Principle Characteristics of Minnesota

Demographics

Known as the Land of 10,000 Lakes, Minnesota is a medium-sized state, covering slightly over 84,000 square miles. In 2018, 5,611,179 people lived in the state, with more than half (55%) of its residents living in the 7-county Minneapolis-St. Paul metropolitan area. 

Figure 1. Map of Minnesota State Community Health Services Advisory Committee Regions

For most of the twentieth century, Minnesota had a relatively homogeneous population. While non-Hispanic whites made up 97.8% of the state’s population in 1960, they made up 81.6% in 2018. Between 2010 and 2018, the state has added over four times as many people of color (Asian/Pacific Islander, Black, multiracial, and/or Hispanic) and American Indians than non-Hispanic white residents. Populations of Color and American Indians are distributed unevenly across the state, being more likely to live in urban than rural areas. Between 2010 and 2018, the fastest growing racial group in Minnesota was the Black population, which grew by 35.6%, adding around 99,500 people. Second fastest was the Asian population, which grew by 32.6%, adding over 70,000 people, followed by multiracial, which grew by 28%, adding 28,000 people. While less diverse than the United States as a whole, in 2018, 30% of Minnesota births were to women of color. Furthermore, 31.9% of children under age 5, and 31.4% of children under 18, were of color or American Indian. The percentage of preschool-age children of color is approaching 50% or more in some areas, such as Mahnomen County (71%), Nobles County (60%), Ramsey County (54%), and Hennepin County (48%).

Minnesota is home to eleven federally-recognized Tribal Nations. The Minnesota Chippewa Tribe is the centralized governmental authority for six of these and its governmental powers are divided between the tribe and the individual bands. Each band directly operates their reservations. The Minnesota Chippewa Tribe is comprised of Bois Forte, Fond du Lac, Grand Portage, Leech Lake, Mille Lacs, and White Earth. Red Lake is the other Chippewa Band and one of only two entirely closed reservations in the U.S. The Chippewa self-identify as Anishinaabe, and are also known as Ojibwe. The other four American Indians tribes are Dakota (Sioux), with four Communities: Lower Sioux, Prairie Island, Shakopee-Mdewakanton, and Upper Sioux. Approximately 120,000 people in Minnesota identify as American Indian and/or Alaska Native, representing 2.2% of the state’s population. About 20% American Indians in Minnesota live on a reservation, 25% in a county adjacent to a reservation, 29% in Hennepin and Ramsey counties, and 26% in other counties.

Figure 2. Minnesota Tribal Nations Map

Fifty-three percent of Minnesota’s foreign-born population are naturalized United States citizens. In 2018, Minnesota’s largest foreign-born groups were born in Mexico, Somalia, India, Laos (including Hmong), Vietnam, China, Ethiopia, and Thailand (including Hmong). Minnesota is home to more refugees per capita than any other state, and the state has the largest Somali and urban Hmong populations in the nation, with most living in Minneapolis and St. Paul. Over half of Minnesota’s Asian population identifies as Southeast Asian (compared to 20.7% nationally). More than 80 languages are spoken in the Twin Cities, and 11.7% of Minnesotans ages 5+ speak a language other than English at home. Many immigrants, who came to the state in their teens or early 20s, are now having children, and influencing the racial and ethnic make-up of the state.

Although birth rates are at historic lows, Minnesota had a population growth rate of 6.1% between 2010 and 2018, adding 325,491 residents (net). Most of Minnesota’s growth has been in the seven-county Twin Cities metropolitan area. The fastest growing counties by population between 2010 and 2018 (net growth) were Carver (16.4% increase), Scott (12.5%), Washington (9.8%), Wright (9.5%), and Hennepin (9.4%). The counties that added the most residents between 2010 and 2018 on net were Hennepin (+108,679), Ramsey (+43,592), Dakota (+30,006), Anoka (+27,007), Washington (+23,376), and Scott (+16,183). Forty-five counties have lost population since 2010.

