hispanic White race, 6.1% were of non-Hispanic Black race, 0.9% were of non-Hispanic Native American or Alaska Native race, 4.3% were of non-Hispanic Asian and Pacific Islander race, 3.1% were of multiple races (non-Hispanic), and 14.5% were of Hispanic ethnicity. Among Kansas children and adolescents (1-21 years) in 2020, 66.2% were of non-Hispanic White race, while about one-third (33.8%) belonged to a racial minority (i.e., either of Hispanic ethnicity, or of non-Hispanic ethnicity and of any other race including multiple races).7 Across age groups, the percentage of young children (1-5 years) and young adults (20-21 years) that were part of a racial/ethnic minority was about one-third, at 34.9% and 32.0%, respectively. More than one in six Kansans ages 1-5 years (19.1%), 6-14 years (19.1%), and 15-21 years (17.5%) were of Hispanic ethnicity. In 2019-2020, about 15.0% of Hispanic children were estimated to have CSHCN.5 The estimated prevalence of CSHCN among non-Hispanic White children was about 22.1%.

 

Languages: Based on 5-year estimates from the ACS (2016-2020), among people at least five years old living in Kansas, about 11.7% spoke a language other than English at home.8 Spanish was spoken at home by about 7.6%. Of those who spoke a language other than English at home, about 4.5% reported that they speak English less than "very well." According to the 2019-2020 NSCH, for about 90.5% of KS children, English was the primary language spoken in the home.5

 

Nativity: An estimated 93.0% of the people living in Kansas were U.S. natives, based on 2016-2020 five-year estimates from the ACS.8 About 64.6% of those who were U.S. natives were living in the state in which they were born. Approximately 7.0% of residents were foreign-born. Of the foreign-born population, about 41.4% were naturalized U.S. citizens, and an estimated 73.6% entered the country before the year 2010. Most foreign-born residents (excluding those born at sea) were estimated to have come from Latin America (52.2%), followed by Asia (33.1%), Europe (6.7%), Africa (6.0%), Northern America (1.4%), and Oceania (0.5%).

 

Education: Based on 2016-2020 five-year estimates from the ACS, Kansas compared favorably with the U.S. average in terms of educational attainment, with about 91.4% of people 25 years and over with a high school education or higher, compared to about 88.5% for the U.S.8 About one-third (33.9%) of Kansans 25 years and over had a bachelor's degree or higher, compared to 32.9% for the U.S. According to the 2019-2020 NSCH, approximately 10.8% of children (1-17) received services under a special education or early intervention plan, compared to 9.4% for the U.S.5 Among Kansas children with SHCN, the estimated prevalence was 30.8%, compared to 32.2% among children with SHCN in the U.S.

 

Income/Poverty: Unemployment rose at the beginning of the COVID-19 pandemic, reaching as high as 12.2% in April 2020 (seasonally adjusted).9 More recently, in February 2022, the unemployment rate was 2.5%. As of May 2021, the annual median wage in KS was $38,050.10 The top three occupations by employment were “Office and Administrative Support Occupations” with an annual median wage of $36,890, followed by “Transportation and Material Moving Occupations” with an annual median wage of $36,590, and “Sales and Related Occupations” with an annual median wage of $29,360. For 2021, the federal poverty level was $27,479 for a family of four with two children, up from $26,246 in 2020.11 Based on the 2020 Small Area Income and Poverty Estimates (SAIPE),12 a lower percentage of Kansans lived in households with incomes below the federal poverty level compared to the U.S. overall (10.6% vs. 11.9%). Additionally, a lower percentage of children under age 18 lived in households with incomes below the federal poverty level (13.0% vs. 15.7% for the U.S.). Based on 2016-2020 five-year estimates from the ACS, about 11.4% of all Kansans had lived in poverty in the past 12 months.13 The percentage was highest among persons of Black or African American race alone (23.9%). Among KS children under 18 years of age, about 13.9% had lived in poverty in the past 12 months. Over half of all children in poverty (52.3%) were in five counties: Sedgwick (23.6%), Wyandotte (12.5%), Johnson (8.0%), Shawnee (5.5%), and Douglas (2.7%). However, rural areas of the state have counties with high percentages of children living in poverty.

