Oversight and Authority

 

The Virginia Department of Health (VDH) is the lead state entity providing core public health functions and essential services. The VDH Strategic Plan establishes the agency’s mission to protect the health and promote the well-being of Virginians, with a vision to become the healthiest state in the nation.

 

To execute this mission, Virginia’s Plan for Well-Being (PfWB) 2025-2029 is a shared vision to improve the health of all Virginians. It outlines priority areas and includes strategies to improve the health of all Virginians. It is a tool for health care professionals, government agencies, community-based organizations, advocates, academicians, policymakers, and other stakeholders to use to catalyze action that will leverage resources and focus work towards measurable improvement. Grounded in data, the Plan for Well-Being identifies strategies to improve outcomes around five priority areas identified by the State Health Assessment Advisory Council in August 2022. A sixth priority area was identified in the spring of 2023, based on the increase of drug overdose deaths and the need to address this issue from a statewide perspective over the PfWB development time period. These priority issues include infant well-being, firearm deaths, obesity, substance use and drug overdose, mental health, and housing, transportation, and economic stability.

 

The scope of the agency’s services includes ensuring food and water safety, disease and injury prevention and surveillance, emergency preparedness, optimal health, and setting licensure and certification standards. As the leading public health agency in the state, the central office is located in Richmond, the state’s capital. The State Board of Health provides leadership in planning and policy development and supports VDH in implementing a coordinated, prevention-oriented program that promotes and protects the health of all Virginians. The agency is led by the State Health Commissioner, with additional oversight from the Chief Operating Officer and Deputy Commissioners distributed across four main operating divisions: Population Health & Preparedness, Administration, Community Health Services, and Governmental and Regulatory Affairs.

 

Virginia’s MCH Program

VDH is responsible for the administration of programs carried out with allotments under Title V. Virginia’s MCH program implements strategies that have broad population health impact. The VDH Office of Family Health Services (OFHS) houses the state Title V program and complementary MCH programs. OFHS programs include the Women, Infants, and Children's Nutrition Program (WIC) in the Division of Community Nutrition; disease prevention and health promotion in the Division of Prevention and Health Promotion; protecting and improving the health of women, infants, children, adolescents, and their families across the life course in the Division of Child and Family Health; providing scientific integrity and quality data analysis, reporting, and program evaluation related to these populations in the Division of Population Health Data; and leading efforts for the state health assessment and state health improvement plan in the Center for Community Health Improvement. MCH block grant funding is allocated by formula to each of Virginia’s 35 local health districts to support local MCH implementation, with two of these districts being governed locally.

 

Virginia’s MCH program works with and garners partnerships across state agencies and programs, including the Department of Medical Assistance Services, Department of Social Services, Department of Education, and Department of Behavioral Health and Developmental Services. Virginia’s Healthy Start and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Programs are administered through the VDH Division of Child and Family Health.

 

MCH Priorities: Virginia’s Title V MCH programming aligns with the agencies mission and core values by establishing 10 upstream approaches to MCH priorities during the 2020-2025 cycle. The new five-year cycle sees seven new priorities established, aligned with MCHB’s four strategic goals:

 

Access

• Utilize comprehensive upstream systems approach to impact MCH outcomes
• Improve access to care through system coordination and navigation

 

Optimal Health

• Strengthen preventive behaviors to improve MCH outcomes
• Promote mental health across MCH populations

 

Capacity

• Enhance state MCH data capacity
• Maintain a capable MCH workforce

 

Impact

• Advance collaboration, partnership and community engagement to build trust

 

Geography

 

The Commonwealth of Virginia encompasses 42,774 square miles (110,784 km2), including land and water areas, making it the thirty-fifth largest state by total area. The state is geographically located in the mid-Atlantic area of the United States, between the Atlantic Coast and the Appalachian Mountains; Washington D.C., the nation’s capital, and Maryland to the north; the Atlantic Ocean to the east; North Carolina to the south; and Tennessee, West Virginia, and Kentucky to the west. Land is distinctly divided by the Appalachian Mountains in the west, countryside, rolling hills, growing cities, and sandy beaches in the east where the Chesapeake Bay separates the contiguous portion of the Commonwealth from the two-county peninsula of Virginia's Eastern Shore. Many of Virginia's rivers flow into the Chesapeake Bay, including the Potomac, Rappahannock, York, and James.