In 2018, Minnesota was home to 1,302,615 children under age 18, representing 23.2% of the population. There were 67,348 live births in the state in 2018, down from the peak of 73,675 in 2007. Minnesota’s age distribution is similar to the United States overall. In 2018, children under the age of five accounted for 6.3% of the state’s population, 18 years and older comprised 76.8%, and people 65+ comprised 15.9%. By 2035, the number of those ages 65+ is expected to surpass the number of those under 18 for the first time in history. Minnesota’s diverse cultural groups have very different age distributions. Our state’s large Baby Boomer generation, born between 1946 and 1964, is overwhelmingly white, one of the reasons for a higher median age among white Minnesotans than any other group. In contrast, most populations of Color are much younger, particularly among Somali and Hmong Minnesotans, with half or more of the population under the age of 22. While Minnesotans ages 18-64 are the majority of the present-day workforce, children under 18 represent the workforce of the near future and their preparation is critical to the continued economic success of the state. Key demographic changes in Minnesota include an aging population, a decrease in birth numbers, an increase in communities of color, growth concentrated in urban areas, and a rising ratio of dependent elderly people and children to the working-age population. These changes will have many implications, impacting the need for and type of healthcare services, housing, education, business, commerce, and social services.

Economics

Minnesota’s seasonally adjusted unemployment rate of 3.3% (December 2019) is slightly lower than the national unemployment rate of 3.5%. In 2018, the median household income for Minnesotans was $70,300. From 2010 to 2018, the number of part-time workers in Minnesota decreased by 88,900 whereas the number of full-time workers increased by 296,900 (59% to 64%).In June 2020, Minnesota’s unemployment rate rose to 9.9% due to the impact of lay-offs related to the COVID-19 pandemic.

Since the beginning of the decade, Minnesota has seen clear and steady progress toward greater economic stability for populations of color. However, there remain significant disparities in the median household income, employment, and poverty between and within racial and ethnic groups. The number of Minnesotan children and families living in poverty remains a concern. In 2018, an estimated 529,000 Minnesotans, including 150,000 children under 18 had family incomes below the official poverty threshold, and the overall poverty rate remains around 10%. More alarming is the persistent disparity in poverty among American Indian children and children of color. Among children ages 0-17, poverty rates in 2018 were highest among those identifying as American Indian (39%), Black (33%), and Hispanic (23%), which was 3.8- to 6.5-times greater than seen among non-Hispanic white children (6%). It is too early to know the long-term economic impact of the pandemic on Minnesota families. Conversations have started related to the COVID cliff, in anticipation of families no longer receiving the additional unemployment compensation.

Education

Minnesota’s high school graduation rate has been improving. In 2018, the state had a record number of high school graduates: 55,869 (83.2%) students graduating. Additionally, 3,641 students from earlier classes earned high school diplomas in 2018, graduating five to seven years after starting high school. Despite rising high school graduation rates, gaps remain between white students and students of color. In 2018, graduation rates increased statewide for all racial/ethnic groups, as well as for English learners, students receiving special education services, and students qualifying for free or reduced-price meals.

Figure 3. High School Graduation Rates by Race/Ethnicity –2014, 2016, & 2018

Figure 3 shows the improvement in graduation rates across race/ethnicity. From 2014-2018, graduation rates increased by:

• 7.2 percentage points (PP) for Black students
• 4.2 PP for Asian students
• 3.6 PP for Hispanic students
• 3.0 PP for students identifying as two or more races
• 2.8 PP for American Indian/Alaska Native students
• 1.9 PP for white students

Minnesota also saw an increase in graduation rates for students receiving special education services, students eligible for free or reduced-price meals, and English learners (4.0 PP, 3.5 PP, and 2.5 PP, respectively).

The graduation rate of students of color and American Indian students combined increased 4.9 percentage points during this same five-year period, representing a 15% reduction in the gap between white and non-white students. This translated to 977 additional students of color and American Indian students, including 515 more Black students, graduating with the Class of 2018 versus that of the Class of 2014.

Health Care Insurance Environment

Comprehensive, quality health care services are important for promoting and maintaining health throughout the lifespan. Minnesota’s health care system consistently ranks near the top in overall performance according to the Commonwealth Fund. In addition to a public health insurance infrastructure that served 93.1% of eligible children and 86.4% of eligible parents in 2017, Minnesota coordinates a comprehensive set of health insurance options intended to help meet the health and well-being needs of Minnesotans. However, not everyone in the state has equal access to health insurance coverage – based on their race, economic situation, geographic location, and other factors.