 

Based on 2016-2020 five-year estimates from the ACS, the percentage of Kansas families living below the federal poverty level in the past 12 months was estimated at 7.6%, compared to 9.1% for the U.S.14 Among families where the householder had related children in the household, poverty was more common among those with a female householder with no spouse present, compared to married-couple families. Among these families, the estimated percentage in poverty in Kansas (32.6%) was slightly lower than for the U.S. (34.4%).

 

Health Insurance Coverage: Data from the Small Area Health Insurance Estimates15 show that the percentage of Kansas children under 19 years old without health insurance increased from 5.1% in 2015 to 5.7% in 2019. After a low of 4.5% in 2016, there was a slight increase in the uninsured population under age 19 in 2017 (5.2%), a slight decrease in 2018 (5.0%), then an increase in 2019 (5.7%). The U.S. percentage also increased from 5.0% in 2015 to 5.6% in 2019. In 2019, nearly half (49.8%) of all uninsured Kansas children under age 19 lived in the four largest population centers: Sedgwick County (Wichita), Johnson and Wyandotte counties (Kansas City metropolitan area), Shawnee County (Topeka), and Douglas County (Lawrence). However, the southwestern part of the state, a largely Hispanic populated area where presumably many are not Medicaid or CHIP eligible, has many counties with high concentrations of uninsured children under age 19. The southeastern portion of the state (Kansas Ozarks), on the other hand, has a cluster of counties with high concentrations of children in poverty, as stated above, but the children are less likely to be uninsured than those in the southwestern part of the state. According to the 2019-2020 NSCH,5 in Kansas, 96.3% of CSHCN were reported to have some type of insurance at the time of the survey: 54.1% had private coverage only, while 35.0% had public coverage only.

 

In 2020, the average monthly eligibility rate for Medicaid and CHIP among Kansans3,16 was highest for non-Hispanic Black persons at 23.8 per 100 people. The next highest rate, by race/ethnicity, was among non-Hispanic American Indian or Alaska Native persons at 14.5 per 100 people. Among Hispanic persons (of any race), the eligibility rate was 21.6 per 100 people.

 

 

Kansas Tribes: In 2020, the non-Hispanic Native American population in Kansas was 23,024, or 0.8% of the total population.2 Kansas is home to four Indian reservations: Iowa, Kickapoo, Potawatomi, and Sac and Fox. American Indian individuals of various tribal affiliations can also be found in the towns and cities across the state.17 It is not a requirement that someone be Native American to live on the Indian reservations; however, a non-Native American would be unable to build a home or live in tribal housing without the head of household being a tribal member. While many of the families who inhabit tribal lands are of multiple races, the head of household must be a tribal member to utilize tribal housing. In the event the head of household were to pass away or leave, the tribe could request that the non-Native parent and Native child leave tribal housing. The Potawatomi reservation is comprised similarly to that of a checkerboard in which areas of “tribal land” are surrounded by non-Native land, or vice versa.18

 

The American Indian and Alaska Native (AI/AN) population is disproportionately affected by many adverse health outcomes, including mental health conditions, suicide, unintentional injuries, obesity, sudden infant death syndrome (SIDS), and diabetes.19 A recent analysis of nationwide mortality data from 2019 found that the non-Hispanic AI/AN population experienced much higher age-adjusted, cause-specific mortality rates compared to the non-Hispanic White population for many of the 15 leading causes of death, including homicide, chronic liver disease and cirrhosis, and diabetes.20 Moreover, the AI/AN population may face barriers to accessing health care, such as cultural barriers, income limitations, and geographic isolation.19

 

 

Kansas’ Strengths & Challenges

 

