Principle Characteristics of Minnesota

Demographics and Geography

Minnesota is a medium-sized state, covering slightly over 84,000 square miles across 87 counties and 11 Tribal Nations. In 2021, 5,707,390 people lived in Minnesota, with over half (55.8%) of residents living in the seven-county Twin Cities metropolitan area.

While non-Hispanic white made up 97.8% of the state’s population in 1960, they made up 76.7% in 2021. Between 2010 and 2020, the state population BIPOC and American Indians increased by over 57.5% while the number of non-Hispanic white residents fell by 3.8%. The BIPOC population is distributed unevenly across the state, being more likely to live in urban than rural areas. Between 2010 and 2020, the fastest growing racial group in Minnesota was the multiracial population, which grew by 176%, adding 220,576 people. Second fastest was the Black population, which grew by 45.2%, adding 124,022 people, followed by the Asian population, which grew by 39.7%, adding 84,956 people. While less diverse than the United States as a whole, in 2020, 33.7% of Minnesota births were to BIPOC persons.

As of 2018, 53% of Minnesota’s foreign-born population were naturalized United States citizens. In 2018, Minnesota’s largest foreign-born groups were born in Mexico, Somalia, India, Laos (including Hmong), Ethiopia, Vietnam, China, 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. Over half of Minnesota’s Asian population identifies as Southeast Asian (compared to 20.7% nationally). Over 100 languages are spoken at home in Minnesota, and 12.3% of Minnesotans ages 5+ spoke a language other than English at home in 2019.

Although birth rates are at historic lows, Minnesota had a population growth rate of 7.6% between 2010 and 2020, adding 402,569 residents (net). Most of Minnesota’s growth has been in the seven-county Twin Cities metropolitan area, and 36 counties have lost population since 2010.

In 2021, Minnesota was home to 1,305,405 children under age 18, representing 22.9% of the population. There were 64,459 live births in the state in 2021, down from the peak of 73,675 in 2007, but up from the low of 63,426 in 2020. In 2021, children under 5 accounted for 5.7% of the state’s population, 18 years and older comprised 77.1%, and people 65+ comprised 16.9%. 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 Indigenous Communities

Minnesota is home to 11 federally recognized tribal nations and communities, including seven Anishinaabe Tribes (Figure 2):

Bois Forte Band of Chippewa
Fond du Lac Band of Lake Superior Chippewa
Grand Portage Band of Lake Superior Chippewa
Leech Lake Band of Ojibwe
Mille Lacs Band of Ojibwe
Red Lake Nation
White Earth Nation

As well as four Dakota (Sioux) communities:

Lower Sioux Indian Community
Prairie Island Indian Community
Shakopee-Mdewakanton Sioux Community
Upper Sioux Community.

Figure 2. Minnesota Tribal Nations and Communities

While each tribe and community has its own governing body, the Minnesota Chippewa Tribe is the centralized governmental authority for six of the Anishinaabe Tribes, also known as bands, with governmental powers divided between the Minnesota Chippewa Tribe and the individual bands who directly operate their tribal nation. Red Lake is the seventh Anishinaabe band and one of only two entirely closed reservations in the United States, meaning the tribe has complete and sole regulatory authority over all lands and people residing within the reservation boundaries. For example, Red Lake Nation is exempt from Public Law 280 which grants a state criminal jurisdiction over people living on reservation lands, as well as power to allow civil litigation under tribal or federal court to be handled by state courts.[1]

As of 2021, approximately 134,138 people in Minnesota identified as American Indian and/or Alaska Native (either alone or in combination with one or more other races) representing 2.4% of the state’s population. About 40,333 (30%) American Indians lived on a reservation/community according to 2017-2021 Census estimates, while approximately 50,870 (37.9%) American Indians/Alaskan Natives live in the Twin Cities metropolitan area.[2] The additional 32.1% of American Indians live in greater Minnesota.

It is important to recognize that structural and systemic racism plays an integral role in perpetuating poor health outcomes among American Indian women, children, and families, who experience the greatest health disparities in Minnesota. These disparities are caused by historical and ongoing trauma, racism, and colonial practices and policies that create barriers to opportunity and thriving. For example, into the 20th century Anishinaabe and Dakota peoples were continuing to experience displacement, broken treaties, and exploitation of their land by the United States and Minnesota State governments, often through violence and coercion, including genocide.[3] These practices over the last several centuries created and continue to maintain the disparities seen in American Indian MCH populations in Minnesota today.

