Geography, Demographics, and Economy

Michigan is the only state made up of two peninsulas and has the longest freshwater shoreline in the world. Comprised of 83 counties, Michigan is the 10th most populous state and 11th largest state by total square mileage. Approximately 10 million people live in the state per the 2023 Vintage Census. Compared to other states, Michigan had the 35th lowest rate of population change from 2022 to 2023 and estimated 37th lowest birth rate in 2023. Most of Michigan’s population resides in the southern half of the Lower Peninsula, with approximately half of the population residing in Southeast Michigan (2022 Vintage Census). The state’s largest cities are Detroit, Grand Rapids and Warren. Over 1.8 million people live in rural areas (2020 Census). The median age of the population is 39.9 years (2018-2022 American Community Survey). Out of the total population, approximately 21.4% are ages 0-17 and 78.6% are ages 18 and over. Michigan’s population is 75.7% White, 13.6% Black or African American, 3.3% Asian, 5.4% two or more races, and 0.5% American Indian and Alaska Native. Out of the total population, 5.5% identify as Hispanic or Latino. Michigan has the country’s second largest population of residents who identify as Middle Eastern or North African (2020 Census).

Michigan’s economy saw improvements over the nine years leading up to 2020. While the seasonally adjusted unemployment rate decreased from 14.0% in June 2009 to 3.8% in January 2019, the unemployment rate spiked to 22.6% in April 2020 at the start of the COVID-19 pandemic (U.S. Bureau of Labor Statistics). The economic impact of COVID-19 was significant, but Michigan’s 2023 labor market continued to show improvement with an annual jobless rate one-tenth of a percentage point below the 2019 pre-pandemic rate of 4.1 percent. Michigan’s seasonally adjusted unemployment rate of 4.3% remained unchanged from December 2022 to December 2023. Michigan’s labor force participation rate reached a 14-year high of 62.2% at the end of 2023.

However, economic recovery has been uneven across the state. According to the 2023 ALICE (Asset Limited, Income Constrained, Employed) report, 39% of households in Michigan struggled to afford the basic needs of housing, childcare, food, technology, health care and transportation. The 2021 poverty rate in rural Michigan was 12.9%, compared with 13.1% in urban areas (USDA Economic Research Service). According to the 2023 Kids Count, Michigan ranks 26th in health, 32nd for economic and overall child well-being, and 42nd in education for children. The percent of children ages 0-17 who live in poverty is 17.6% for the state, with a poverty range of 5.7% (minimum) to 42.3% (maximum) across counties and major cities. Statewide, 53.3% of students receive free and reduced-price lunch.

Roles and Priorities of the State Health Agency

The Title V program is located in the Division of Maternal and Infant Health (DMIH), which is housed in the Bureau of Health and Wellness (BHW) in the Public Health Administration. DMIH includes the Family Planning program, Maternal Infant Health Program, Michigan Perinatal Quality Collaborative, Early Hearing Detection and Intervention program, infant safe sleep, breastfeeding, maternal and fetal morbidity and mortality reduction, Fetal Infant Mortality Review, the Doula Initiative, Safe Delivery of Newborns, Fetal Alcohol Spectrum Disorder efforts, and more. DMIH works in partnership with the Children’s Special Health Care Services (CSHCS) Division and the Division of Child and Adolescent Health (DCAH) to administer Title V. CSHCS includes CSHCS Customer Support, Policy and Program Development, Quality and Program Services, and the Family Center for Children and Youth with Special Health Care Needs (Family Center). DCAH oversees school-based health centers, oral health for children and pregnant women, teen pregnancy prevention, the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, the Early Childhood Comprehensive Systems grant, and Title V funding to Michigan’s 45 local health departments. Title V works collaboratively with other programs in the Michigan Department of Health and Human Services (MDHHS) which includes Medicaid; environmental health; emergency preparedness and response; communicable and chronic disease; food and cash assistance; and Child Protective Services (CPS) and foster care.