Insurance Coverage and Cost

Despite a strong economy, Minnesota’s uninsured rate saw one of its largest, one-time increases since 2001, from 4.3% in 2015 to 6.3% in 2017 – leaving approximately 349,000 Minnesotans uninsured. The rate increase coincided with two private market trends: a decline in Minnesotans with coverage offered by employers (group coverage), and a decrease in enrollment in the individual market. Public coverage increased by 3 percentage points to 36.5% over this two-year period. Top reasons cited for losing insurance in the 2017 Minnesota Health Access Survey included losing a job that offered coverage, losing eligibility for coverage, or finding the cost of coverage too high (53% reporting). Unlike in 2015 when the decrease in uninsured rates was felt in nearly all demographic groups, this new group of uninsured were more likely to be young adults (age 18 to 34), in a lower income bracket, and people of color or American Indians. Analysis by the State Health Access Data Assistance Center looking at 5-year estimates from 2014-2018 showed large ranges in uninsured rates by geography, race/ethnicity, and educational attainment among Minnesotans. The economic development region (EDR) with the highest average uninsured rate among its county constituents was the Headwaters region in North Central Minnesota (12.10%) and the lowest was the Central region (3.99%). In the Twin Cities EDR, uninsured rates vary widely across race/ethnicity and are highest for those identifying Hispanic ethnicity, American Indian/Alaska Native alone (12.5%), and Black/African American, and some other race. Another stark disparity in uninsured rates exists across levels of educational attainment: less than a high school education (17.0%), high school diploma (7.2%), some college/associate degree (4.6%), bachelor’s degree or higher (1.8%).

While household incomes grew 80% between 1997 and 2016, family budgets devoted to health care spending rose more than twice as fast. Figure 4 displays the disproportionate increase in health care spending compared to common expenses. There is no substantial evidence that increased health care spending leads to similar positive gains in health.

Figure 4. Cumulative Growth in Household Spending, Select Categories (1997-2016)

Impact of COVID-19 Pandemic on Insurance

Like others across the United States, many Minnesotans have found themselves unemployed and/or without health insurance due to the economic implications of the COVID-19 pandemic. Minnesota did option to open up its individual market (MNsure) for a special enrollment period for a short period of time (March 23, 2020 – April 21, 2020) for those who were uninsured – those who found themselves unemployed or without insurance after that period would theoretically be eligible for an individual special enrollment period due to their change in circumstances. At the time of writing, the state is still compiling numbers on how the pandemic has impacted uninsurance rates.

The national Coronavirus Aid, Relief, and Economic Security (CARES) Act requires that COVID-19 tests be covered without cost sharing – and this applies to all health insurance coverage in Minnesota. However, this cost-sharing applies to the test only, and not office visits that are associated with being tested. Therefore, some Minnesotans have found themselves with high cost medical bills associated from office visits. Some insurance carriers in the state have agreed to waive cost-sharing for in-network visits associated with the COVID-19 test. However, it is left to the person seeking the test to check with their insurance provider to see what is covered and what is in network. To help with this issue, MDH has worked in partnership with communities to provide safe and free onsite COVID-19 tests in areas with outbreaks, increasing cases, or other barriers to existing test sites. However, registration is typically required for these events and spots fill up very fast.

Minnesota Health Care Programs

Minnesota Health Care Programs (MHCP) provide health care coverage to eligible families with children, adults, people with disabilities, and seniors. MHCP include Medical Assistance (Minnesota’s Medicaid Program), MinnesotaCare, and the Minnesota Family Planning Program (described below). These programs are administered by the Minnesota Department of Human Services (DHS).

MHCP financed 43.9% of all births (29,574 infants) in 2018, down slightly from 44.8% in 2017 and 44.7% in 2016. Total spending on health care services for MCHP was approximately $13 billion in 2018, and was forecasted to be $13.9 billion for FY2020 (before the COVID-19 pandemic). The latest MDH Minnesota Health Care Spending report showed that the slower health care spending growth in 2016 was driven by reductions in spending for beneficiaries of MHCP. The spending reduction resulted from changes in how the Minnesota DHS negotiated payments to health plans.

Medical Assistance

Medical Assistance (MA) is a state and federal program that provides health insurance that covers a broad array of health services for people, including families and children with low-incomes, older adults, and people with disabilities. Medicaid covers one out of every five Minnesotans, a monthly average of 1.1 million Minnesotans. As the third largest insurer in the state after self-insured employer-based coverage and Medicare, it makes up nearly 16% of the state’s health insurance market. The composition of enrollees is 65% families with children, 17% seniors and people with disabilities, and 18% adults without children. Children ages 0 to 18 are the single largest group making up 45% of total enrollment. Figure 5 shows the percentage of the population from each region of Minnesota that are enrolled in MA.