“Today, treaties continue to affirm the inherent sovereignty of American Indian nations, enabling tribal governments to maintain a nation-to-nation relationship with the United States government; manage their lands, resources, and economies; protect their people; and build a more secure future for generations to come”.[4] In recognition of Minnesota American Indian tribes and communities as sovereign nations – as well as acknowledgement of the harmful relationships of distrust and corruption with the federal and state governments – Minnesota, including MDH and the CFH Division, are committed to centering healing, trust, and strengths as we work to rebuild these relationships to support a thriving American Indian population.

In honoring tribal sovereignty, rebuilding healthy nation-to-nation relationships means honoring the lived experience and voices of Minnesota’s American Indian community members while honoring tribal government and research authorities, including Tribal IRBs and research boards. Given the history and ongoing use of research on American Indian peoples without permissions and to further harmful ideations and stereotypes of American Indian peoples, tribal nations and communities are cautious and particular about who, when, and how they choose to provide or engage in data driven efforts. Therefore, the Title V program can only ensure representation in our program data insofar as tribal nations and communities give us this permission. Additionally, Minnesota is not alone in the challenges around data disaggregation for American Indian and Alaska Native populations due to federal and state policies and practices that deem data around these populations as too small a sample size, statistically insignificant, as well as other areas of issue.

“American Indians and Alaska Natives may be described as the ‘Asterisk Nation’ because an asterisk, instead of a data point, is often used in data displays when reporting racial and ethnic data”.[5]

While these challenges are often referring to quantitative data, efforts to collect qualitative data presents its own set of challenges due, again, to historically harmful relationships with those who request this data, such as state government. This requires extensive, meaningful, and authentic relationship-building at not only a nation-to-nation level, but also at the population, community, and individual levels. Much of this relationship-building is happening both formally and informally at the community and individual level, including across many of the programs supported through Title V. Individual staff and programs have built successful relationships with tribal nations and communities and engage in a variety of qualitative data collections efforts in partnership with American Indian communities such as Photovoice, Indigenous evaluation and research methods, community-action research, and others. However, this becomes difficult at a larger overarching Title V level to effectively engage with tribal nations and communities for the purposes of Title V data efforts when no Title V dollars are distributed directly to Minnesota’s tribal nations and communities. Minnesota’s Title V program has begun exploring innovative approaches to ensure engagement and representation through relationship-building with our current funding structure, based in legislative statute.

Economics and Urbanization

Minnesota’s seasonally adjusted unemployment rate dropped to 1.8% in Minnesota in June 2022 and is lower than the national unemployment rate of 3.6%. In 2020, the median household income for Minnesotans was $75,523. 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%). Minnesota has seen steady progress toward greater economic stability for BIPOC communities; however, there remain significant disparities in the median household income, employment, and poverty between and within racial and ethnic groups.

The number of Minnesota children and families living in poverty remains a concern. In 2020, an estimated 457,119 Minnesotans, including 121,125 children under 18 had family incomes below the official poverty threshold, and the overall poverty rate was around 8.3%. More alarming is the persistent disparity in poverty for BIPOC communities. Among children ages 0-17, poverty rates in 2019 were highest among those identifying as American Indian (40%), Black (40%), and Hispanic (17%), which was 3.4- to 8.0-times greater than seen among non-Hispanic white children (5%).

Systems of Care in Minnesota

Health Care Insurance Environment

Comprehensive, quality health care services are important for promoting and maintaining health across the lifespan. Minnesota’s healthcare system consistently ranks near the top in overall performance according to the Commonwealth Fund. Minnesota coordinates a comprehensive set of health insurance options intended to help meet the health and well-being needs of Minnesotans.