MDHHS and MCH Goals

The MDHHS vision to “Deliver health and opportunity to all Michiganders, reducing intergenerational poverty and promoting health equity” is supported by 11 goals:

• Public health investment
• Racial equity
• Address food and nutrition, housing, and other social determinants of health
• Improve the behavioral health service system for children and families
• Improve maternal-infant health and reduce outcome disparities
• Reduce lead exposure for children
• Reduce child maltreatment and improve rate of permanency
• Implement the Families First Preservation Services Act
• Expand and simplify safety net access
• Reduce opioid and drug-related deaths
• Manage to outcomes and invest in evidence-based solutions

Michigan’s MCH programs align with several of these goals. The 2020-2023, Mother Infant Health & Equity Improvement Plan (MIHEIP) guided the work of Michigan's stakeholders and MDHHS over the last several years. Michigan has implemented strategies to address the social determinants of health and equity, worked to build strong collaborative relationships statewide and, together with partners, has improved maternal and infant outcomes. The 2024 – 2028 Advancing Healthy Births: An Equity Plan for Michigan Families & Communities is the next iteration of the plan and focuses on sustainable actions and multifaceted approaches to advance outcomes for birthing people and their infants. Michigan continues to strive toward the strategic vision of “zero preventable deaths, zero health disparities.” The new plan was developed collaboratively by MDHHS and stakeholders and was informed by input garnered from regional town hall meetings, Mother Infant Health and Equity Collaborative (MIHEC) meetings, Regional Perinatal Quality Collaboratives (RPQCs), Michigan families, healthcare providers, community leaders and maternal infant health stakeholders. In 2024, Michigan was also selected to participate in the National Governors Association Improving Maternal and Child Health in Rural America State and Territory Policy Learning Collaborative and the Health and Human Services Postpartum Maternal Health Collaborative. These initiatives will provide further opportunity to address maternal, infant, and child health outcomes.

Advancing maternal and infant health outcomes continues to be a priority for Gov. Whitmer. In 2020, Gov. Whitmer released the Healthy Moms, Healthy Babies initiative to address health disparities and provide all women with access to high-quality health care. Expansion of Healthy Moms, Healthy Babies continues through allocations in the state budget. The 2021 and 2022 budgets allocated funds to increase access to evidence-based home visiting and continuous postpartum Medicaid coverage for 12 months postpartum. The 2023 budget allocated funds to support doula infrastructure and increase investment in Early On. The Governor’s FY 2024 budget allocated funding for Healthy Moms, Healthy Babies and also expanded access to family planning services, support for the Michigan Perinatal Quality Collaborative, expansion of CenteringPregnancy, support for birthing hospitals’ participation in Levels of Maternal Care verification, and additional support for birthing hospital participation in the Michigan Alliance for Innovation on Maternal Health (AIM) program. In 2023, Gov. Whitmer also signed the Reproductive Health Act to help remove barriers to healthcare and retain access to reproductive health.

A Home Visiting Leadership team and a Home Visiting Advisory are charged with building an integrated home visiting system for families. Michigan’s evidence-based home visiting (EBHV) system includes the Maternal Infant Health Program, Nurse-Family Partnership, Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Infant Mental Health, Play and Learning Strategies, and Family Spirit. The Leadership team includes funders of all EBHV in Michigan, aligning activities such as professional development and supporting coordinated referrals. Michigan hired a statewide home visiting professional development coordinator and has utilized technical assistance to develop and pilot family outreach strategies. The Home Visiting Advisory has an active role in system development through discussions about centralized access, professional development, and equity. Title V participates in the Advisory.

Michigan is expanding EBHV to better support families who have been impacted by child welfare involvement and family separation. Eleven HV programs have expanded to support families through the Families First Prevention Services Act. Thirteen programs are new or have expanded to specifically serve families impacted by substance use, a leading cause of child welfare involvement. Professional development is being provided to programs to ensure staff have access to information and training that will improve service delivery for families. Michigan is piloting peer navigators within the healthcare system to break down barriers of shame and stigma. Peer navigators with lived experience will connect families to resources, including EBHV, and will provide support 12 weeks postpartum. Seven agencies are currently implementing the program, supporting pregnant and postpartum people, with up to five additional agencies planned for FY 2024.

Early childhood partnerships and systems building are also critical to support children and their families. In 2023, the state experienced a shift in early childhood systems building. The Office of Great Start (OGS) within the Michigan Department of Education (MDE) was moved to a new department, Michigan Department of Lifelong Education, Advancement, and Potential (MiLEAP). MiLEAP is tasked with mobilizing resources to collaborate with leaders at the local, regional, and state level to put every Michigander on a path to prosperity from preschool through postsecondary. During this transition, the Great Start Operations Team which has been Michigan’s convening body of state agencies and partners to provide strategic direction for early childhood coordination, was put on hold. MDHHS remains in partnership with both MiLEAP and MDE as a new structure to develop early childhood systems building is created. It is anticipated that several MDHHS program areas, including public health and home visiting, will be included on the new convening body.