Infant Mortality Reduction: Kansas Title V is a lead partner in convening and facilitating efforts to reduce infant mortality and eliminate disparities in maternal and infant health. Over the past several years, the Title V program has invested in comprehensive approaches to prenatal care and education, tobacco/smoking cessation (before, during, after pregnancy), and pre/early term birth. From concept to reality, the state has worked to integrate initiatives into existing systems to provide the mechanism to achieve current success and future expansion of successful programs. There were 224 infant deaths in 2020, for an infant mortality rate of 6.5 infant deaths per 1,000 live births for Kansas residents.2 This rate was 22.6% higher than the 2019 rate, which was 5.3 infant deaths per 1,000 live births. This does not meet the Healthy People 2030 target for infant deaths, which is 5.0 infant deaths per 1,000 live births. The rate for non-Hispanic Black mothers in 2020 was 16.9 deaths per 1,000 live births, which was 3.4 times the rate among non-Hispanic White mothers (4.9 deaths per 1,000 live births). The rate for Hispanic mothers was 7.0 deaths per 1,000 live births. Infant death rates for non-Hispanic Black mothers have consistently remained higher than those of non-Hispanic White and Hispanic mothers for the past twenty years (2001-2020). Rates for Hispanic mothers have been higher than those for non-Hispanic White mothers in most years in the period.

 

State Rankings: Health ranking systems can help identify areas where Kansas is succeeding in comparison to other states, and areas where the state could improve. The Annie E. Casey Foundation’s (AECF) KIDS COUNT® Data Book uses 16 indicators to rank each state across four domains: (1) Economic Well-Being, (2) Education, (3) Health, and (4) Family and Community.21 These represent what children need the most to thrive. The 2021 Data Book presents state profiles with trends (comparing data from 2010 with those from 2019, whenever possible), providing a picture of child well-being prior to the COVID-19 pandemic. In many areas, Kansas data improved, with exception of only three sub-categories: fourth-grade reading, eight grade math, and low-birth weight babies. Kansas ranked 18th for overall child well-being, 11th in economic well-being, 23rd in education, 25th in health, and 24th in family and community. The following images are from the Kansas 2021 KIDS COUNT® Profile.

 

 

 

 

 

In 2021, the United Health Foundation’s America’s Health Rankings® ranked Kansas in the bottom half of states22 in each of these areas: Physical Environment (39th), Clinical Care (31st), Behaviors (31st), and Health Outcomes (33rd). Kansas ranked 24th in Social and Economic Factors.

 

COVID-19 Pandemic Impact: The pandemic influenced Kansans’ healthcare utilization, particularly in 2020 and early 2021, based on data collected over time by the US Census Bureau’s Household Pulse Survey. For instance, during the period of March 3-29, 2021, 23% of Kansas adults living in households with children reported that they delayed getting medical care because of the pandemic.23 Among those who were Hispanic or Latino (any race), the estimate was 34%. Among those who were Black or African American (both Hispanic and non-Hispanic), the estimate was 18%. Meanwhile, 20% of non-Hispanic White adults living in households with children reported this. More recently, during the period of June 9-July 5, 2021, 13% of Kansas adults living in households with children reported this.

 

Basic needs, such as food security and housing, have also been a concern during the pandemic. During the period of October 28-November 23, 2020, 20% of Kansas households with children had little or no confidence in their ability to pay the next rent or mortgage payment on time.23 For the same period, 17% of Kansas households with children sometimes or often did not have enough food to eat in the previous week. More recently, during the period of January 26-February 7, 2022, these estimates were 19% and 10%, respectively.

 

Health Equity and Disparities: Racial disparities persist in Kansas, particularly in MCH outcomes. The non-Hispanic Black infant mortality rate in Kansas is around twice that of the non-Hispanic White infant mortality rate.24,25 Non-Hispanic Black persons are also affected by severe maternal morbidity at a significantly higher rate than persons from any other racial/ethnic group.26

 

 

 

 

 

Socioeconomic disparities are also prevalent in Kansas. Birth certificate data reveal that Medicaid-covered births are less likely than non-Medicaid-births to have had first-trimester prenatal care during pregnancy.24 Medicaid-covered births also experience a higher prevalence of low birth weight and preterm delivery.

 

Kansas Birth Statistics by Payment Source for Delivery and Year24,27

Image Source: KDHE Bureau of Family Health, Title V Outcome Measures and Performance Measures

 

Other factors that can influence health are health literacy and providers’ communication with patients. An area where increased health education is needed is in maternal health. Based on a review of pregnancy-related deaths that occurred in 2016-2018, the Kansas Maternal Mortality Review Committee (KMMRC) has emphasized the need for increased “patient education and empowerment” to help prevent future deaths.26

 

Social Determinants of Health (SDoH): To better address negative trends and disparities in health outcomes, it is important to also understand physical and social determinants that can influence one’s ability to thrive in their environment. When social determinants overlap, the risk of negative outcomes can grow. Kansas must work to address SDoH across multiple fronts to most effectively create change in communities. The U.S. Department of Health and Human Services groups SDoH into five areas: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context.28 For each, an example affecting Kansas families is provided below.