Insurance Coverage and Cost

According to the most recent Minnesota Health Access Survey, around 264,000 Minnesotans (4.0%) lacked health insurance coverage in 2021. The maintained high rate of coverage in 2019 was consistent with levels experienced after the full implementation of the Affordable Care Act in Minnesota in 2014 when 95.3% of Minnesotans had health insurance coverage. The Premium Security Plan, created by the Minnesota Legislature in 2017, aimed to lower premiums for Minnesotans who purchase coverage in the individual market. Compared to 2017, coverage was significantly higher in 2019. To do this, Minnesota reduces the financial obligation of insurers by covering part of their expenses for high-cost health care claims (reinsurance). However, systemic racism creates barriers to accessing health insurance – BIPOC communities are approximately twice as likely to be underinsured than white people living in Minnesota. The uninsured are also more likely to be young (age 18 to 34), in a lower income bracket, have a high school education or less, and live in rural areas.

A study conducted by the MDH Health Economics Program highlights the changes in how telehealth is being used in Minnesota, and the potential for it to help many Minnesotans get the care they need, when they need it, and covered by their insurance. The preliminary report aligns with the Health and Human Services bill recently passed by the Minnesota legislature and signed into law by Gov. Tim Walz. The law extends coverage for audio-only care to June 2025, to permit more time to study and understand this relatively new form of telehealth.

Key findings from report to the legislature include:

The COVID-19 pandemic sparked a profound shift in telehealth’s role as part of our health care ecosystem.
Audio-only telehealth addresses narrow but important access challenges, especially for Minnesotans residing in rural areas or with challenges using or accessing video-based telehealth.
Minnesota patients and health care providers value telehealth’s benefits, including the convenience and flexibility it offers.
Telehealth sits at the nexus of rapidly changing systems. Telehealth shows promise for improving access, equity, and engagement in health care, but the long-term impact on health outcomes and how the availability of in-person care might change remains uncertain.

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 (MA) and MinnesotaCare (MNCare). These programs are administered by the Minnesota Department of Human Services (DHS).

MHCP financed 43.3% of all births (28,550 infants) in 2019, down slightly from 43.9% in 2018. Total spending on health care services for MCHP was approximately $13.4 billion in FY 2020 an 8.9% increase from FY 2019.

Medical Assistance

Medical Assistance (MA), Minnesota’s Medicaid Program, 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. MA covers one out of every four Minnesotans, a monthly average of 1.2 million people. 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, 15% seniors and people with disabilities, and 20% adults without children (figure 3). Children ages 0-18 are the single largest group, making up 49% of total enrollment.

Figure 3. Percentage of the Medical Assistance Enrollees Verses Expenditures by Population

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Income eligibility requirements for MA vary by age (Table 1). 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).

Effective Jan. 1, 2024, or upon federal approval and completion of state implementation requirements (whichever is later), a child under 19 years of age eligible for Medical Assistance must remain eligible for 12 months. Effective Jan. 1, 2025, 12-month continuous eligibility will be extended to include children under age 21, and children under age six will remain eligible for Medical Assistance without interruption from the time they are first determined eligible up until the month they reach six years of age. Continuous eligibility ensures that children who are already enrolled in Medical Assistance do not lose their coverage due to administrative hurdles or minor fluctuations in their family’s income [6].

Table 1. Minnesota’s Income Eligibility Levels for Medicaid

As of 2018, most Minnesotans enrolled in MA receive services through managed care organizations (about 79% of enrollees). The remaining enrollees (around 234,000 people or 21% of enrollees) received services through the traditional fee-for-service system (FFS), where providers receive a payment from the DHS directly for each service provided to an enrollee. Individuals who remain on FFS are primarily 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.

The American Rescue Plan Act, signed into law in March 2021, gives states the option to extend the Medicaid and Children’s Health Insurance Program (CHIP) postpartum periods for pregnant people from 60 days to 12 months. This option makes Medicaid and CHIP funds available for states to provide coverage during an extended postpartum period. This gives providers opportunities to assess physical recovery from pregnancy and childbirth, and to screen for and provide care to address conditions that can lead to morbidity and mortality in the later postpartum period. The 2021 Minnesota legislature enacted a law to adopt this option provided in the and extend the Medical Assistance (MA) and CHIP-funded MA postpartum period effective July 1, 2022. Though this policy does not apply to MinnesotaCare, or to Emergency Medical Assistance (EMA) which covers labor and delivery costs.

