This overview provides key information about the Commonwealth of Massachusetts to contextualize the Title V program structure and approaches described in the Application/Annual Report. It describes Massachusetts’ demographics, geography, and economy; health care environment; the state public health structure; roles and responsibilities of the state health agency; and state statutes and regulations relevant to Title V.
Demographics, Geography, and Economy
Massachusetts has 6.8 million residents[1] and is the fourth most densely populated state in the U.S.[2] It is often thought of as urban because of the dense concentration of people in metro-Boston and other cities; however, as of 2017 160 cities and towns in Massachusetts (45%) are considered rural based on the definition set by the Massachusetts Department of Public Health (MDPH) State Office of Rural Health.[3]
An estimated 80.7% of Massachusetts residents identify as White, 9.6% as Black or African American, 12.0 % as Hispanic, 7.8% as Asian, 0.8% as American Indian or Alaska Native, 0.2% Native Hawaiian and Other Pacific Islander, and 6.1% some other race.[4] Immigrants make up 17% of the state’s population, and one-fifth of the Massachusetts labor force is foreign born, with immigrants supporting the state’s healthcare, science, and service industries, among others. The top countries of origin for immigrants were China (8%), the Dominican Republic (8%), India (7%), Brazil (7%), and Haiti (5%).[5] During 2019, 31.3% of births were to non-US-born women.[6] Nearly 24% of people speak a language other than English at home, the most common being Spanish.[7]
In 2016-2020, the median age was 39.6 years. An estimated 19.8% of the population was under 18 years, 36.7% was 18 to 44 years, 26.9% was 45 to 64 years, and 16.5% was 65 years and older.[8]
Approximately 11.7% of the population (including 4.7% of children and youth under the age of 18) has one or more types of disability, including visual, hearing, ambulatory, cognitive, self-care, and independent living disabilities.[9] In 2019, 41.4% of Massachusetts adults aged 18-64 with a disability were employed (+3.2% from 2018), compared to 81.7% of adults without a disability. Furthermore, 27.8% of people with disabilities lived below the poverty line, compared to 10.5% of people without disabilities.[10]
Massachusetts is a center of higher education and is home to leading research universities and private research laboratories. Massachusetts is also a global leader in life sciences, from public health, pharmaceuticals, and medical devices to diagnostics and nanotechnology. Massachusetts has a high proportion of college graduates, with 44.5% of the population having a Bachelor’s degree or higher, compared to 32.9% nationally.[11] In January 2022, the unemployment rate was 4.8%, down from a high of 17.1% in April 2020 during the COVID-19 pandemic, but above the 3.0% unemployment rate in January 2020.[12] During 2016-2020, 9.8% of people were in poverty; an estimated 12.2% of children under 18 were below the poverty level.[13] The median household income is $84,385, higher than the U.S. household median ($64,994).[14] Despite the high median income, Massachusetts is an expensive state to live. Many households are cost-burdened; 29.5% of homeowners and 48.9% of renters spent more than 30% of their household income on housing.[15]
Health Care Environment
Insurance Coverage
According to the 2019 Massachusetts Health Insurance Survey (MHIS),[16] published in April 2020, the uninsurance rate remained low at 2.9%, well below the national rate based on estimates from the National Health Interview Survey. MA children aged 0-18 years had an uninsurance rate of 1.6%. The uninsured were disproportionately Hispanic, representing 30.7% of the uninsured population versus 11.6% of the general population in MA. Most respondents to the 2019 MHIS reported a usual source of care other than the emergency department (91.0%, including 95.4% of children) and a visit to a general doctor in the past 12 months (86.4%). This represents an increase in both estimates from 2017. In addition, 17.0% of respondents visited a mental health professional over the past 12 months. Hispanic residents were less likely than Black residents and White residents to report a usual source of care (81.8%, 91.0%, and 91.6%, respectively).
Despite the high rate of insurance coverage, health care costs remain a concern for many families. Nearly half of 2019 MHIS respondents (48%) reported affordability issues over the past 12 months. More than one in seven (14.6%) reported spending a high share of income on out-of-pocket costs (defined as spending 5% or more of income for families below 200% of the FPL or 10% or more for families at or above 200% of the FPL) and 37.2% of residents who were insured for the past 12 months had unexpected medical bills.