 

• Economic Stability: According to the 2019-2020 NSCH, about 67.7% of Kansas children were part of households that could always afford to eat good nutritious meals during the past 12 months.5 By income, the percentage was lowest (45.4%) among Kansas children whose household income was at 0-199% of the federal poverty level. Moreover, according to the 2019-2020 NSCH, about four in ten Kansas children with SHCN (40.9%) lived in households with incomes less than 200% of the federal poverty level.5 An example of the importance of economic stability is access to healthy foods. The estimate among Kansas CSHCN was only 57.3%.

 

• Education Access and Quality: According to the 2019-2020 NSCH,5 Kansas children living in households with lower income are less likely to have adults in the household who have a college degree or higher education, compared to children living in households with higher income.
• Health Care Access and Quality: Access to care has been recognized as a challenge for the MCH population living in both urban and rural geographic areas, but for different reasons. Families in rural areas may face barriers accessing transportation and getting to providers who may be unavailable in their area. Meanwhile, families in more densely populated areas may have a wider availability of services yet may not have time off work or the insurance needed to receive services. In addition to these barriers, the CSHCN population also often experiences reduced access due to the lack of pediatric specialists in the state.
• Neighborhoods and the Built Environment: The safety of a neighborhood can influence family well-being. According to the 2019-2020 NSCH, for 70.6% of Kansas children, a family member “definitely agreed” that the child lived in a safe neighborhood.5 However, just over half (54.7%) of Kansas children whose household income was at 0-199% of the federal poverty level lived in safe neighborhoods (based on a response of “definitely agree”).

 

 

• Social and Community Context: Adverse childhood experiences, such as incarceration of a parent or guardian, can negatively impact long-term well-being.29 According to the 2019-2020 NSCH, 19.8% of Kansas children had been reported to have experienced two or more adverse childhood experiences.5 The nationwide estimate was 18.1%. For Kansas CSHCN, the estimate was 37.9%.

 

 

Health Equity & Disparities: The agency has ramped up the investment into Health Equity with the creation of a dedicated staff member for health equity and the establishment of the Cross-Agency Health and Environmental Collaborative (CHEC), formerly the Health Equity Action Team. Two Bureau staff participate in this team and are actively involved in initiatives such as health equity training, hiring practices and data collection. Title V is committed to improving health equity and eliminating disparities through:

• Collecting and using quantitative and qualitative data to determine where to pilot/target programming based on disparities
• Increasing access to prenatal education and service access in communities with demonstrated disparities (Kansas Perinatal Community Collaboratives/Becoming a Mom®)
• Providing culturally appropriate prenatal education (bi-lingual curriculum and instructors)
• Providing culturally appropriate breastfeeding support and resources in communities with demonstrated disparities (e.g., Chocolate Milk Cafes [peer support] Black Breastfeeding Coalition, a Latina Breastfeeding Coalition, Spanish language breastfeeding training for home visitors, increased breastfeeding educators and peer counselors of color)
• Assessing the need for health coverage, transportation, housing, food, education, etc. (e.g., holistic care coordination)
• Including an equity lens on all aspects of the Title V State Action Plan and including specific strategies to combat health inequities
• Assuring gap-filling services for those without insurance/access (e.g., Medicaid postpartum coverage extension, reimbursement for perinatal mood and anxiety disorder screening in multiple settings, including the pediatric setting)
• Screening for social determinants through local MCH programs
• Development of a health equity learning collaborative (MCH Opportunity Project) that allows local communities to uncover root causes of a health equity issue in their community
• Raising awareness of health disparities with public education campaigns in partnership with the Kansas African American Affairs Commission
• Expanding the Community Baby Shower model focused on safe sleep to integrate smoking cessation, breastfeeding education, behavioral health and referral to services on site; partnering with managed care organizations (MCOs) to align efforts
• Implementing a centralized, web-based data sharing system (DAISEY) that allows for monitoring outcomes and quality improvement along MCH programs; ongoing assessment if local programs are serving those most in need and in line with the Title V purpose
• Implementing a centralized, web-based data tracking system (Community Check Box) that allows monitoring of activities and initiatives focused on health equity and ethnic and racial minorities
• Supporting development among the MCH workforce through provision of health equity and SDoH trainings to the Family Advisory and Maternal and Child Health Councils