 

Population Density & Urbanization

Virginia has 11 Metropolitan Statistical Areas, with Northern Virginia (Washington-Arlington-Alexandria), Hampton Roads (Virginia Beach-Norfolk-Newport News), and Richmond-Petersburg being the three most populous. The Commonwealth is divided into 133 localities (95 counties and 38 independent cities) with a population density of 201.6 per square mile. The largest independent cities are Virginia Beach (457,066), Chesapeake (251,153), Norfolk (235,037), the state’s capital Richmond City (227,595) and Newport News City (184,774). Norfolk forms the urban core of the Hampton Roads metropolitan area, which has a population nearly 1.7 million people and is the site of the world’s largest naval base, Naval Station Norfolk.

 

Over 3.2 million people, or 37% of the population, live in Northern Virginia. This population accounts for the Virginia portion of the Baltimore-Washington combined statistical area, which is considered the third largest combined statistical area in the United States. The most populous jurisdiction (and county) in the state is Fairfax County in Northern Virginia, with a climbing population over 1.14 million. Fairfax County has a major urban business and shopping center in Tysons Corner, Virginia's largest office market. Neighboring Prince William County (484,625) is Virginia's second most populous county, and is home to Marine Corps Base Quantico, the FBI Academy and Manassas National Battlefield Park. According to an article in the Washington Post, analysis of U.S. Census Bureau data has shown that Prince William County has leapfrogged Virginia Beach to become the second-most-populous jurisdiction in Virginia. Three out of four of the state's largest counties, now in Northern Virginia, account for 29% of the state’s population growth. Loudoun County in Northern Virginia with its 427,082 residents surpasses Chesterfield County in the Richmond MSA with its 371,610 residents. 

 

Virginia is a place where state averages hide the contrasting stories of its subpopulations. There are approximately 1.0 million residents living within rural areas of the state, compared to over 7.5 million within urban areas. Virginia Department of Health has grouped the Commonwealth’s localities into 35 health districts and 5 health regions. The Northern region, composed of Alexandria, Arlington, Fairfax, Loudoun, and Prince William Health Districts, is densely populated and include 3 of the 50 richest places in America according to 24/7 Wall St., 2023. Conversely, the Southwest region—comprising the Alleghany, Central Virginia, Cumberland Plateau, Lenowisco, Mount Rogers, New River, Pittsylvania/Danville, Roanoke City, and West Piedmont Health Districts—is rural, characterized by the rugged, mountainous terrain of the Appalachians, and is both the least populous and marked by a relatively homogeneous racial and ethnic composition. Its expansive terrain and vast geographic area pose many transportation challenges. The Central region is composed of the Chesterfield, Crater, Chickahominy, Henrico, Piedmont, Richmond City, and Southside Health Districts and features a mix of urban, suburban, and rural communities. In this region, urban centers host large state colleges, universities, and business districts; suburban areas are primarily residential with limited industrial activity; and rural areas are largely agricultural. The Northwestern region includes the Central Shenandoah, Lord Fairfax, Rappahannock, Rappahannock/Rapidan, and Blue Ridge Health Districts, and it shares similar community characteristics. The Eastern region—comprising the Chesapeake, Eastern Shore, Hampton, Norfolk, Peninsula, Portsmouth, Three Rivers, Virginia Beach, and Western Tidewater Health Districts—runs along the east coast, adjacent to the Chesapeake Bay and Atlantic Ocean. This region also includes the Eastern Shore, a peninsula separated from the mainland by the Chesapeake Bay. The Eastern Shore Health District is characterized by a lower population density and higher rates of economic challenges. Additionally, this region has the largest concentration of military installations and facilities of any metropolitan area in the world. The coastal infrastructure, marked by numerous bridges and tunnels, can impede access to services, and residents frequently experience severe traffic congestion. Periodically, hurricanes and tropical storms affect the area, leading to flooding and related environmental health concerns.