In 2021, Michigan was awarded an Early Childhood Comprehensive Systems (ECCS) Grant which is housed in DCAH. The five-year project is intended to foster the development and integration of maternal and early childhood systems of care that are equitable, sustainable, comprehensive, and inclusive of the health system. The ECCS Advisory Committee is developing a strategic plan for infrastructure and fiscal supports to aid alignment between early childhood partners, including Title V and MIHEIP staff, and to achieve integration rather than duplication. The draft plan recognizes the role of trauma in systems of care, the need for systemic support of family leadership, and a push for an early childhood fiscal vision.

Advancing Equity

Advancing equity is a priority within the State of Michigan and MDHHS. At the state level, Gov. Whitmer has implemented many initiatives to address equity. Executive Directive 2019-09 established Equity and Inclusion Officers within each state department. Executive Directive 2020-07 required implicit bias training for licensed health care professionals. Racism was recognized as a public health crisis in August 2020 through Executive Directive 2020-09. As part of that directive, all state employees must complete an implicit bias training. Related goals have included building Diversity, Equity, and Inclusion (DEI) infrastructure and leadership and measuring DEI efforts across state departments. Several DEI initiatives were also created in direct response to the COVID-19 pandemic. The Michigan Coronavirus Task Force on Racial Disparities was created in April 2020 to investigate causes of COVID-19 racial disparities and recommend actions to address disparities. Results of these efforts, which included transparency in data reporting and the establishment of neighborhood testing sites, are discussed in prior Title V applications. The Taskforce released a final report in February 2023.

At the departmental level, MDHHS continues to assess and support DEI. The MDHHS DEI Plan details the Department’s “commitment to eliminating systematic inequities and promoting diversity, equity and inclusion.” A DEI Council was created to promote and foster a culture that values DEI throughout MDHHS and the diverse communities it serves. The Race, Equity, Diversity, and Inclusion (REDI) Office was created in 2020 “to address racial, health, social and wealth disparities, that impact both internal and external partners.” REDI released its Inaugural Report in 2023 to highlight community engagement strategies and other initiatives to address health disparities. The MDHHS Office of Equity and Minority Health (OEMH) is part of REDI. The OEMH provides training and technical assistance to the MDHHS workforce on implicit bias, systemic racism, cultural and linguistic competency, health equity, and equitable community engagement. A DEI newsletter provides information and resources on topics like implicit bias, racial identity, organizational change, and DEI studies. In 2023, the OEMH partnered with the Public Health Administration to discuss race and ethnicity data collection standards that would both align with federal reporting requirements and reflect the diversity of Michigan.

Starting in 2021, all MDHHS job postings require a Valuing Diversity and Inclusion competency in the posting questions, as well as DEI questions in the interview. A Countering Bias in the Interview training is required for all MDHHS interview panelists. Within annual performance plans, a DEI objective is required. “Introduction to Health Equity” and “Systemic Racism” trainings are required for all MDHHS staff. These trainings address factors that contribute to inequities; the impact of health inequities; how systems may perpetuate inequitable outcomes; and how MDHHS can help to achieve health equity. Since 2022, training related to Michigan’s Tribal Governments is mandatory for MDHHS employees to support tribal relations and address disparities.

The MDHHS Office of Policy and Planning also led development of a collaborative, statewide Social Determinants of Health (SDOH) Strategy. The goal of the SDOH Strategy is to “Improve the health and social outcomes of all Michigan residents while working to achieve health equity by eliminating disparities and barriers to social and economic opportunity.” Phase 1 of the SDOH Strategy included the release of “Michigan’s Roadmap to Healthy Communities” in 2022. The initial focus areas were health equity, housing stability, and food security. Phase 2 of the SDOH Strategy launched with a virtual summit in January 2023 and focused on community health worker expansion, community information exchanges, food security, and housing stability. Phase 3 launched in January 2024 with the 2nd Annual SDOH Summit. It focuses on SDOH Hubs to foster collaboration and support community-driven work; aligning efforts using a Health in All Policies approach; and continuing to build on equity partnerships.

A range of SDOH initiatives are underway through MDHHS, including the Produce Prescription Pilot Program to address food security in partnership with Michigan Tribes; SDOH Hub Pilots; the Rural Health Equity plan, led by the Michigan Center for Rural Health; the SDOH Community Influencer Program; and the "Good Housing = Good Health" program, a partnership between MDHHS and the Michigan State Housing Development Authority to address housing stabilization and SDOH. Gov. Whitmer also proclaimed January 2024 as Social Determinants of Health (SDOH) Month. Notably, to support preventive care and address health disparities, MDHHS expanded Medicaid coverage to include Community Health Worker services as of January 1, 2024. In March 2024, MDHHS requested public input on potential services designed to address health-related nutrition needs through health plans participating in the Medicaid and Healthy Michigan Plan.