In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth provides coverage to more than 2 million members – 30% of Massachusetts residents. This high level of enrollment contributes to Massachusetts’ low uninsurance rate.[17] The current MassHealth 1115 waiver, effective July 1, 2017 – June 30, 2022, aims to transform the delivery of care for MassHealth members and to change how that care is paid for, with the goals of improving quality and establishing greater control over spending. The waiver has implemented the most significant re-structuring of the program in two decades, shifting the delivery system toward value-based care. Through an Accountable Care Organization (ACO) model, MassHealth partners directly with provider organizations to deliver coordinated and quality care to its members. There are 16 ACOs (including one pediatric ACO) that are held financially accountable for cost, quality, and member experience. The 1115 waiver has also contributed to maintaining near universal health care coverage for the Commonwealth, supported the Commonwealth’s safety net, and expanded access to substance use disorder services.
MassHealth submitted a request to Centers for Medicare and Medicaid Services (CMS) in June 2021 to renew the 1115 waiver for five years (from July 1, 2022 – June 30, 2027).[18] Amendments were requested to: expand eligibility for the Medicare Savings Programs to comply with state law, extend eligibility for postpartum coverage to 12 months, authorize postpartum coverage for members not otherwise eligible due to immigration status, enhance services for specialized populations such as care coordination for children with medical complexity, and provide flexibility related to place of services. MassHealth anticipates CMS approval of the 1115 waiver extension in June 2022. For more information about the MassHealth 1115 waiver and Title V collaboration with MassHealth, see the Health Care Delivery System section.
Workforce and Infrastructure
According to the MDPH Healthcare Workforce Center, as of 2017 (the most recent data available), there were 28,428 physicians in Massachusetts with an active license, with 52% reporting a maternal and child health (MCH)-related specialty (e.g., pediatrics, family medicine, obstetrics and gynecology, and child and adolescent psychiatry). Of these, 8.8% (3,769) were pediatricians. Although Massachusetts has the highest number of physicians per population in the United States, these providers are not equitably distributed across the state. Over one third (38%) of physicians with an MCH-related specialty practice in Suffolk County (including Boston), which is home to just 11% of the state population. Many areas in the state, including rural communities, lack adequate access to care.
Massachusetts is home to a world-class pediatric hospital (Boston Children’s Hospital) and nine other tertiary care hospitals that provide Level III neonatal care. There are 52 community health centers (CHCs) that have more than 300 total access sites across the state.[19] CHCs are integral in providing high quality medical, dental, vision, pharmacy, behavioral health, addiction services and other community-based services to residents regardless of their insurance status or ability to pay. CHCs work to eliminate inequities in health outcomes by hiring multilingual and multicultural staff at every level of their organizations, deploying community health workers to help patients navigate the complex health system, and assisting residents in accessing health care coverage. CHCs also represent a major source of care for medically underserved women and children. According to the Statewide Economic Impact of Massachusetts Community Health Centers released in December 2020,[20] CHCs served 1,037,086 patients, including 221,611 (21%) children and adolescents. In addition, 75% of patients were low income, 74% identified as an ethnic or racial minority, 1% were veterans, 1% were agricultural workers, and 4% were homeless. CHCs accounted for 24% lower costs for health center Medicaid patients, $1.1 billion in savings to Medicaid, and $1.8 billion in savings to the overall health system.
Overall Health Status
Massachusetts is consistently recognized for good health status in national rankings. According to America’s Health Rankings 2021 Annual Report,[21] Massachusetts ranks #1 in clinical care and health outcomes, and #8 in social and economic factors. Strengths include a low prevalence of non-medical drug use, low prevalence of obesity, and high childhood immunization rates. Identified challenges included high income inequality, high preventable hospitalization rate, and high percentage of housing with lead risk. MDPH and Title V recognize that good health in Massachusetts is not equally shared. Persistent health inequities in access to services and in economic and health outcomes across demographic characteristics, most notably by race and ethnicity, point to historical and structural systems of oppression that continue to disadvantage people of color in the state. For example, 9.8% of the Massachusetts population lives below poverty level; however, only 7.9% of White residents live below the poverty level compared with 23.0% of Hispanic residents, 17.6% of Black residents, and 11.8% of Asian residents.[22]
Impact of COVID-19
The COVID-19 pandemic is both exacerbating pre-existing public health concerns and creating new health crises to address. Even people who have not become sick with COVID-19 are managing stress, uncertainty, and isolation during this challenging time. In fall 2020, MDPH staff and stakeholders conducted the COVID-19 Community Impact Survey (CCIS) to better understand the immediate and long-term health needs, including social and economic consequences facing the Commonwealth. MDPH uses these data to prioritize resources and inform policy actions to help address these impacts.