Figure 5. Percentage of the Population within the Region Enrolled in Medicaid

Income eligibility requirements for MA vary by age, and are included in Table 1 below. It is important to note that if someone makes more than the income limit, they may still be eligible for coverage using a spenddown (a cost-sharing approach that allows people with incomes greater than the applicable limit to “spend down” their excess income to the appropriate income limit by deducting certain health care expenses).

Table 1. Minnesota’s Income Eligibility Levels for Medicaid

Population	Income Eligibility Level, based on Federal Poverty Level (FPL)
Infants up to 2 years old	283% FPL
Pregnant women	275% FPL
Children 2 – 18 years old	275% FPL
Parents Children 19-20 years old Adults under 65 years old	133% FPL (>133% - 200% FPL income eligibility for MinnesotaCare)
Adults 65 years old and older People who have a disability or are blind	100% FPL

Most Minnesotans enrolled in MA receive services through health plans or managed care organizations (approximately 79% of enrollees). The remaining enrollees (around 234,000 people or 21% of enrollees) receive services through the traditional fee-for-service system, where providers receive a payment from the DHS directly for each service provided to an enrollee. Those who remain on fee-for-service primarily consist of those who are not required to enroll in managed care or who have chosen to opt out of managed care. In general, this includes: those with disabilities, people who are eligible with a spenddown, children receiving adoption assistance, and American Indians who live on a federally-recognized reservation.

MinnesotaCare

MinnesotaCare is a state and federal program that provides a low-cost health insurance option to people who do not have access to affordable employer-sponsored health insurance and have higher income levels than those eligible for Medicaid. Minnesota is one of two states with this type of insurance coverage program, which is known as a Basic Health Program. MinnesotaCare provides comprehensive health care coverage for more than 94,000 Minnesotans, who pay no more than $80 a month in premiums. Income eligibility is for adults with incomes over 133% federal poverty line (FPL) up to 200% of FPL.

Additional Assistance for Families of Children with Disabilities

Minnesota is one of 19 states that allows parents who have a child with a disability the option to obtain MA through the Katie Beckett provision under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) if they are unable to meet the Medicaid income limit. Prior to this, families with children with disabilities who needed MA coverage but wanted care at home faced significant eligibility barriers due to the consideration of the income and assets of the parents. Oftentimes, those parents with a household income above eligibility requirements would have to place their child with a disability in an institutional setting to be able to obtain MA. Under Minnesota’s TEFRA program, higher income families raising a child with a disability can access MA by paying a fee. The payment amount is determined using a sliding scale based on the family’s annual adjusted gross income. Fees do not exceed the cost of services delivered. Legislation passed in 2017 in Minnesota to provide parental fee relief, and bills continue to be introduced to eliminate the parental fee. Nearly 3,000 Minnesota children with disabilities are enrolled in TEFRA.

Children’s Health Insurance Program

The Children’s Health Insurance Program (CHIP) supplements existing federal Medicaid funds that provide health care coverage for low-income Minnesota families. Minnesota has used CHIP funds to expand our state’s MA program. When the program was created in 1997, Minnesota already covered most of the children Congress intended to cover through CHIP. Therefore, the Minnesota Legislature chose to use CHIP funds to extend benefits to a small group of children who did not have coverage at the time: those under age 2 with family incomes between 275% and 283% of the FPL. In 2001, Minnesota obtained a federal Section 1115 waiver to allow the state to use CHIP funds to add coverage for parents of some children on Medicaid. Over time, Congress also revised the CHIP law (Title XXI of the Social Security Act) to allow states to extend coverage to pregnant women who were ineligible for Medicaid and to use CHIP funding for Medicaid-enrolled children with incomes above 133% of the FPL. Minnesota uses its federal CHIP funds to cover the populations in Table 2 below.

Table 2. Populations Covered by Federal CHIP Funding in Minnesota (2018)

Advanced Premium Tax Credit

Another public program that assists Minnesotan’s with health care coverage is the Advanced Premium Tax Credit, a federal program that reduces the cost of premiums for individual health insurance based on income, available through federal or state marketplaces, such as MNsure (Minnesota’s health insurance marketplace). Approximately 113,000 people enrolled in health plans through MNsure in 2019. This is a decrease from the record number of enrollees who signed up in 2018 (116,358) and 2017 (114,810).