Equity is also being addressed within MCH programs, including but beyond Title V. In addition to equity strategies discussed in Title V state action plans, MCH activities include:

• The Medicaid doula reimbursement policy went into effect January 1, 2023. The policy allows for reimbursement of doula services for individuals covered or eligible for Medicaid insurance. A Doula Advisory Council with diverse statewide representation, including tribal doulas, was created to inform the advancement of doula services in Michigan.
• The Infant Safe Sleep program allocates funds and provides technical assistance in an equitable, data-driven manner. Funding is allocated to five local health departments (LHDs) and the Inter-Tribal Council of Michigan (ITC). The counties where the five LHDs are located account for 51% of sleep-related infant deaths in the state and experience racial disparities among the deaths. ITC serves American Indian families throughout the state; American Indian babies die at 2.6 times the rate of white babies.
• The Maternal Infant Health Program (MIHP) holds monthly Health Equity Meetings to create program documents and services using an equity lens. At the local level, MIHP agency staff are required to take a Health Equity and Systemic Racism course so that staff are equipped to provide equity-based services tailored to family needs. Licensed social workers and registered nurses who provide MIHP case management services are required to pursue education on implicit bias and its effect on service delivery. They also assist in referring families to community supports like healthy food, transportation, and housing.
• The Early Hearing Detection and Intervention (EHDI) DEI plan aims to reduce the number of children who are "lost to follow up" after a failed hearing screen, particularly in medically underserved areas or populations. A study analyzing five years of data was conducted to identify the characteristics of infants who are more likely to be lost to follow-up. EHDI plans to use the findings to create focused outreach and education strategies. Additionally, EHDI is working in collaboration with external partners to pilot a telehealth project. The project will assess the impact of remote audiology diagnostic services in supporting follow-up care in underserved areas or populations.
• To advance birth outcomes, Regional Perinatal Quality Collaboratives (RPQCs) actively address disparate outcomes, health inequities and social determinants of health through quality improvement efforts, convening diverse partners to support efforts and collaborate with regional partners, and authentically engaging families as key partners so that efforts address the root cause and resonate with communities.
• The DMIH DEI Council was formed in September 2022. The council meets monthly to move health equity in the division forward. The DMIH DEI Council developed two resources for managers to utilize when onboarding new employees to the Division, including an onboarding checklist and a slide deck. These items contain pertinent information related to mandatory and supplemental training opportunities on health equity, systemic racism and implicit bias. It also introduces the Division’s culture of equity and inclusion.
• The DMIH received $500,000 to raise awareness of uterine fibroid disparities through education and outreach programming. A social media and education campaign was developed and launched. Education infographics and posters are available in the internal clearinghouse. Additionally, through partnership with the Region 9 Perinatal Quality Collaborative, people with lived experiences with uterine fibroids participated in a storytelling project and produced videos. National uterine fibroid expert and physician, Dr. Erica Marsh, was a keynote speaker at the 2023 Maternal Infant Health Summit and served as a content specialist for this project.
• An initiative to support DMIH strategic planning efforts is being developed to use a common process and SMARTIE goals in the creation of the strategic plan. Each DMIH program area will undergo a strategic plan review and revision process to ensure that health equity goals are developed as SMARTIE goals.
• A mandatory three-part learning series on implicit bias and microaggressions was facilitated by Dr. Vicki Sapp for DMIH staff in 2023.
• DCAH is working with two home visiting programs that participated in the MIECHV Health Equity CoIIN to understand what family goals/supports are being achieved with the program’s increased knowledge about the history of racial inequities in their counties. This knowledge has prompted changes in policy for practices such as transportation support, access to health care, and improved family interviews to ask better questions about access to resources within neighborhoods.
• DCAH convenes a 17-member Diversity, Equity, and Inclusion committee and is using a variety of resources, including a division specific DEI Survey, to establish goals and create a key driver diagram to move toward impacting those DEI goals. All Division staff and other colleagues will be invited to participate in the implementation of improvement projects. The DEI Committee has implemented a robust Communications Plan to share committee activities, resources, and opportunities across the division and within MDHHS.
• The Bay Area Regional Health Inequities Initiative framework was incorporated into ECCS grant activities. An ECCS Family Coordinator was contracted to help embed family leadership across government systems and throughout the ECCS grant.
• DCAH expanded use of the Rapid Adolescent Prevention Screening tool + additional SDOH questions within CAHCs to assess need and connect to local resources.
• The Expanding Health Equity in CSHCS initiative began in FY 2022. The goal is to eliminate racial, ethnic, and geographic disparities in CSHCS. The project team has reviewed extensive data and is creating a valid and reliable system to quantify racial and ethnic disparities to identify gaps in care. In partnership with the Managed Care Plan Division, CSHCS will work to identify performance standards to address barriers to care. Policy and contracting levers will be established to sustainably address disparities. Throughout the process, transparency and accountability will be promoted to drive improvements in disparities. The project mirrors work underway in the MDHHS Managed Care Plan Division.
• WIC has implemented a new webinar series ‘Exploring Cultural Practices.’ Attendees become familiar with common foods, meal preparation, and traditional meals of different cultures. This training helps staff be culturally responsive and appropriate, and to use effective methods to communicate nutrition messages. Recordings of past webinars are available in the WIC Webcast Catalog.