MNCare

MNCare 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 MA. Minnesota is one of two states with this type of insurance coverage program, which is known as a Basic Health Program. As of July 2021, MNCare provided comprehensive health care coverage for 103,687 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 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 over the Medicaid income limit. Prior to this, families of 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. However, during the 2023 legislative session, legislation was passed in Minnesota to provide parental fee relief – including the elimination of parental fees under both MA TEFRA and Home and Community-Based Services (HCBS) waivers [7].

Children’s Health Insurance Program (CHIP)

CHIP supplements existing federal Medicaid funds that provide health care coverage for low-income families (Table 2). 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 (children under age 2 with family incomes between 275% and 283% of the FPL). Over time, Minnesota obtained a federal Section 1115 waiver to allow the state to use CHIP funds to add coverage for parents of some children on MA and Congress revised the Title XXI of the Social Security Act to allow states to extend CHIP coverage to pregnant women who were ineligible for MA.

Table 2. Populations Covered by Federal CHIP Funding in Minnesota (2017)

Advanced Premium Tax Credit

Another public program that assists Minnesotans 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). Nearly 130,000 people living in Minnesota enrolled in private health plans through MNsure in 2022 for coverage in 2023. “MNsure’s tenth open enrollment period was a great success for the organization and the Minnesotans we serve. We helped nearly 60% of enrollees access financial help that will lower their health care costs by an average $6,220.”

Healthy Start Performance Improvement Project

Five Minnesota Health Plans – Blue Plus, Health Partners, Hennepin Health, South Country Health Alliance, and UCare – launched the Healthy Start performance improvement project in 2021. The project focuses on ensuring a “healthy start” for Minnesota children and families by improving services provided to pregnant women and infants, with a particular focus on reducing racial and ethnic disparities. The project includes working with a wide variety of partners to improve access to and coordination of resources to help mothers and children get the right care at the right time in the right setting. Ultimately, the aim is to close healthcare disparities in the following:

Timely prenatal and postpartum care
Well Child visiting in the first 30 months of life
Childhood immunization status
Low birth weight.

Impact of COVID-19 Pandemic on Insurance

Since March 2020, Minnesota – like other states – maintained continuous health care coverage for Medicaid enrollees. Minnesotans who newly gained eligibility or already had eligibility for Minnesota Medicaid or Minnesota Care remained enrolled in the coverage regardless of life changes that previously would have affected their coverage. Continuous coverage helped Minnesotans access care during a global pandemic and maintained high insurance coverage rates in the state. With these continuous coverage provisions, enrollment in Minnesota’s Medicaid program, as well as MinnesotaCare, grew by more than 360,000 people to a total of more than 1.5 million Minnesotans. In June 2023, per the federal government, Minnesota and other states will be returning to standard Medicaid eligibility procedures, including an annual eligibility review and renewal process. This rollback presents challenges for potential loss of coverage and impacts on overall health and well-being. DHS – Minnesota’s Medicaid Program deliverer – has developed a comprehensive plan to support mitigation of the loss of eligible coverage and help ineligible Minnesotans connect with other health care coverage options.

Meeting the Needs of Minnesota’s Most Under-Resourced Communities

Hospitals

Minnesota is home to many excellent 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 2021, there were 128 state licensed hospitals with 16,139 beds, of which 78 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. Unfortunately, Minnesota hospitals are finding it increasingly difficult to sustain themselves. Between 2000 and 2020, the number of community hospitals in the state decreased by 5.9% (from 135 to 127).

Pregnant persons living in rural areas have experienced the issue of declining availability of hospital services, with the number of community hospitals offering birth services in rural counties falling 37.8% between 2000 and 2015. Twelve counties lost hospital birth services between 2012 and 2022 [8]. 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. Continued disruption to rural hospitals’ ability to offer birth services further deepens disparities 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 Level 1 facilities having the most capabilities). As of 2022, around 99% of Minnesotans lived within 60 minutes of a trauma hospital [9], which is an important predictor of survival after sustaining a traumatic injury or needing life-saving care. Though Minnesotans overall fair well when it comes to living near a trauma hospital, designated pediatric trauma facilities are lacking in rural Minnesota. All four Level 1 pediatric facilities are in the Twin Cities or Rochester. There are three Level 2 pediatric facilities serving Minnesota residents: one in Duluth and two in bordering states (Fargo, ND and Sioux Falls, SD).