 

Kansas’ Systems of Care for Underserved & Vulnerable Populations

 

A focus of the Kansas Title V program is to provide ongoing leadership to advancing and improving systems of care for underserved and vulnerable MCH populations. Engaging in and monitoring other statewide initiatives and assessments assists with a better understanding of the landscape for services and access to providers.

 

In 2021, the State Office of Primary Care and Rural Health conducted a statewide needs assessment to gain a better understanding of the primary care landscape for rural and underserved populations of Kansas. Not surprisingly, the assessment showed some of the greatest challenges Kansas faces in provision of care in rural and frontier communities:

• Specialty services are lacking and difficult to reach; distance to services is a barrier (particularly for frontier residents)
• Health care costs are a deterring factor, specifically deductibles and coverage of services
• Opportunities exist increase access to services, such as: provide non-traditional clinic hour; increase access to telehealth; and utilization of the non-physician providers
• The most needed health care services included OB/GYN, Cardiology, and Family Practice
• More dental and mental health providers are needed throughout Kansas

 

The 2020 Health Professional Underserved Areas Report outlines the Kansas health care professional shortage designation and details about the health care infrastructure in underserved populations. This report, produced by the KDHE Office of Primary Care and Rural Health, also describes the key health care facility designations that serve rural and underserved populations.

• Community Mental Health Centers (CMHCs): There are 26 CMHCs in Kansas that provide comprehensive mental health rehabilitation services, such as psychosocial rehabilitation, community psychiatric support and treatment, peer support, case management and attendant care.
• Critical Access Hospitals (CAHs): There are 82 facilities designated as CAHs by the federal Centers for Medicare and Medicaid Services (CMS), per the KS Health Care Provider Directory.
• Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes (LALs): There are 21 designated FQHCs and LALs in Kansas serve underserved communities or populations, per the Health Resources Services Administration, to provide comprehensive services such as preventative health, dental, mental health and substance abuse, and hospital and specialty care, and transportation services necessary for adequate patient care.
• Rural Health Clinics (RHCs): There are 195 RHCs in Kansas to increase access to primary care services for patients in rural communities, per the KS Health Care Provider Directory.
• Safety Net Clinics (SNCs): There are 18 SNCs in Kansas available to provide care to individuals regardless of their insurance status ability to pay.
• Urban Indian Health Organizations (UIO): Operated by Tribes or Tribal organizations, there is only 1 of these outpatient health care programs and facilities in KS, per the Indian Health Service.

 

Primary Care Health Professional Shortage Area (HPSA): As of April 2022, only 18 counties were not eligible for HPSA designation.30 There were 33 counties with a geographic Primary Care HPSA designation, one of which was designated and under review; besides these, other counties were proposed for withdrawal, proposed for withdrawal and under review, or previously withdrawn and under review. In 2020, the supply of family medicine physicians per 100,000 population (17.8) was significantly lower in Kansas than the national average (29.9).31 The supply of obstetricians/gynecologists (7.2)[*] was higher than the national average (5.7). The supply of pediatricians (6.2)* was lower than the national average (8.4).