The survey was conducted from September – November 2020. There were over 33,000 adult respondents and over 3,000 youth (under 25) respondents. It was available in 11 languages, with focus groups conducted in ASL, and employed a sampling strategy to reach key populations including people of color, LGBTQ+ individuals, people with disabilities, essential workers, people experiencing housing instability, older adults, and individuals living in areas hardest hit by COVID-19. The survey reached 10 times as many Indigenous and LGBTQ respondents as past annual surveys, over five times as many non-English speaking, Hispanic, and Asian respondents, and more than twice the number of respondents among the deaf/hard of hearing and Black communities. This unprecedented number of responses enabled MDPH to provide granular population and geography specific findings to inform pandemic response efforts across the Commonwealth.
Key findings cover topics including access to healthcare, risk mitigation and access to COVID-19 testing, discrimination and race, social determinants of health, employment, housing security, intimate partner violence, mental health, and substance use. Findings are also organized by population, including parents and families, caregivers, youth, young parents, people with disabilities, sexual orientation and gender identity, essential workers, and rural communities. The pandemic has substantially impacted normal healthcare operations, put stress on healthcare capacity, and disrupted healthcare capacity even for people who normally face few barriers to care. It has also impacted people’s ability and willingness to access critical and essential healthcare services. Concerns were felt most acutely by populations who already faced healthcare barriers prior to the pandemic, and who also have the highest rates of delayed urgent care now. Although 60% of respondents who needed care could access it via telehealth, technology-related barriers remain a challenge for many populations.
In terms of access to COVID-19 testing, people who struggled to practice social distancing were less likely to have a work from home option and were less likely to get tested. People who do not work from home were also twice as likely to test positive. Key populations prioritized through Massachusetts testing initiatives like the Stop the Spread program reported some of the highest rates of testing, suggesting that these efforts were successful. Groups who were more likely to report not getting tested because they did not know where to go included: transgender community, males, non-binary people and those questioning their gender identity, LGBTQ+ community, people with disabilities, American Indian/Alaska Natives, people who identify as multiracial, Asians, people with lower income, and people who speak languages other than English.
The CCIS showed that Massachusetts parents were 50% more likely than non-parents to worry about housing. Parents who were concerned about expenses or childcare were more likely to report poor mental health compared to parents who were not worried about expenses or childcare. Sub-groups of parents who were more likely to report worrying about expenses, basic needs, and poor mental health included: non-binary, transgender, questioning, queer, and bisexual/pansexual people, people of color, parents under the age of 35, and parents of children and youth with special healthcare needs. CCIS findings suggest that parents, including parents of CYSHN, could benefit from targeted supports accessing basic needs such as housing, accessing food, and resources supporting mental health. MDPH is planning to administer a second version of the CCIS, with involvement from the Title V program to add and update MCH-specific questions.
See the State Action Plan Narrative by Domain for discussion of CCIS data related to specific Title V priorities.
Public Health Structure
Public health in Massachusetts is a statewide commitment to ensure that all residents have the opportunity to experience the best health and well-being regardless of race, ethnicity, socioeconomic status, geographic location, physical ability, or other characteristic. This vision is supported by a strong health care delivery system and public health infrastructure, led by MDPH. MDPH provides outcome-driven, evidence-based programming to prevent illness, injury, and premature death; ensure access to high quality health and health care services; respond quickly to emerging public health threats; and promote wellness and health equity for all residents of the Commonwealth.