Within Title V, the 2020 five-year needs assessment identified three key “pillars” that are important to all MCH populations: achieving equitable health outcomes, engaging families and communities, and delivering culturally and linguistically appropriate health education. Strategies related to these pillars are included in the NPM and SPM state action plans.

Strengths and Challenges that Impact the MCH Population

The Title V five-year needs assessment was completed in 2020 prior to the COVID-19 pandemic. It identified strengths and challenges that impact the MCH population which are discussed in detail in the FY 2021 application. Strengths include longstanding relationships with local public health, commitment to addressing health disparities and pursuing equity, elevation of family voices to serve CSHCN, a robust home visiting network, health campaigns that leverage technology and community voice, recognition of the impact of social determinants on health, and resources and services to meet basic needs.

Challenges identified through the 2020 needs assessment included the impact of poverty coupled with system limitations to address poverty as a driver of health disparities; gaps in capacity and access to services for basic needs like transportation, childcare, and healthcare; inconsistent distribution of culturally or linguistically relevant health information; gaps in respite care for caregivers of CSHCN; barriers to accessing behavioral health services; and racism and other drivers of health inequity.

Since March 2020, the most significant public health challenge has been the COVID-19 pandemic. Detailed information about the pandemic is included in the four prior Title V applications. In 2021 and 2022, Title V conducted assessments to gauge the pandemic’s impact on the MCH population. In 2023, assessment activities focused on the impact of the pandemic on local public health. Findings are included in prior Needs Assessment Updates. Information on COVID-19 including vaccination, testing, and treatment is available on the State’s Coronavirus website. Data confirmed and probable cases, trends, demographics, and laboratory testing is available on the COVID-19 Data Dashboard. Efforts to address COVID-19 vaccination and other routine vaccination among the MCH population are discussed in the Needs Assessment Update of this application.

Components of the State’s Systems of Care

Health Services Infrastructure and Financing

Michigan’s health care infrastructure includes 176 hospitals, including 37 critical access hospitals that serve rural areas (Michigan Health & Hospital Association). The state has 78 birthing hospitals and 21 Neonatal Intensive Care Units. Michigan also has six children’s hospitals (Children’s Hospital Association). The health care system includes 39 Federally Qualified Health Centers with over 250 delivery sites (Michigan Primary Care Association); 122 school-based/school-linked health centers (MDHHS); 34 Family Planning agencies providing services at 94 clinic sites (MDHHS); and 230 rural health clinics (Michigan Center for Rural Health). According to HRSA data on Health Professional Shortage Areas (HPSAs), as of March 2024, Michigan had 252 primary care HPSAs (versus 285 in 2023); 241 dental health HPSAs (versus 248 in 2023); and 232 mental health HPSAs (versus 257 in 2023). These include facility, geographic area, and population group HPSAs.

The public health infrastructure to protect and promote community health is supported by MDHHS and 45 local health departments (LHDs) that serve all 83 counties and the City of Detroit. MDHHS works closely with LHDs to provide comprehensive public health services. This decentralized structure allows for local efforts to address local needs while staying connected to the state for support, funding, and other resources.

Coverage expansions under the Affordable Care Act (ACA) provided Michigan consumers with two new options: Healthy Michigan Plan (HMP) and Health Insurance Marketplace (Marketplace). Eligible individuals above 133% of the federal poverty level (FPL) could enroll in private health insurance coverage through the Marketplace. In April 2014, Michigan expanded HMP to cover residents who were at or below 133% of the FPL and who were not previously eligible for traditional Medicaid. According to the HMP website, the plan provides health care coverage to Michigan residents who:

• Are age 19-64 years.
• Have income at or below 133% of the FPL.
• Do not qualify for or are not enrolled in Medicare.
• Do not qualify for or are not enrolled in other Medicaid programs.
• Are not pregnant at the time of application.