 

Image Credit: KDHE Office of Primary Care and Rural Health

 

Mental Health Professional Shortage Area (HPSA): Ensuring access to mental health care is also important. Two areas of emerging concern for the MCH population include youth suicide and perinatal depression. The suicide rate among Kansas adolescents ages 15-19 has increased significantly, from 11.6 per 100,000 in 2014-2016, to 19.3 per 100,000 in 2018-2020.3,25,27 Depression is also common among the pregnant and postpartum population, with 14.3% of Kansans with a recent live birth in 2020 indicated as having symptoms of postpartum depression.32

 

Despite the need for mental health care in Kansas, as of April 2022, only 6 of the 105 counties in Kansas were not eligible for designation as mental health HPSAs.30 Meanwhile, 68 of the 105 counties in Kansas were designated, 4 counties were proposed for withdrawal, and 27 were proposed for withdrawal and under review. Due to the shortage of providers, ensuring adequate access to mental health services for Kansas youth will require an innovative approach that increases capacity across a range of medical settings and offers new avenues for care. Kansas is home to more than 700,000 children, all of whom should have access to integrated healthcare. Such integration would require primary care providers (PCPs), including pediatricians, family practice physicians and non-physician PCPs who can screen, diagnose, and treat children and adolescents with uncomplicated mental illness, such as anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD). A reformed model of care would also require the establishment of an expert pediatric mental health care team to provide training, consultation, and support services to PCPs.

 

 

Image Credit: KDHE Office of Primary Care and Rural Health

 

 

Kansas Statewide Farmworker Health Program (KSFHP): Supports comprehensive primary care services for migrant and seasonal farmworkers and their families. This program addresses the unique health care needs through a state-wide voucher case management system for services such as: immunizations, screening tests, physical examinations for children and adults, brief office visits, behavioral health, substance abuse services, laboratory/x-ray, vision care, pharmaceutical, prenatal care, and dental services.

 

Community Health Workers (CHWs): Support individuals by connecting them to the information and services needed for optimal, individualized health outcomes. There are currently 36 counties that CHWs reside in, but all 105 counties in Kansas have access to a CHW. However, not all Kansans have access to a CHW at this time, as beneficiaries of certain insurance plans and/or managed care organizations. The Center for Public Health Initiatives at Wichita State University estimates that there are currently over 500 CHWs in Kansas.

 

Financing and Coverage for MCH Service Delivery Systems

 

Medicaid/Children’s Health Insurance Program (CHIP): Also known as KanCare, Kansas Medicaid is administered through the KDHE Division of Health Care Finance. Medicaid provides health coverage for traditional Medicaid and CHIP. For most eligible groups, including children, pregnant women, low-income adults, people with disabilities and people with both Medicare and Medicaid dual eligibility, services are provided through a managed care model. Enrollees choose, or are assigned to, one of three managed care organizations (MCOs), who receive monthly payments from the state. MCOs are given incentives to ensure enrollees receive services that help reduce costs over time by improving their health and quality of life.33

 

Contracts with the MCOs require them to provide essential services through Medicaid, including prenatal care, well-child visits, preventive services, hospital care, medication, in home care, community-based services and nursing facility care. The MCOs also must ensure services are available statewide and at Medicaid-required levels. They may provide additional services not traditionally covered by Medicaid to help prevent hospital admissions or institutionalization. Additionally, Kansas has adopted seven Home and Community-Based Services (HCBS) waivers to provide flexibility around additional services not covered by Medicaid or CHIP.33 See the table that follows for a list of those waiver programs.

 

Image Credit: Kansas Health Institute, 2019 Medicaid Primer

 

Medicaid expansion is an ongoing topic of discussion in Kansas, as only one of twelve states that has not expanded Medicaid coverage to all adults up to 138% of the federal poverty level. Several legislative initiatives have occurred in recent years; however, bills continue to be unsuccessful during regular legislative sessions.

 

Other Medicaid policy initiatives listed below have been the focus for public health and Title V.

• Postpartum Medicaid Expansion: As a result of a collaborative effort between Title V and Medicaid, resulting in many conversations over the past two years with legislators and stakeholders the Title V team drafted an impact paper that assisted with getting this policy in place. Extension of postpartum coverage (up to one full year vs. only 60 days) was included in the Governor’s signed SFY2023 budget. Medicaid has submitted the State Plan Amendment (SPA) and will retroactively apply coverage effective April 1, 2022. The Title V team and Medicaid are working together to assure the expansion coverage includes all crucial care and services during the postpartum timeframe.
• Maternal Depression Screening: A new policy became effective January 1, 2021, which authorized providers to screen for perinatal mood and anxiety disorders and bill under the child’s Medicaid ID at well-child visits. Training and education for providers and technical assistance around billing and coding has been provided. The Behavioral Health Consultant is working with Medicaid to review preliminary data regarding the delivery of these screenings and policy impact.
• Family Planning Waiver: An impact paper on the importance and benefits of publicly funded family planning services is under development to consider a waiver or state plan amendment to provide affordable reproductive health to under-insured and uninsured individuals across the state.