Meeting the Needs of Minnesota’s Most At-Risk Populations

Minnesota has worked to build a comprehensive and holistic system of supports aimed at meeting the needs of our most at-risk populations, including persons of color and American Indians, those from rural areas of the state, and persons with disabilities.

Hospitals

Minnesota is home to many phenomenal hospitals, including the number one ranked hospital in the United States, according to U.S. News and World Report – the Mayo Clinic in Rochester. As of March 2020, there were 129 state licensed hospitals with 16,157 beds, of which 77 are designated Critical Access Hospitals (CAHs). CAHs are smaller hospitals (fewer than 25 beds), mostly in rural areas, which receive higher reimbursement from Medicare, as long as they maintain certain services. However, Minnesota hospitals are finding it harder and harder to sustain themselves. Between 2000 and 2015, the number of community hospitals in the state decreased by 5.8%.

Pregnant persons living in rural areas have particularly experienced the issue of declining hospital services, as the number of community hospitals offering birth services in rural counties fell 37%. This is especially concerning because giving birth in a hospital without obstetric services can lead to higher rates of hemorrhage, emergency surgery, and maternal death. More rural hospitals are planning to stop offering birth services in 2020, further deepening disparities seen in access to prenatal and birth care.

Minnesota’s hospitals voluntarily participate in a statewide trauma system by attaining designation as a Level 1, 2, 3, or 4 trauma hospital. These designation levels reflect the resource capabilities of the hospital (with a Level 1 facility having the most capabilities). Around 98% of Minnesotans live within 60 minutes of a trauma hospital, which is an important predictor of survival after sustaining a traumatic injury or needing life-saving care. However, though Minnesotans overall fair well when it comes to living near a trauma hospital, designated pediatric facilities are lacking in rural Minnesota. All four Level 1 pediatric facilities are located in the Twin Cities or Rochester. There are three Level 2 pediatric facilities serving Minnesota residents in Duluth and two in bordering states (Fargo, ND and Sioux Falls, SD).

Health Care Homes and Behavioral Health Homes

Health Care Homes (HCHs) was a cornerstone of Minnesota’s bipartisan health reform efforts in 2008. The voluntary program continues to support primary care providers, families, and patients to work in partnership to improve health outcomes and quality of life for patients, including those with chronic conditions or disabilities. As of December 2019, a total of 378 clinics in Minnesota were certified as HCHs (55% of the 683 primary care clinics in the state), serving 64 counties (74%). Minnesota’s HCH efforts reduced Medicaid costs by 9% and helped to reduce inpatient hospital admissions, hospital outpatient visits, skilled nursing facilities and pharmacy costs. Even more impressive was that racial disparities were significantly smaller for Medicaid, Medicare, and Dual Eligible beneficiaries served by HCHs versus those served in non-certified clinics.

Behavioral Health Homes (BHHs) were implemented in 2016 for eligible people with serious mental illness, serious and persistent mental illness, emotional disturbance, or severe emotional disturbance -- a subpopulation of persons known to be at higher risk for poorer health outcomes and fragmented care. BHH services build upon the successes of HCH and create a comprehensive care coordination service that integrates physical health, mental health, the health concerns of substance use, long-term services and supports, and social services for people. There are currently 37 provider locations certified to provide BHH services.

Family Planning

The Minnesota Family Planning Program (MFPP) and the Family Planning Special Projects (FPSP) program provide vital family planning services to low-income or otherwise underserved people.

The MFPP, administered by DHS, provides family planning services (e.g., contraception services, and sexually-transmitted infection screening and treatment) and transportation services to and from providers of family planning service for people between 15 and 50 years old, who are not eligible for other public programs, and who have an income at or below 200% of the federal poverty level. Applicants may apply directly at a provider's office.

The FPSP program is administered by MDH, and provides low-income, high-risk people pre-pregnancy family planning services. MDH receives state and federal TANF funds to provide statewide family planning services and infrastructure support to family planning clinics. Using these funds, the FPSP program awards more than $6.3 million annually to local family planning providers including counties, Tribal governments, and nonprofit organizations. Funding is targeted to people who would have difficulty accessing services because of barriers such as poverty, lack of insurance, or transportation. During state fiscal year 2019, FPSP reached around 101,560 people through outreach activities (e.g., classes and health fairs), and provided 28,942 men and women with a range of family planning method services – with 22.5% of women choosing Tier 1 (most effective), long-acting reversible contraceptives.