 

Demographics

 

Virginia is the 12th most populous state in the U.S., with an estimated population of nearly 8.7 million people (World Population Review). The median age of Virginians is 37.8 and ratio of females to males is 1.03 with females taking a slightly higher percentage of the population. Virginia is noted as the 9th highest state in terms of percentage of Asian and African American populations (Virginia Population 2024).

 

Race/Ethnicity

As of 2023, 59% identified as non-Hispanic White, 18.4% identified as non-Hispanic Black, 10.7% identified as Hispanic (all races), 6.8% non-Hispanic Asian, 4.3% identifying as non-Hispanic with more than one race, 0.1% non-Hispanic American Indian or Alaska Native, 0.1% Native Hawaiian and Pacific Islander (2023 ACS 5-Year Estimates). According to the Census Bureau, Virginia ranks 10th in having the largest African American population (HHS Office of Minority Health).

 

Virginia sits on ancestral lands of various Indigenous Tribes that were firmly established before the English settlement in Jamestown and have made significant contributions to the survival of new settlers in Virginia. The Commonwealth of Virginia consists of 11 state recognized tribes (Virginia Indians), 7 which are federally recognized tribes (Federally Recognized Indian Entities). Of those identifying as American Indian and Alaska Native, 42.5% identified as Latin American Indian, 2.2% identified as Lumbee Tribe of North Carolina, 1.4% identified as Navajo Nation, and 8.3% identified as an Other American Indian Tribe (2023 ACS 5-Year Estimates). Indigenous populations largely reside in Northern Virginia, Richmond, and Hampton Roads in the eastern part of the Commonwealth.

 

There are over 1.7 million women of childbearing age (15-44 years) in 2022, with race and ethnicity composition consisting of 55.4% non-Hispanic White, 20.5% non-Hispanic black, 8.3% non-Hispanic Asian, 0.1% non-Hispanic Native Hawaiian or Pacific Islander, 0.3% non-Hispanic Native American or Alaska Native, and 12.0% Hispanic (any race) (2022: CDC WONDER Population Estimates); 12.9% of Virginia’s population are foreign-born (2023 ACS 5-Year Estimates). Additionally, veterans account for 7.4% of Virginia’s total population estimated at nearly 638,000. (2023 ACS 5 Year Estimates).

 

Age and Sex

In the Commonwealth of Virginia, 49.5% are male and 50.5% are female, with an estimated 98 males per 100 females. The age breakdown of Virginians is 5.7% under 5 years, 21.8% under 18 years, and 16.3% of persons 65 years or older, an increase from the year prior (2023 ACS 5-Year Estimates). There are 179,831 grandparents, with 35.2% responsible for their grandchildren under age 18 (2023 ACS 5-Year Estimates).

 

 

 

Economic Well-Being

 

Educational Attainment

Educational attainment is a predictor of personal wealth and well-being and is directly related to social. For those in Virginia over 25 years of age, 5.1% have a 9th to 12th grade education with no diploma, 23.9% are high school graduates or equivalent, 23.3% have a bachelor’s degree, and 18.1% have a graduate or professional degree (2023 ACS 5-Year Estimates). These percentages show in increase in educational attainment for bachelor’s degrees and graduate degrees while showing a decrease in those with a 9th to 12th grade education without obtaining a high school diploma.

 

Economy/Income/Poverty

Virginia’s economy is made up of various facets, including local and federal government, military, farming, business, manufacturing, tourism, and healthcare/medical. Virginia has over 4.4 million civilian workers with 15% are in service occupations. The unemployment rate in Virginia is below the national rate (5.2%) at 4.3%. The median household income in Virginia is $90,974 compared to $78,538 in the U.S. (2023 ACS 5-Year Estimates).