Established in 1869, MDPH was the first state board of health in the United States. Throughout its history, MDPH has been a pioneer in the development and implementation of public health programs and strategies, including being the first state to establish a childhood lead poisoning prevention program and universal newborn screening program. With over 3,000 employees, MDPH uses a variety of approaches including screening, education, research, regulation, inspection, and the provision of funding to local programs and interventions to promote health for all residents in the Commonwealth.[23]
Massachusetts has a decentralized public health system, with each of its 351 cities and towns having its own governing body and health board with authority to provide public health services to its residents. These local public health authorities work in partnership with the MDPH Office of Local and Regional Health and others to deliver a core set of services. Local public health authorities are charged with a broad set of responsibilities for enforcement of state sanitary, environmental, housing, and health codes, such as protection of the food supply through inspections of restaurants and other food establishments; inspections and permitting of septic systems, landfills, and other solid waste facilities; and developing, testing, and building awareness of emergency preparedness plans for a wide range of hazards. Unlike many other states, Massachusetts does not provide base funding to local public health authorities for core public health services. Local public health services are primarily funded by local property tax revenues and fees.[24]
Massachusetts is a national leader in MCH programs and policy. The state’s commitment to the MCH population is demonstrated by matching of federal Title V funds. While states are required to match every $4 of federal Title V money with at least $3 of state and/or local money, Massachusetts provides a substantial overmatch. The philosophy of the Title V program is to address the health needs of pregnant people, parents, and children, focusing on a life course approach and addressing the impact of structural racism on MCH. Efforts in Massachusetts focus on the policies, systems, programs, and services needed to optimize the health of the entire family.
The MDPH Bureau of Family Health and Nutrition (BFHN) administers the Title V program. The Title V Director, also the BFHN Director, reports to the MDPH Associate Commissioner. MDPH is housed within the Executive Office of Health and Human Services (EOHHS), the largest secretariat in state government. EOHHS is comprised of 12 agencies, including Medicaid, Department of Children and Families, Department of Developmental Services, and MDPH. This structure provides Title V with capacity to promote systems of service, coordinate initiatives, and work collaboratively across a range of partners necessary for a comprehensive approach to Title V goals. The context of Title V within MDPH and EOHHS means that priorities and initiatives are synergistic and collaborative. An MDPH organizational chart is attached.
State Health Agency Roles and Responsibilities
In February 2022, Margret Cooke was appointed MDPH Commissioner after having served as Acting Commissioner since June 2021. The vision, mission, and priorities of MDPH are depicted in the graphic below. MDPH endeavors to provide timely access to data to reduce disparities and improve outcomes, address the social determinants of health, and eliminate health inequities. The principles underlying this work are everyday excellence, passion and innovation, and inclusiveness and collaboration. These principles refer to a culture of continuous improvement and performance management, passion about MDPH’s work, developing creative solutions to complex policy issues and population health management strategies, learning from internal and external partners, and ensuring people with diverse experiences and skills are involved in decision making. Together, these principles lay a solid foundation to achieve MDPH’s mission and vision.
Data Access and Capacity
An important effort that ties together the Commissioner’s priorities is the development of the Population Health Information Tool (PHIT),[25] which launched in June 2019. PHIT is a web-based compendium of health data that is available to the public to inform community health needs assessment, program planning, and policy making. PHIT is organized around six social determinants of health – education, employment, violence, social environment, housing, and built environment – to support Massachusetts in better addressing factors beyond clinical care that influence population health. PHIT users can access data dashboards and community-specific health priority reports, as well as contextual information to interpret the data and identify health inequities.
PHIT integrates data from myriad sources, including but not limited to Pregnancy Risk Assessment Monitoring System, Pregnancy to Early Life Longitudinal Data System, Behavioral Risk Factor Surveillance System, Vital Statistics, Injury Surveillance System, Birth Defects Monitoring Program, Substance Addiction Services, Early Hearing Detection and Intervention, WIC, and Early Intervention. Also included in PHIT are the Health Equity and Neonatal Abstinence Syndrome (NAS) Data Dashboards. The Race and Hispanic Ethnicity Health Equity Dashboard provides health outcome data from across MDPH in a centralized location. Key findings supplement charts to help viewers gain introductory level understanding of the impact of race on the health of Massachusetts residents. The NAS Dashboard includes data that address measures across three key time periods – pregnancy, birth, and infancy – for clinical providers, public health workers, and community agencies to monitor the care of families affected by perinatal substance use.