Together, these funding sources support a statewide system of family planning clinics. Because of changes in federal Title X Family Planning Grant eligibility requirements Planned Parenthood in Minnesota chose not to accept funding. Because of this funding reduction, multiple sites within Greater Minnesota were unable to continue to support their clinics and thus reduced access to women’s health services across the state.

Family Home Visiting

Family home visiting (FHV) is a voluntary, home-based service ideally delivered prenatally through the early years of a child's life. FHV provides social, emotional, health-related and parenting support and information to more than 14,000 of Minnesota’s most at-risk families, and links them to appropriate resources. By participating in home visiting, some examples of services a family may receive are:

• Connections/referrals for pregnant persons to prenatal care;
• Early support to parents in their role as a child’s first teacher;
• Help in creating a safe and healthy environment for a young child to thrive in; and
• Parenting skills and support that decrease the risk of child abuse.

FHV services in Minnesota are supported by a number of funding streams, including state, federal, and local resources. At the state level, MDH oversees and distributes funding for home visiting services provided under Temporary Assistance to Needy Families (TANF) funding, the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, Minnesota evidence-based home visiting funding, and Minnesota's Nurse-Family Partnership legislation. Funding administered by MDH is granted to Community Health Boards, Tribal Governments, and non-profit organizations. Local tax levies and Medical Assistance reimbursement also fund FHV in Minnesota.

Women, Infants, and Children (WIC) Special Supplemental Nutrition Program

WIC is a special supplemental nutrition program for pregnant and post-partum women, infants and children up to age 5 who are at nutritional risk and meet specific income guidelines or who are enrolled in TANF, SNAP or Medicaid. The program is funded by USDA and provides the following services to influence lifetime nutrition and health behaviors in high-risk populations:

Nutrition Services & Breastfeeding Support

• Participants receive an individualized nutrition assessment along with education and referrals to community resources.
• WIC promotes and supports breastfeeding, including exclusive breastfeeding for the first six months of an infant’s life.
• WIC supports healthy diets and infant feeding practices. These practices can help prevent obesity and anemia among other benefits.
• Many local WIC programs provide peer breastfeeding support to mothers and infants.

Healthy Foods

• WIC provides healthy foods including fruits, vegetables, whole grains and low fat dairy. The WIC food package contributes to healthy diets, which aid in preventing obesity and chronic disease.

In 2019, MN WIC provided healthy food and nutrition services to over 162,000 pregnant women, infants and young children.

Minnesota’s Government

In 2019, Tim Walz was elected Minnesota’s 41st Governor and Peggy Flanagan is Minnesota’s 50th Lieutenant Governor, our first American Indian Lieutenant Governor. The Governor’s career has been defined by public service, from serving our country in the military to serving our students as a high-school teacher and coach, to serving our state in Congress. The Lt. Governor’s career has focused on giving back, particularly to children, families, communities of color, American Indians, and low-income and working people. As a former State Representative and community organizer, Lt. Governor Flanagan brings her experiences of building coalitions and advocating for children and families. This new Administration has committed to “make Minnesota the best place for each and every child to grow up.”

Children’s Cabinet

Minnesota’s Children’s Cabinet is an interagency partnership the Governor has charged with helping to make Minnesota the best place for each and every child to grow up. The Children’s Cabinet was established in 1993 (Minnesota Statute § 4.045), and is a broad interagency partnership of 22 state agencies that utilizes a whole-family systems approach to support the healthy development of children and families. The cabinet includes Commissioners from the Minnesota Departments of Administration, Agriculture, Commerce, Corrections, Education, Employment and Economic Development, Health, Housing Finance Agency, Human Rights, Human Services, Labor and Industry, Management and Budget, Military Affairs, Natural Resources, Public Safety, Revenue, and Transportation. Representatives from the state’s Office of Higher Education, Met Council, Minnesota IT Services, the Iron Range Resources and Rehabilitation Board, and Pollution Control Agency also participate.

The Children’s Cabinet works to bring efficiency and effectiveness to state government efforts to improve child and youth outcomes. The work of the Cabinet can also involve collaboration with counties, local communities and other stakeholders.