 

Compared with the U.S. population, a lower percentage of Virginia families lived in households with incomes below the federal poverty level (9.6% vs. 12.2% for the U.S.). Additionally, there were 12.7% children (under 18 years old) living in households with incomes below the federal poverty level, which is lower than the national percentage of 16.3%. However, wealth varies significantly across the state (2023 ACS 5-Year Estimates). Between 2022 to 2023, 13.5% of children with special health care needs lived in families with incomes below 100% of the federal poverty level, compared to 12.8% of children without special health care needs (NSCH 2022-2023).

 

Housing

The factors that relate to housing have the potential to affect health in major ways. These factors include physical conditions within homes, conditions in the neighborhoods surrounding homes, and housing affordability. Among occupied housing units in Virginia, 32.8% are rented. In renter-occupied units, 48% pay 30 percent or more of their household income to rent (2023 ACS 5-Year Estimates). In 2023, 63% of Virginia children lived in low-income households with high housing cost burden (KIDSCOUNT Data Center) with the median rent in Virginia at $1,514. The median home value for owner-occupied units in Virginia is $360,700 (2023) compared to $295,500 (2021), a 22.0% increase in median home value. Communities without safe and affordable housing affect the overall ability of families to make healthy choices and access to quality homes.

 

Food Security

Food insecurity is a social and economic condition where access to food is limited or uncertain. In Virginia, 963,980 residents are facing hunger, and 1 in 7 are children (Feeding America). According to 2023 America’s Health Rankings, 10.0% of Virginia households were unable to provide adequate food for one or more household members due to lack of resources, an increase from prior years. Charity and government assistance programs are necessary to help bridge the meal gap. 44.9% of households receiving Supplemental Nutrition Assistance Program (SNAP) benefits have children (Feeding America).

 

 

 

Community and Social Well-Being

 

Social and emotional support

Research has supported that social and emotional support from others can be protective for health. Overall, nearly one-third of Virginia children were living in single parent households (KIDSCOUNT Data Center). There were 3.7% of total children in a grandparent responsible household (ACS 5-Year Estimates). The majority of Virginia parents (76.1%) report that they have someone to turn to for day-to-day emotional support with parenting or raising children (NCHS 2022-2023). There were 86.5% of adolescents that have an adult mentor outside the household who they can rely on for advice or guidance (NSCH 2022-2023).

 

Discrimination

Perinatal care discrimination is among other community factors that negatively influence health. During their pregnancy, mothers expressed experiencing discrimination or harassment due to their race, ethnicity, or culture (2.1%); language or accent (2.0%); weight (1.7%); and type or lack of health insurance (1.6%). Approximately 15% of Non-Hispanic Black mothers, 7.8% of Hispanic mothers, and 1% of mothers identifying as Non-Hispanic another race reported discrimination or harassment due to their race, ethnicity, or culture during their lifetime (Virginia PRAMS 2023). Among high school students, 19.4% have been a victim of teasing or name-calling because of their actual or perceived race or ethnic background (Virginia VYS 2021).

 

Health Care Access

 

Primary Care Access and Health Insurance Coverage

Based on the 2023 ACS 5-Year Estimates, 92.9% of Virginians have health insurance of some kind, where 73.7% were private and 32.6% were public. Among the uninsured population, 16.9% were under the age of 19, 21.3% were young adults (ages 26 to 34), 26.6% had less than a high school education, and racial identification was 40.5% as White, 17.6% as Black or African American, 1.3% as American Indian and Alaska Native, and 35.2% identifying as Hispanic (2023 ACS 5-Year Estimates). Virginia expanded the Medicaid program on January 1, 2019, a significant change in health care policy that was realized without the expenditure of state dollars. More than 380,000 Virginia adults are enrolled and receiving services under the new eligibility rules. Additionally, Medicaid extended coverage in the postpartum period to 12 months through a Section 1115 waiver as of July 1, 2022.