As of January 2024, 897,289 beneficiaries are enrolled in HMP (HMP County Enrollment Report) which is an increase from March 23, 2020 (674,853 beneficiaries). The Medicaid program kept Medicaid eligibility cases open until the end of the COVID-19 Public Health Emergency, which is discussed in the Needs Assessment Update.

The Healthy Michigan Plan (HMP) provides beneficiary access to quality health care, encourages utilization of high-value services, and promotes adoption of healthy behaviors. HMP benefits include preventive/wellness services, chronic disease management, prenatal care, oral health, and family planning services.

ACA consumer protections improved access to private insurance for CSHCN by eliminating preexisting condition exclusions and discrimination based on health status, the two most frequent enrollment barriers. The ACA also expanded access to parent employer coverage for adults 19-26 years of age. The number of individuals dually enrolled in CSHCS and Healthy Michigan Plan for January 2024 was 1,875. LHDs, Family Resource Centers, and designated state staff work with families and community partners to help families understand and access private and publicly funded resources to meet needs.

CSHCN often require and use more health care services than other children. Specialty care and extensive, on-going, or long-term treatments and services may be required to maintain or improve health status. Financing these costs can pose significant challenges and burdens for families even with access to private insurance. Health care costs can include deductibles, cost sharing, and premium payments. Private insurance may not include any covered benefit for a specific, medically necessary service. In other cases, only a limited benefit may be available. Although ACA eliminated annual and lifetime dollar limits, other annual limits exist, and benefits may be exhausted for the current contract year even though needs continue. CSHCS helps to limit costs to families and continues to be a resource for achieving appropriate and equitable health and specialist care. Steady CSHCS enrollment following ACA’s implementation reflects the value of CSHCS to families even when private insurance is available.

In FY 2024, the CSHCS program expanded age eligibility from up to age 21 to up to age 26. This expansion will improve access to health care services for young adults with chronic or complex health conditions who need specialty medical care. In addition, the expansion will provide critical support for young adults as they transition to adult services. With the program’s expansion, it is expected that an additional 9,000 individuals will have access to CSHCS. 

Integration of Services

MDHHS and Michigan’s MCH programs recognize the importance of integrating physical and behavioral health services to improve health and address individual or family needs. In March 2022, MDHHS announced a behavioral health restructuring (described in the Cross-Cutting/Systems Building plan) to support services across community-based, residential, and school locations. MDHHS initiatives to address behavioral and mental health needs include:

• The Michigan Peer Warmline is a statewide, anonymous line for any Michigander experiencing a mental health or substance use condition. The warmline is staffed by certified peer support specialists and recovery coaches. Additionally, the Michigan Crisis and Access Line (MiCAL) is now available statewide after being piloted in the Upper Peninsula and Oakland County in 2021. MiCAL is staffed 24/7 and provides crisis and warmline services, information, and coordination with local systems of care such as Community Mental Health Services Programs.
• In January 2024, MDHHS announced a Request for Proposal (RFP) to establish a capacity building center to support training and workforce development for individuals who provide behavioral health services. MDHHS issued a separate RFP to establish a program to provide stipends for student interns in Michigan’s public behavioral health system.
• The Expanding, Enhancing Emotional Health (E3) model helps to address the need for mental health services for children and youth. E3 is a designated model through the Child & Adolescent Health Center (CAHC) Program. E3 programs provide on-site comprehensive mental health services from mild to moderate severity of need by a licensed Mental Health Professional. Services include assessments, brief intervention, ongoing therapy, referrals, and follow-up. E3 sites are open year-round and provide telehealth when school is not in session. Services are designed for children and adolescents 5-21 years of age when access to behavioral health resources are limited or inaccessible in a community. Currently, 102 E3 sites operate in 40 counties.  
• The Child & Adolescent Health Center program is continuing to expand in new communities in 2024 through an annual $25 million investment from the state budget. This will expand primary care, nursing, and mental health services to underserved children and adolescents throughout the state. An additional 44 new partner sites were brought on in 2023, and an additional 20 are anticipated in 2024.
• Michigan continued to roll out expanded coverage for nursing and mental health services for general education students through a CMS approved Medicaid waiver. The Caring 4 Students (C4S) expansion allows schools that provide mental health and nursing services to general education students to receive Medicaid reimbursement. All 56 Intermediate School Districts participate in C4S. Michigan is one of 16 states that have expanded eligibility to include general education students.
• In August 2020, MDHHS was approved for a two-year CMS Certified Community Behavioral Health Clinic (CCBHC) Demonstration. In 2021, the demonstration was extended an additional four years. CCBHC demonstration sites provide nine core behavioral health services, including care coordination with primary care providers, and must meet standards for service provision, staffing, governance, and quality and financial reporting. Gov. Whitmer’s FY 2025 budget proposal includes $193.3 million to strengthen Michigan’s CCBHC demonstration program by expanding CCBHC sites and increasing program support. The proposal would expand access for up to 50,000 additional Michigan residents.
• The Michigan Child Collaborative Care (MC3) provides psychiatry support to primary care providers who have patients with behavioral or mental health concerns. Behavioral Health Consultants provide guidance to providers on diagnostic questions, medication recommendations and appropriate psychotherapy. Recommendations for local resources are also provided. MC3 provides behavioral health education for primary care providers, including cultural sensitivity. MC3 is administered collaboratively by MDHHS, the University of Michigan, and Michigan State University.
• An MC3 Perinatal Patient Care pilot program is also being implemented in six counties. The program offers free same-day access to behavioral health consultants who provide virtual counseling, case management and care coordination for perinatal patients. Patients complete an electronic screening tool and same-day brief intervention. The screening results are used to create short-term plans of care which may include virtual counseling, case management, and care coordination.
• DMIH received State Opioid Settlement funds to support ongoing efforts at three health systems to implement ‘rooming in’ programs in the hospitals’ birthing units. The family-centered model encourages parent-infant bonding and uses non-pharmacological care of infants born substance-exposed, ensuring they remain with their parent or caregiver in a private hospital room. Hospital staff provide support for breastfeeding, skin-to-skin contact, calming techniques, and referrals to services. The funds will also support expansion of the program to two additional hospitals in 2024.
• CSHCS continues to work with Behavioral Health partners to identify challenges accessing services experienced by populations served by the mental/behavioral health, intellectual/developmental disabilities, and physical health systems. Work includes regular meetings to discuss program changes and brainstorm how to address systemic access issues.

Title V and Medicaid

Michigan’s Title V and Title XIX programs are both housed within MDHHS and share the common goal to improve the health and well-being of the MCH population through implementation of affordable health care delivery systems, expanded coverage, and strategies to address social determinants of health and reduce health disparities. Areas of collaboration include maternal and infant care, perinatal care, child and adolescent health, developmental screening and referral, home visitation, oral health, and CSHCS. Key partnerships are discussed in the Title V–Title XIX section of this application.

In January 2024, 2,015,936 Medicaid beneficiaries were enrolled in Medicaid Health Plans and 867,271 beneficiaries were enrolled in fee for service. Medicaid uses a managed care delivery system to maximize the health status of beneficiaries, improve beneficiary experience, and lower cost. Medicaid contracts with nine Medicaid Health Plans (MHPs) to achieve these goals through evidence- and value-based care delivery models; health information technology; strategies to prevent chronic disease; and coordination of care that includes assessing social determinants of health such as transportation, housing, and food access. MDHHS requires MHPs to annually report the Healthcare Effectiveness Data and Information Set (HEDIS) and uses a Pay for Performance Incentive Program with access, process, and outcome metrics for all managed care populations, including women and children. Each MHP governing body must either have a minimum of 1/3 representation of Medicaid enrollees or the plan must establish a consumer advisory council that reports to the governing body. The council must include at least one Medicaid enrollee, one family member or legal guardian of an enrollee, and one consumer advocate. MHPs must recruit CSHCS beneficiary parents/guardians to participate in non-compensated governing bodies or consumer advisory councils.

To help achieve integrated care, MHPs are required to work with MDHHS to develop initiatives to better align services with Community Mental Health Services Programs/Prepaid Inpatient Health Plans (PIHPs) to support behavioral health. Medicaid incentivizes performance by MHPs and PIHPs on shared populations and metrics. MHPs must also provide or arrange for the provision of community health worker (CHW) or peer-support specialist services to enrollees who have behavioral health needs and complex physical co-morbidities. CHWs serve as a key resource for services and information needed for enrollees to have healthier, more stable lives. CHW services include home visits; participating in office visits; arranging for social services; and helping enrollees with self-management skills.