Through a partnership with the Center for Health Information and Analysis (CHIA), MDPH also assembles and manages the Public Health Data Warehouse (PHD), a unique surveillance and research tool that provides access to linked, multi-year longitudinal individual level data to enable analyses of health priorities and trends. MDPH created the PHD in 2017, in an unprecedented effort to link data sets across state government to effectively address public health priorities, with an initial focus on opioid overdoses. Public and private partnerships help the MDPH Office of Population Health identify and answer key questions to inform public health responses and policymaking.
Another MDPH priority for the use of the PHD was to generate new, actionable information that will help Massachusetts address inequities in MCH outcomes, especially those across racial groups and other social factors. In 2018 a workgroup identified the MCH datasets to be included in the PHD (such as WIC, Department of Children and Families, Early Intervention, and the Massachusetts Immunization Information System), and designed research questions of interest to Title V and MCH in Massachusetts. The workgroup proposed, and the Commissioner accepted, an initial focus on three MCH topics: maternal morbidity and mortality, preterm birth and infant mortality, and adolescent health and wellness. Staff reassignments during the COVID-19 pandemic resulted in delays securing data use agreements and accessing the data sets comprising PHD. Most datasets have been assembled, and it is expected that all datasets will be ready for analysis by mid-April 2022.
In addition to PHIT and the PHD, MDPH has access to the Massachusetts All Payer Claims Database (APCD), a comprehensive source of health claims data from public and private payers in Massachusetts. Administered by CHIA, it is used by health care providers, health plans, researchers, and others to address a variety of issues, including price variation, population health and quality measurement. APCD data have been used in an evaluation of MDPH home visiting programs.
Performance Management and Quality Improvement
MDPH is committed to continuous performance management (PM) and quality improvement (QI) as a proven way to enhance the Department’s performance. The Department’s PMQI efforts help guide funding decisions, identify priorities, and analyze results to ensure that public monies are strategically invested in effective programs and services. The Director of the Performance Management and Quality Improvement (PMQI) Team oversees the integration of QI culture at MDPH and chairs the PMQI Council. The PMQI Council meets bi-monthly to implement the department’s QI plan which involves annually assessing the QI culture, communicating PMQI efforts and successes across MDPH, and building PMQI capacity on all levels. The PMQI Team and Council integrate their efforts with the Department’s mission to achieve health equity, improve health outcomes, work collaboratively with its partners, and offer trainings on QI models and tools.
With its robust performance measurement framework and focus on implementing evidence-based practices and promising innovations, Title V is a leader in MDPH’s PMQI efforts. Title V staff continue to regularly participate in and help to provide instruction at Lean Six Sigma White, Yellow, Green and Black Belt trainings. In addition, Title V staff have always been members of and significant contributors to the PMQI Council.
Public Health Accreditation and State Health Assessment
In 2017, MDPH was awarded national accreditation by the Public Health Accreditation Board (PHAB). Since that time, MDPH has maintained its accreditation status by submitting annual PHAB reports and building capacity in PMQI. Title V staff actively contributed to achieving initial PHAB accreditation, including developing the State Health Assessment to ensure alignment of MCH priorities and objectives, and have since been contributors to the PHAB Annual Reports. These contributions are often noted by PHAB evaluators as important accomplishments that should be shared with other accredited health departments (e.g., Racial Equity Data Road Map, home visiting program QI projects, the MA MIECHV needs assessment and program planning process). MDPH will continue to maintain its national accreditation by submitting annual reports and applying for reaccreditation in 2022/2023.
COVID-19 Pandemic Response
For over two years, MDPH has played a central role in the state’s pandemic response. Key steps taken by MDPH since the beginning of the pandemic include:
- Developing public health guidance for providers, such as school nurses and other school personnel, substance addiction providers, homeless shelters, and home visitors.
- Keeping public health partners including local boards of health, Emergency Medical Services, college and university health systems, and health emergency preparedness teams informed with the latest state and federal guidance.
- Performing surveillance of potential cases and contacts and implementing the Community Tracing Collaborative.
- Creating COVID-19 data dashboards that present daily and cumulative reports on Massachusetts COVID-19 vaccination, cases, testing, and hospitalizations, nursing facility data, cases by city/town, residents subject to COVID-19 quarantine, and data from state facilities.