The Cabinet utilizes a results-based accountability lens in these priority areas:

• Healthy Beginnings (addressing infant and maternal mortality)
• Child Care and Early Education
• Mental Health and Well-Being
• Housing Stability

The Children’s Cabinet established work groups of Assistant Commissioners, Division Directors, and subject matter experts from each agency, to address the priorities. The CFH Division Director, along with Title V staff, participate fully in these initiatives, bringing subject matter expertise; coordination of data; programs and services; and a developing health and racial equity perspective to the work. This work has culminated in grant proposals, including: the Preschool Development Implementation Grant, legislative proposals related to systems coordination, and collaborative processes with sister agencies around race equity training for early childhood leadership through the BUILD initiative.

Maternal and Child Health Advisory Task Force

The MCH Advisory Task Force was created by the Minnesota Legislature in 1982 (Minnesota Statute § 145.8811) to advise the Commissioner of Health on:

1. The health care needs of mothers and children throughout Minnesota;
2. The type, frequency and impact of maternal and child health services in the state;
3. Program guidelines and criteria considered essential to providing an effective maternal and child health care program to low-income populations and high risk persons and fulfilling the purposes of the state and federal maternal and child health statutes;
4. The use of federal and state funds available to meet maternal and child health needs;
5. Priorities for funding the following maternal and child health services:
   1. Prenatal, delivery and postpartum care;
   2. Comprehensive health care for children, especially from birth through five years of age;
   3. Adolescent health services;
   4. Family planning services;
   5. Preventive dental care;
   6. Special services for children with chronic illness or disabilities, and
   7. Any other services that promote the health of mothers and children; and
6. Establish statewide outcomes that will improve the health of mothers and children.

The Task Force consists of 15 legislatively-authorized members appointed by the Commissioner of Health to four-year teams with equal representation in three categories:

• Professional representatives with expertise in maternal and child services,
• Community health boards representatives, and
• Consumer representatives interested in the health of mothers and children.

For a complete list of members on the MCH Advisory Task Force, please refer to the MCH Advisory Task Force webpage (health.state.mn.us/communities/mch/mchatf/members.html).

Minnesota Department of Health

The mission of MDH is to protect, maintain and improve the health of all Minnesotans. The department has broad responsibilities in the areas of health protection, health improvement, and reforming the health care system around a public health framework. Historically, Minnesota is cited consistently among the top 10 states for overall health, best run state, and best state to raise a family. However, these overall ratings mask the significant inequities and the persistent health disparities based on race, geography and/or economic status within Minnesota. While significant attention has been given to health equity and the need for safe, stable environments for our children, the disparities persist.

Healthy Minnesota Partnership

MDH facilitates the Healthy Minnesota Partnership, which brings together community partners to improve the health and quality of life for people, families, and communities. The partnership is responsible for developing a statewide health improvement plan based upon a statewide health assessment. The 2017 Statewide Health Assessment gave us a picture of the health and well-being of people across the state, and resulted in increased emphasis on the persistent inequities for populations of color and American Indians, the LGBTQ community, women and children, and for people with disabilities. The statewide health assessment set the stage for Healthy Minnesota 2022, which identified three priorities: the opportunity to be healthy is available everywhere and for everyone; places and systems are designed for health and well-being; and all can participate in decisions that share health and well-being. Included with each priority are two key conditions to track using an array of indicators (see Figure 6).

Figure 6. Healthy Minnesota 2022 Framework

Health Equity at MDH

Research shows that the conditions needed for health are peace, shelter, education, food, income, and social justice. In short, health is created where people live, work, and play. Minnesota needs to address health disparities as part of a broad spectrum of public investments in housing, transportation, education, economic opportunity and criminal justice. The MDH Center for Health Equity (CHE) was created in 2013 to advance health equity within the health department and across the state. The mission of the CHE is to connect, strengthen, and amplify health equity efforts within MDH and across the state of Minnesota. Figure 7 shows the mission, values, and approaches of the CHE at MDH. One of the first initiatives of the CHE was the development of the 2014 Advancing Health Equity report, which focused our work as a health department on eliminating health disparities.

Figure 7. MDH Center for Health Equity Mission, Values, and Approaches

Legislative Priorities

During the 2019 Legislative session, with a strong emphasis on early childhood, the Administration worked closely with the legislature to address these priority areas for Minnesota’s children and families. Despite a significant budget surplus at the time, the divided House and Senate did not pass any bills related to these priorities. The bills that passed enhanced the oversight of nursing homes across the state and expanded services to address the opioid epidemic.