Health Care Homes and Behavioral Health Homes

Health Care Homes (HCHs), designed to coordinate care among the primary care team, specialists and community services, are a cornerstone of Minnesota’s bipartisan health reform efforts of 2008. The voluntary program continues to support primary care providers, families, and patients who work in partnership to improve health outcomes and quality of life for patients, including those with chronic conditions or disabilities. By 2014, Minnesota’s HCH efforts reduced MA 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. As of December 2021, a total of 391 clinics in Minnesota were certified as HCHs (60% of the primary care clinics in the state), serving 69 counties (79%).

Behavioral Health Homes (BHHs) were implemented in 2016 for eligible people with serious and persistent mental illness, emotional disturbance, or severe emotional disturbance - a subpopulation of persons known to have a higher likelihood of experiencing poor 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. There are currently 52 provider locations certified to provide BHH services.

Family Planning

The Minnesota Family Planning Program (MFPP) and the Sexual and Reproductive Health Grant – formerly Family Planning Special Projects (FPSP) – provide vital family planning services to low-income/underserved people. The MFPP, administered by DHS, is an insurance program that pays for family planning services 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 FPL.

The FPSP program is administered by MDH and provides pre-pregnancy family planning services for people whose incomes are below the federal poverty level and placed at increased risk for unintended pregnancy. MDH receives state and federal funding for TANF to provide statewide family planning services and infrastructure support to clinics that provide family planning services. Using these funds, the FPSP program awards over $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. From July 2022 to December 2022, FPSP reached around 34,235 people through outreach activities and provided 9,126 clients a range of contraceptive method – with 20.6% of clients choosing Tier 1 (most effective), long-acting reversible contraceptives.

In addition, federal Title X Family Planning Grant resources were restored in Minnesota in 2022. Planned Parenthood North Central States and Ramsey County Public Health administer $3.5 million to support equitable, affordable, client-centered, and high-quality family planning services throughout the entire state.

Family Home Visiting (FHV)

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 7,000 of Minnesota’s families that are economically and socially disadvantaged, 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
Parenting skills and support that decrease the likelihood of child abuse

FHV services in Minnesota are supported by several funding streams, including state, federal, and local resources. At the state level, MDH oversees and distributes funding for home visiting services provided under 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. All 51 Community Health Board grantees administer home visiting services in their communities.

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 have an increased risk of developing malnutrition 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:

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.

During FFY 2022, an average of 99,746 low-income women, infants, and children up to age five participated monthly in the MN WIC program. In 2021, MN WIC served an estimated 36.6% of all infants born in Minnesota.

Minnesota’s Government

In November 2022 Governor Tim Walz, Minnesota’s 41st Governor, and Peggy Flanagan, Minnesota’s 50th Lieutenant Governor and our first American Indian Lieutenant Governor, were re-elected.

Children’s Cabinet

Minnesota’s Children’s Cabinet is an interagency partnership the Governor tasked with making Minnesota the best place for children 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 engages with two external advisory bodies: Children’s Cabinet Advisory Council and the State Advisory Council for Early Education and Care. These groups, made up of individuals with the perspective of youth and families, diverse and underrepresented communities, and tribal and county leadership, provide guidance to inform the priorities and activities of the Children’s Cabinet. The State Title V MCH Director represents MDH on the State Advisory Council for Early Education and Care.

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.

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:

The health care needs of mothers and children throughout Minnesota
The type, frequency and impact of maternal and child health services in the state
Program guidelines and criteria considered essential to providing an effective maternal and child health care program to populations below the federal poverty threshold and placed at risk of not having access to essential health care services and fulfilling the purposes of the state and federal maternal and child health statutes
The use of federal and state funds available to meet maternal and child health needs
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
7. Any other services that promote the health of mothers and children
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 terms with equal representation in three categories:

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

For more information, please refer to the MCH Advisory Task Force webpage.

Minnesota Department of Health

The mission of MDH is to protect, maintain and improve the health of all Minnesotans. MDH 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.

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 the BIPOC community, 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 (Figure 4).

Figure 4. Healthy Minnesota 2022 Framework

Health Equity at MDH

The MDH Center for Health Equity (CHE) was created in 2013 to advance health equity within MDH and across the state, and in 2022, the Bureau of Health Equity was created with MDH’s first Assistant Commissioner for Health Equity, which elevated health equity as an issue and area of public health practice within the state. The mission of the CHE is to connect, strengthen, and amplify health equity efforts within MDH and across the state of Minnesota.