- Conducting the CCIS to better understand the immediate and long-term health needs, including social and economic consequences facing the Commonwealth due to the pandemic.
- Convening a Health Equity Advisory Group to generate recommendations for the MDPH Commissioner on responding to the COVID-19 pandemic with a health equity lens to ensure equitable access to resources and services and prevent inequities and disproportionate negative outcomes.
The Baker-Polito Administration has focused on equity throughout its COVID-19 response, including in vaccination efforts and data reporting. A major accomplishment was establishing the Vaccine Equity Initiative to increase awareness and acceptance of the vaccine, access to vaccination locations, and vaccine administration rates among populations and communities disproportionately impacted by COVID-19. In its first year, the progress of state/local and public/private collaboration has yielded:[26]
- More than 70% of the eligible population (age 5+) in 13 of the 20 VEI communities are fully vaccinated as of March 8, 2022. Four of these communities are over 80% fully vaccinated.
- In Chelsea, a community that was described by the media early on as an “epicenter” of the pandemic, over 91% of the eligible population is fully vaccinated.
- Thirteen of the 20 communities are now at or above the national average rate of eligible residents with at least one dose, which is over 81%.
- By the end of February 2022, booster rates were increasing in the twenty equity communities at a faster pace than non-VEI communities. Over half of eligible residents in VEI communities have had their booster (52.5%).
While Massachusetts is a leader in vaccine administration and equity, the Administration recognizes there is more work to do, and VEI efforts continue.
In 2021, MDPH was awarded CDC funding to address COVID-19 and advance health equity in racial and ethnic minority groups and rural populations within Massachusetts. Grant activities fall into four categories – COVID-19 mitigation, data metrics, community engagement and support, and social determinants of health. There is a strong emphasis on building the state’s data infrastructure.
- Data metrics: The funds support health equity data collection, analysis, dissemination, and management, allowing MDPH to understand the public health needs of the communities hardest hit by COVID-19. Examples of projects include using an innovative Community Evaluator model to collect qualitative data to assess the needs of priority population groups related to COVID-19; increasing the number of products for which there are translations, accessibility, and plain language materials; purchasing storage and processing space to support the addition of COVID-19 datasets within the Public Health Data Warehouse; and developing a PRAMS for new Dads survey to assess the experience of fathers during pregnancy and the birth of their child, and their experiences with COVID-19 testing, vaccination, health status, social determinants of health, mental health and racism during the COVID-19 pandemic.
- COVID-19 mitigation: The funds support COVID-19 activities in rural communities including testing, COVID-19 outreach and educational services, assistance to individuals who face barriers to isolating or quarantining, vaccination, and connecting residents to local and state resources for social needs. Mobile clinics provide in-person testing and home-testing kits, vaccines, and information regarding COVID-19. MDPH extended the Vaccine Equity Initiative framework to rural communities that have the highest need and gaps in services.
- Community engagement and support: The funds support health equity capacity building of MDPH staff, local boards of health, and other public health professionals using a population health approach and will engage racial and ethnic minority populations and rural communities in developing improved approaches to testing and contract tracing.
- Social determinants of health: Funds support grants to local communities to address the social determinants of health with a focus on the key drivers of the disproportionate impact of COVID-19 on priority populations, as well as community outreach on the Federal Emergency Management Administration's (FEMA) funeral assistance program.
Title V staff and programs have supported pregnant people, infants, children, youth, children and youth with special health needs, and their families through the COVID-19 pandemic in a variety of ways, such as:
- Offering services virtually (e.g., home visiting).
- Raising awareness for families and providers of the importance of emergency care planning and providing a variety of resources for this purpose.
- Facilitating access to concrete supports (e.g., unemployment benefits, diapers, transportation, groceries, personal protective equipment).
- Coordinating an information and referral pipeline for families of CYSHN.
- Creating a mechanism for emergency family support funding to low-income families of CYSHN who have experienced unexpected financial hardships related to job or income losses, hospitalizations, the death of a child or family member, and other similar catastrophic events.
- Establishing a surveillance system to monitor outcomes for pregnant women with lab-confirmed COVID-19 and their infants and adding COVID-related questions to the PRAMS survey.