The DMIH and Michigan Medicaid jointly oversee several programs for the Medicaid-eligible MCH population. One of the largest collaborations is the Maternal Infant Health Program (MIHP), Michigan’s largest population-based home visiting program available to all pregnant people and infants up to age one eligible for Medicaid insurance. MIHP services provided to beneficiaries enrolled in an MHP are administered by the MHPs. In FY 2023, MIHP provided services to 11,299 adults and 14,515 infants.

Another area of coordination is for CSHCN. In January 2024, CSHCS program data indicate that 29,309 CSHCS beneficiaries were dually enrolled in an MHP. MHPs are responsible for the medical care and treatment of CSHCS members while community-based services beyond medical care and treatment are provided through an LHD’s CSHCS office. MHPs are responsible for coordinating and collaborating with LHDs and Children’s Multidisciplinary Specialty Clinics to provide a range of essential health care and support services to enrollees. MHPs are also responsible for coordination and continuity of care for enrollees who require integration of medical, behavioral health and/or substance abuse services.

Information Systems

MDHHS uses CareConnect360 (CC360), a statewide web-based care management system that allows for the bi-directional exchange of health care information. CC360 allows for the identification and coordination of services to Medicaid beneficiaries by sharing information between state health plans and Prepaid Inpatient Health Plans. CC360 makes it possible to analyze healthcare program data, manage and measure programs, and improve enrollee health outcomes. CC360 will help to improve communication among MIHP agencies by sharing care elements to support successful case management, so MIHP home visitors are engaged as part of the care team. It will also allow for comparison of population health data across counties or regions.

MI Bridges is also a key component of the MDHHS service platform to meet consumer needs. MI Bridges is an online site managed by MDHHS that enables users to apply for benefits (including healthcare, food and cash assistance, childcare, and state emergency relief) and to find resources such as transportation, food, and utility assistance. MI Bridges users can review and access their benefits information; renew benefits; and share beneficiary information. In 2020, functionality was built into MI Bridges to include home visiting. In 2022, the self-referral function was updated so that families now receive a custom list of home visiting models in their community for which they are eligible. Information on each model, including program descriptions and parent testimonials, are provided to help identify a model to best fit their needs.

MDHHS also uses health information systems to support the care and services provided to the MCH population. The Michigan Care Improvement Registry (MCIR) allows for the identification of children who are not up to date on Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) well child visits according to the American Academy of Pediatrics Bright Futures Recommendations for Preventive Pediatric Health Care periodicity schedule. All MHPs have access to MCIR, and it is an approved data source for Medicaid HEDIS immunization and lead testing data. MIHP providers also have access to MCIR to facilitate referrals and access to preventive services.

State Statutes Relevant to Title V (Effective August 1, 2023)

The Michigan Public Health Code, Public Act 368 of 1978, governs public health in Michigan. The law indicates the state health department shall “continually and diligently endeavor to prevent disease, prolong life, and promote the public health through organized programs” (MCL 333.2221). Furthermore, it shall “promote an adequate and appropriate system of local health services throughout the state and shall endeavor to develop and establish arrangements and procedures for the effective coordination and integration of all public health services including effective cooperation between public and nonpublic entities to provide a unified system of statewide health care” (MCL 333.2224).

For the fiscal year ending September 30, 2024, state funding for MCH and CSHCS programs was appropriated through Public Act 119 Enrolled House Bill 4437, Article 6, Department of Health and Human Services. CSHCS is mandated by the Michigan Public Health Code, Public Act 368 of 1978, in cooperation with the federal government under Title V of the Social Security Act and the annual MDHHS Appropriations Act. State general funds for MCH programs are itemized in Sec. 116, Family Health Services, of Public Act 119 of 2023, and CSHCS is addressed in Sec. 117.

Additional MCH funding requirements and legislative reporting relate to evidence-based programs to reduce infant mortality (Sec. 1308); family planning/pregnancy prevention; health outcomes before, during, after pregnancy (Sec. 1301, 1312, 1314); grants to local collaborators in perinatal quality collaboratives to improve maternal and infant health outcomes (Sec 1325); prenatal care outreach and rural home visiting (Sec. 1311); fetal alcohol syndrome services (Sec. 1313); oral health initiatives (Sec. 1315-1316, 1343); drinking water declaration of emergency fund support services (Sec. 1306); healthy exercise programs for school-age children (Sec. 1342); and statewide immunization media campaign (Sec. 1349).

Requirements in the FY 2024 Health and Human Services budget for CSHCS included criteria in Sec. 1360 for MDHHS to provide services; Sec. 1361 authorizes that some funding be used to develop and expand telemedicine capabilities and to support chronic complex care management.