 

Health Care Professional Shortages and Birthing Hospitals

In 2021, the Bureau of Labor Statistics reported 3,570 Family Medicine Physicians in Virginia, and 390 obstetricians/ gynecologists. There were 890 pediatricians, 3,500 dentists and 390 dental specialists or orthodontists, and 210 oral and maxillofacial surgeons in the state. There are needs recognized across the state that can be unique to different areas of the state, such as transportation challenges and availability of providers. There were 54 counties/census tracts in Virginia designated as Primary Care Health Professional Shortage Areas (HPSAs), 33 in Dental Care, 7 in Mental Health, and 114 counties/census tracts designated as medically underserved areas (HRSA Data Warehouse). In addition, Virginia had 49 birthing hospitals that serve pregnant women in the Commonwealth as of 2024 (see Figure). Forty-one counties (30.8%) are considered as maternity care deserts, and women travel up to 85 minutes to their nearest birthing hospital (March of Dimes). Virginia has lower median allowed values for vaginal and C-section deliveries (including professional and facility costs) occurring at in-network hospitals than the national median, as well as lower median charged values to uninsured patients or delivering at out-of-network hospitals (Fair Health).

 

State Statutes and Other Regulations

 

Statutes

The state plan for the Virginia CYSHCN Program is found in the Virginia Administrative Code (VAC). The plan closely mirrors some of the recommendations of AMCHP and the Maternal and Child Health Bureau.  In the plan, the Virginia CYSHCN Program is defined along with the program scope and content.  The CYSHCN unit includes four programs: Care Connection for Children, Child Development Services Program, Sickle Cell Program, and Bleeding Disorders Program. In addition, the CYSHCN Program connects with newborn screening services in the VAC and has responsibilities in support of newborns confirmed to have certain conditions as described on the newborn screening panel. In addition, the General Assembly passed legislation in 2020 for the Board of Health to adopt regulations to implement an adult comprehensive sickle cell network, as well as funding to support the adult clinics' infrastructure. The regulations have been incorporated in the VAC, and outlines the scope and services the adult comprehensive sickle cell network provides.

 

Section 32.1-77 of the Code of Virginia authorizes the Virginia Department of Health (VDH), led by the State Health Commissioner, to prepare and administer the state’s Title V plan for MCH.

 

Section 32.1-64.1 through 69.2 also codifies the Virginia Early Hearing Detection and Intervention (EHDI), the dried blood spot (DBS) and Critical Congenital Heart Disease (CCHD) newborn screening (NBS) programs, as well as the Virginia Congenital Anomalies Reporting and Education System (VaCARES) program, the state's birth defect surveillance program.  Associated regulations for EHDI, DBS and CCHD can be found in Chapters 71 and 80 of the Department of Health's Administrative Code.

 

Section 32.1-283.1 codifies the Child Fatality Review Team (since 1994), while Section 32.1-283.8 codifies the Maternal Mortality Review Team (since 2019). Updates to the latter section were made in 2023, to increase the frequency with which reports are submitted to the General Assembly, and 2024, to update membership to include Department of Corrections.

 

Section 32.1-77.1 defines the term “state-certified doula” in the Commonwealth and establishes parameters for state certification. It gives authority to the Board of Health/VDH to promulgate regulations for doula certification, establish a state-certified doula registry, and oversee the training and certifying organizations. The regulations for doula certification can be found in Chapter 403 of the Department of Health’s Administrative Code. Relatedly, Chapter 552 of the budget bill passed during the 2021 General Assembly Special Session 1 directs VDH to establish a task force to advise on the doula certification process and other doula-related policy measures.

 

Section 32.1-15.1 defines the term “certified community health worker" (CHW) in the Commonwealth and establishes parameters for state certification. It gives authority to the Board of Health/VDH to promulgate regulations for certification of certified CHWs. The agency is currently in the process of promulgating such regulations.