 

Financial Assistance for CSHCN: KS-SHCN provides this assistance through nine (9) direct assistance programs, referred to as DAPs. Each of the following DAPs have eligibility criteria and annual maximum assistance amounts. All families who meet medical and financial eligibility for the program can receive support through up to two DAPs each year. A chart outlining the DAP services is available online. More information can be found in the CSHCN Section.

• Medication (DAP-Rx) provides payment or reimbursement for prescription medications, nutritional supplements, vitamins, and OTC medications.
• Medical Equipment and Supplies (DAP-ME/S) provides reimbursement for prescribed durable medical equipment and medical supplies (e.g., catheters; ostomy supplies; diabetic testing equipment and supplies; diapers/pull-ups; hearing aid molds, repairs and batteries; glasses, lens replacement or prosthetic eye) based on the clients need.
• Travel (DAP-T) provides mileage reimbursement for those requiring travel to access care.
• Co-Payments/Deductibles/Co-Insurance (DAP-C/D/CI) provides reimbursement for the client’s portion of co-payments, deductibles, and/or co-insurance.
• Hemophilia (DAP-H) provides one comprehensive treatment center visit annually, and can cover the costs associated with the clotting factor therapy.
• Medical Services (DAP-MS) provides direct payment to providers for uninsured individuals. Services include medical appointments, medical testing (labs and x-rays), specialty testing, hospitalizations/surgery (hospital bill and hospital surgery related services), other services (physical, speech, occupational therapy), interpreter services, and other specialty care services.
• Orthodontic Treatment Services (DAP-OTS) provides cleft lip/palate clinic appointments, orthodontic evaluations, and coverage for services provided under approved orthodontic treatment plans.
• Metabolic Products (DAP-MP) provides metabolic formula and low-protein food products for those with amino acid disorders, such as PKU and MSUD.
• Caregiver Relief (DAP-CR) provides reimbursement for trained and approved care providers to provide relief and respite for family caregivers of children with complex medical needs.

 

References

 