Early Childhood

Minnesota’s state agencies recommitted themselves to focus on supporting families with young children who are experiencing racial, geographic, and economic inequities so they can be born healthy and thrive within their families and communities. An impetus for this recommitment was the state’s receipt of a Preschool Development Planning Grant (PDG) in 2019. The grant is a partnership between the Minnesota Departments of Health, Education, and Human Services, along with the Children’s Cabinet. Several staff from MDH supported the work of the planning grant, including conducting a needs assessment, in partnership with community grantees. The needs assessment involved holding listening sessions across the state with multiple stakeholders. Community partners and families stressed the need for an inclusive and streamlined system where families can access education, human services, and health services and also stressed that services should be trauma informed, culturally responsive, and more family centric. A strategic plan was developed based on the learnings from the needs assessment, and then in December 2019, Minnesota was awarded a $26 million PDG implementation grant.

MDH staff engaged in additional early childhood initiatives, including:

• Expanded Help Me Grow, which has focused on implementing the national Help Me Grow model within the state. During 2019, partners developed an online resource directory called Help Me Connect. This project is described in more detail in the Child Health domain.
• Early Childhood Longitudinal Data System, where staff contributed to developing shared data, narrative, and indicators around five key outcomes: Kindergarten readiness, 3rd grade reading, high school graduation, closing the opportunity gap, and college and career readiness.

Children Impacted by Incarceration

Late in 2018, the State Community Health Advisory Council identified the need for a workgroup to address the role of local public health (LPH) in working with children who have parents who either are or were incarcerated at some point during the child’s life. This grew out of the Minnesota Student Survey data that indicated 1 in 6 of Minnesota children have a parent who is either currently incarcerated or has spent time in jail or prison. Title V staff facilitated the workgroup for part of the year, with the Division Director participating on the work group.

Recommendations from the workgroup resulted in some local jails making changes to allow for more open visitation and friendlier visit settings for children, as well as developing and encouraging parenting support and education during incarceration. Collaborative work continues with five jails across Minnesota through a community of practice, with a recent grant application to the Department of Justice to further support and advance this work.

Title V MCH Block Grant Specific Statues

Minnesota Statutes § 145.88 – 145.883 lay out requirements for the distribution of Minnesota’s federal Title V Maternal and Child Health Block Grant award. Statutory language allows the Commissioner of Health to retain up to one-third of the block grant to:

• Meet federal requirements of a statewide needs assessment and prepare the annual federal block grant application and report,
• Collect and disseminate statewide data on the health status of mothers and children,
• Provide technical assistance to LPH agencies in meeting statewide outcomes,
• Evaluate the impact of maternal and child health activities on the health status of mothers and children,
• Provide services to children under age 16 receiving benefits under Title XVI of the Social Security Act, and
• Perform other maternal and child health activities as listed in federal code for the MCH block grant and as deemed necessary by the Commissioner of Health.

The remaining two-thirds of the approximately $9.1 million awarded annually to Minnesota is distributed by formula to Community Health Boards (CHBs) that provide local public health services across the state. In addition, the statute requires that CHBs provide at least a 50% match for the Title V funds they receive. Title V funds allocated to LPH agencies must be used for programs that:

• Address the highest risk populations, particularly low-income and minority groups with a high rate of infant mortality and children with low birth weight
• Specifically target pregnant people whose age, medical condition, maternal history or chemical use substantially increases the likelihood of complications associated with pregnancy
• Address the health needs of young children who have or are likely to have a chronic disease or disability
• Provide family planning and preventive medical care for specifically identified target populations
• Address child and adolescent health issues
• Address child abuse and neglect prevention, reducing juvenile delinquency, promoting positive parenting and resiliency in children through public health nurse home visits

Minnesota statutes also articulate maternal and child health program requirements and state supported efforts for a variety of services, including: family planning; abstinence education; fetal alcohol syndrome; maternal depression screening, education and information; breast-feeding; safe sleep for newborns; promoting Baby Friendly hospitals; Women’s Right to Know; Positive Alternatives to Abortion Program; maternal mortality review; Family Home Visiting Program; Birth Defects Information System; the Early Hearing Detection and Intervention Program; and tests of infants for heritable and congenital disorders.