 

Updates to Previously Reported Virginia Legislation and Initiatives

Virginia House Bill 1157 (2018 General Assembly) provides that the Department of Health shall serve as the lead agency with responsibility for the development, coordination, and implementation of a plan for services for substance-exposed infants in the Commonwealth. It details that plans shall (i) support a trauma-informed approach to identification and treatment of substance-exposed infants and their caregivers and (ii) include (a) options for improving screening and identification of substance-using pregnant women, (b) use of multidisciplinary approaches to intervention and service delivery during the prenatal period and following the birth of the substance-exposed child, and (c) referral among providers serving substance-exposed infants and their families and caregivers. The report and plan have been approved and has been posted to the legislative information system in May 2021. Efforts are currently underway to evaluate the feasibility of implementation and make updates, as necessary.

 

House Bill 1950 (2021 General Assembly) directed the VDH Office of the Chief Medical Examiner (OCME) to convene a workgroup to assess the feasibility of implementing the Fetal Infant Mortality Review Team (FIMRT), in which the Director of the Division of Child and Family Health served as a member. Although a report was published with the findings and recommendations from this workgroup in December 2021, a bill has not been submitted in successive legislative cycles to allow for its implementation at this time.

 

Virginia House Bill 2111 (2021 General Assembly) established the Maternal Health Data and Quality Measures Task Force for the purpose of evaluating maternal health data collection to guide policies in the Commonwealth to improve maternal care, quality, and outcomes for all pregnant women in the Commonwealth. The 2023 General Assembly directed the Task Force to also explore training for providers. A final report of recommendations was posted in January 2024. The work of this Task Force was re-established through the Governor’s Executive Order 32, and a new bill was passed in the 2025 General Assembly to continue the work through 2026.

 

New Legislation and Initiatives

The 2024 and 2025 General Assembly sessions brought forth legislation that impacts Virginia’s MCH populations, and VDH MCH staff have been involved in various capacities of their implementation. The following are significant legislation that passed, but does not encompass all efforts:

•         Budget line item to hire maternal community health workers in Local Health Districts with higher rates of maternal mortality.
•         House Bill 204 (2024) Maternal Mortality Review Team; adds a representative of the Department of Corrections and a representative of the State Board of Local and Regional Jails as members of the MMRT.
•         House Bill 252 (2024) Sickle cell disease; creates a statewide registry of sickle cell disease patients to be maintained by the State Health Commissioner.
•         House Bill 831 (2024) Maternal Mortality Review Team; Directs the Office of the Chief Medical Examiner and MMRT to convene a work group to expand the work of the MMRT to develop criteria for collection and review of maternal morbidity data.
•         House Bill 935 (2024) Coverage for doula care services; requires health insurers covering obstetrical services to cover doula care services by state-certified doulas; requires Health Insurance Reform Commission to consider/recommend doula services as part of its annual review of essential health benefits
•         Executive Directive 11 (2025) directs the State Health Commissioner and the Department of Health to improve the publication of actionable data on maternal health and develop a comprehensive maternal health resource website.
•         House Bill 1782 (2025) Newborn screening requirements; federal Recommended Uniform Screening Panel; directs the Department of Health to determine whether additional disorders on the federal RUSP should be included in Virginia’s screening program.
•         House Bill 2109 (2025) Maternal Health Data and Quality Measures, Task Force on; directs the State Health Commissioner to reestablish the task force through Dec 2026.
•         House Bill 1918 (2025) Women's Menstrual Health Program established; provision of education, training, and information; directs the Commissioner of Health to establish a Women’s Menstrual Health Program.
•         House Bill 2446 (2025) Postpartum Depression Education Act; directs the Department of Health to establish a public awareness campaign, develop and distribute educational materials, and create an online resource hub focused on perinatal and postpartum depression.
•         Budget line item in collaboration with Virginia’s Medicaid and Perinatal Quality Collaborative to fund pilot perinatal health hub programs for community-based providers to improve perinatal outcomes.