1. Kansas - Wikipedia. https://en.wikipedia.org/wiki/Kansas  
2. Oakley D, Crawford G, Savage C. Kansas Annual Summary of Vital Statistics, 2020. Topeka, KS: Kansas Department of Health and Environment (KDHE), 2021. https://www.kdhe.ks.gov/DocumentCenter/View/15354/2020-Annual-Summary-PDF  
3. U.S. Census Bureau. Bridged-race population estimates, July 1, 2020.
4. U.S. Census Bureau. 2016-2020 American Community Survey 5-Year Estimates. Table B09005. Household Type for Children Under 18 Years in Households (Excluding Householders, Spouses, and Unmarried Partners). https://data.census.gov/cedsci/table?q=B09005%3A%20HOUSEHOLD%20TYPE%20FOR%20CHILDREN%20UNDER%2018%20YEARS%20IN%20HOUSEHOLDS%20%28EXCLUDING%20HOUSEHOLDERS,%20SPOUSES,%20AND%20UNMARRIED%20PARTNERS%29&g=0400000US20  
5. National Survey of Children's Health (NSCH). Combined 2019-2020 NSCH. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website. www.childhealthdata.org
6. University of Kansas, Institute for Policy and Social Research. Population Density Classifications in Kansas by County, 2020. http://www.ipsr.ku.edu/ksdata/ksah/population/popden2.pdf  
7. Centers for Disease Control and Prevention (CDC). CDC WONDER Online Database. Single-race Population Estimates, United States, 2010-2020: July 1st resident population by state, age, sex, single-race, and Hispanic origin; vintage 2020 estimates released by U.S. Census Bureau on July 27, 2021. http://wonder.cdc.gov/single-race-single-year-v2020.html                                                       
8. U.S. Census Bureau. 2016-2020 American Community Survey 5-Year Estimates. Table DP02. Selected Social Characteristics in the United States. https://data.census.gov/cedsci/table?q=DP02%3A%20SELECTED%20SOCIAL%20CHARACTERISTICS%20IN%20THE%20UNITED%20STATES&g=0400000US20&tid=ACSDP5Y2020.DP02
9. U.S. Bureau of Labor Statistics. Local Area Unemployment Statistics. https://www.bls.gov/lau/
10. U.S. Bureau of Labor Statistics. May 2021 State Occupational Employment and Wage Estimates: Kansas. https://www.bls.gov/oes/current/oes_ks.htm
11. U.S. Census Bureau. Poverty Thresholds. https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html
12. U.S. Census Bureau. Small Area Income and Poverty Estimates (SAIPE), 2020. https://www.census.gov/data-tools/demo/saipe/#/?map_geoSelector=aa_c&s_state=20&s_year=2020
13. U.S. Census Bureau. 2016-2020 American Community Survey 5-Year Estimates. Table S1701. Poverty Status in the Past 12 Months. https://data.census.gov/cedsci/table?q=S1701%3A%20POVERTY%20STATUS%20IN%20THE%20PAST%2012%20MONTHS&g=0400000US20&tid=ACSST5Y2020.S1701
14. U.S. Census Bureau. 2016-2020 American Community Survey 5-Year Estimates. Table S1702. Poverty Status in the Past 12 Months of Families. https://data.census.gov/cedsci/table?q=S1702%3A%20POVERTY%20STATUS%20IN%20THE%20PAST%2012%20MONTHS%20OF%20FAMILIES&g=0400000US20&tid=ACSST5Y2020.S1702
15. U.S. Census Bureau, Small Area Health Insurance Estimates (SAHIE), 2019. https://www.census.gov/data-tools/demo/sahie/#/
16. KDHE Division of Health Care Finance, 2020.
17. Kansas Historical Society. Kansapedia. American Indians in Kansas. https://www.kshs.org/kansapedia/american-indians-in-kansas/17881
18. Julia Soap, Doctor of Physical Therapy (DPT); Drew Duncan, Screening and Surveillance Unit Director, Bureau of Family Health.
19. U.S. Department of Health and Human Services. Office of Minority Health. Profile: American Indian/Alaska Native. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62
20. Arias E, Xu JQ, Curtin S, Bastian B, Tejada-Vera B. Mortality profile of the non-Hispanic American Indian or Alaska Native population, 2019. National Vital Statistics Reports; vol 70 no 12. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi.org/10.15620/cdc:110370
21. Annie E. Casey Foundation. 2021 KIDS COUNT® Data Book. https://www.aecf.org/m/resourcedoc/aecf-2021kidscountdatabook-2021.pdf
22. United Health Foundation. America’s Health Rankings® Annual Report 2021. https://assets.americashealthrankings.org/app/uploads/2021-annual-report-%E2%80%93-state-summaries.pdf
23. Annie E. Casey Foundation. KIDS COUNT® Data Center. https://datacenter.kidscount.org/
24. KDHE, Kansas birth data (resident)
25. KDHE, Kansas death data (resident)
26. KDHE. Kansas Maternal Mortality Report, 2016-2018. December 2020.
27. KDHE, Bureau of Family Health. Title V Outcome Measures and Performance Measures: 2023 Application/2021 Annual Report.
28. U.S. Department of Health and Human Services, Healthy People 2030. Social Determinants of Health. https://health.gov/healthypeople/priority-areas/social-determinants-health
29. CDC. Injury Center. Fast Facts: Preventing Adverse Childhood Experiences. https://www.cdc.gov/violenceprevention/aces/fastfact.html
30. KDHE, Bureau of Community Health Systems, Office of Primary Care and Rural Health. April 2022.
31. Bureau of Labor Statistics, Occupational Employment Statistics, Occupational Employment Statistics Query System: https://data.bls.gov/oes/#/home
32. KDHE, Kansas Pregnancy Risk Assessment Monitoring System (PRAMS), 2020.
33. Kansas Health Institute, Kansas Medicaid Primer 2019. Publication number KHI/19-01. www.khi.org/assets/uploads/news/14859/2019_medicaid_primer_r_web.pdf

* Indicator has a confidence interval width >1.2x the estimate and should be interpreted with caution.