Some recent highlights of the CHE:

Publishing the Eliminating Health Disparities Initiative (EHDI) impact report, Cultivating a Health Equity Ecosystem: Lessons Learned from the Eliminating Health Disparities Initiative. This groundbreaking report emphasizes the impact of consistent funding and support of community-driven solutions, as well as the need for institutions of power to (re)assess their role in uplifting or polluting the health equity ecosystem.

Increasing the size of CHE from just three staff to 34 – and still growing.
Leading the training of all 1,600+ MDH staff statewide in a half-day racial and health equity training to create common language and understanding of our collective role in addressing inequities.
Hosting the 2019 Health Equity Summit, which spurred the creation of the Health Equity Leadership Network.
Numerous initiatives which centered communities most impacted to address long-standing health disparities, such as infant health and early childhood development.
Catalyzing the transformation of how MDH does business by embedding equity into all we do.
Creating MDH’s Health Equity Advisory and Leadership (HEAL) Council to hold ourselves accountable to communities most impacted.

Legislative Priorities and Wins

The 2023 Legislative Session was historic for children and families in the state of Minnesota. The House and Senate passed billions of dollars to support a transformative biennial budget for the state (2024-2025) and throughout prioritized programs and policies that support the health, well-being, education, and economic security of families to support Governor Walz’s goal to make Minnesota the best state in the nation for kids to grow up. Among the many provisions, the Legislators passed the following [10][11]:

A nation-leading Child Tax Credit which provides up to $1,750 per child for lower income families, is expected to cut child poverty by 33%.
Invested a historic amount in education and schools including by indexing general education funding to inflation.
Established a statewide Paid Family and Medical Leave insurance program to provide partial wage replacement for up to 12 weeks of leave for medical reasons, bonding, or caring for a family member.
Made a $1 billion investment in housing access and affordability.
Increased food access by providing free school meals, and increasing funding for food banks, prepared meals, and food assistance outreach.
Expanded health coverage by providing continuous Medicaid coverage for young children up to age 6 and 12-month continuous coverage for all other children enrolled in Medicaid.
Invested nearly $100 million in children’s mental health supports.
Provided $64.4 million in FY24-25 and $117.7 million per biennium ongoing to increase the number of school counselors, social workers and other student support personnel across the state.
Established the Department of Children, Youth, and Families, a new cabinet-level agency to elevate child, youth, and family priorities and funding needs.

The Legislature also created and expanded several MCH programs at MDH including:

Sustainable funding for the Help Me Connect electronic navigator.
Creation of the Minnesota Partnership to Prevent Infant mortality including $3.5 million (in FY24 and FY25) in grants to local public health, Tribal nations, and community organizations to support upstream community-driving program to reduce infant mortality.
State funds to sustain the Minnesota Perinatal Quality Collaborative.
Grant funds for county jails to implement a set of model practices to improve connections between incarcerated parents and their children, including parenting education, improved intake, and family-friendly visiting spaces.
Funding to increase access to culturally relevant developmental and social - emotional screening and connections to services during early childhood.
Grants to expand health education and health services to existing or new school-based health clinics (SBHC) and schools statewide to meet the health needs of students K-12. These grants will support schools in their response to physical, mental, and behavioral health needs of their students.
Creation of a Pregnancy and Substance Use Task Force to create guidance on toxicology testing in pregnancy and the postpartum period and requirements for reporting for prenatal exposure to a controlled substance and specific grants for community organizations addressing substance use in pregnancy.
Creation of student parent centers at institutes of higher education to conduct screenings and referrals for the health concerns of parents and children, including early childhood development, routine health screenings, and addressing concerns such as alcohol misuse, depression, intimate partner violence, and other health concerns.
Doubling the amount of grant funding available for family planning programs throughout the state.
$4 million per biennium ongoing for additional funding for Family Home Visiting.

Title V MCH Block Grant Specific Statutes

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 populations who experience disparate health outcomes, particularly people with low-income and from minority groups with a high rate of infant mortality and children with low birth weight
Specifically consider the needs of 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 populations of focus
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.