- Using CCIS findings to respond to the needs of youth and families (e.g., addressing the impacts youth are experiencing beyond educational delays).
- Influencing prioritization of family caregivers of medically complex CYSHN to receive vaccinations as “unpaid essential” home health care workers during Phase 1 of the Massachusetts COVID-19 Vaccination Plan.
- Serving as site managers at UMass Chan Medical School’s VaxAbilities clinics for children with disabilities.
Title V staff have also taken active roles in advancing the goals of the Vaccine Equity Initiative. They have served as community liaisons, working with municipalities and Local Boards of Health to identify barriers to vaccine access (transportation, registration, etc.) and develop community tailored solutions. They have volunteered as MDPH COVID-19 vaccine ambassadors, supporting efforts to provide clear, accurate, consistent information about vaccine, build trust and vaccine confidence, dispel vaccine misinformation, and encourage vaccine uptake. Ambassadors attended community meetings to speak or answer questions about vaccine development and safety and facilitate communication back with MDPH. Title V staff provided project management support to vaccine communications efforts, including public and provider communications and community outreach. They also linked Massachusetts Immunization Information System (MIIS) and birth certificate data to better understand vaccination uptake among pregnant people and using the data to help inform vaccine outreach to pregnant people. Currently, Title V staff are leading and participating on the Pediatric and Family Workstream, focused on increasing vaccination among children ages 5-11 and their families, including children and youth with special health needs, and preparing for potential authorization of children under the age of 5.
State Statutes and Regulations Relevant to Title V
Title V priorities are contextualized within state statutes and other regulations to improve population health through the most effective and efficient mobilization of available resources. There are no statutes in Massachusetts directly related to the establishment or operation of a Title V program as defined by HRSA/MCHB. There are, however, many statutes and regulations that address issues related to MCH and CYSHCN. Examples of relevant statutes and regulations, many of which involved leadership or significant input by Title V, include:
- established a commission to make policy recommendations to eliminate racial inequities in maternal health
- expanded birth defects monitoring and surveillance regulations
- postpartum depression legislation
- expanded newborn blood screening regulations
- expanded public health practice for dental hygienists
- expanded breastfeeding in public places
- required periodic measurement of BMI in schools
- training for physicians, nurses, and other providers on domestic and sexual violence
- medical review and approval of short and long-term respite care for complex medical conditions in skilled nursing facilities
- formation of a PANS/PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections/Pediatric Acute-onset Neuropsychiatric Syndrome) Advisory Council to the MDPH Commissioner
- bullying prevention in schools
- sports concussion policy and management in schools
- junior operator law and primary child passenger restraint law for children under age 14
- lowering the regulatory definition of blood lead poisoning to 10µg/dL
- MassHealth coverage of long-acting reversible contraceptive devices inserted in the immediate postpartum period separate from the global delivery fee
- paid family and medical leave legislation
- pay equity legislation that clarifies unlawful wage discrimination and makes workplaces fairer and more equal.
COVID-19 continues to change both the lives of families and children and the public health system in innumerable ways. The Title V priorities, set before the pandemic began, are more important – and in many ways more challenging – to address than ever. However, the Title V program is well positioned in the state’s public health and health care environment to contribute to the response and recovery from the COVID-19 pandemic and to improve outcomes for the MCH population in Massachusetts.
[1] US Census Bureau, 2016-2020 American Community Survey 5-Year Estimates, Massachusetts.
[2] US Census Bureau, U.S. and World Population Clock
[4] US Census Bureau, 2016-2020 American Community Survey 5-Year Estimates
[5] American Immigration Council, Immigrants in Massachusetts, 2020
[7] US Census Bureau, 2016-2020 American Community Survey 5-Year Estimates, Narrative Profile
[8] US Census Bureau, 2016-2020 American Community Survey 5-Year Estimates, Narrative Profile
[9] US Census Bureau, 2016-2020 American Community Survey 5-Year Estimates, Narrative Profile
[10] Massachusetts Rehabilitation Commission, 2020 Disability Facts & Statistics
[11] US Census Bureau Quick Facts
[13] US Census Bureau Quick Facts
[14] US Census Bureau Quick Facts
[15] US Census Bureau, 2016-2020 American Community Survey 5-Year Estimates, Narrative Profile
[16] Center for Health Information and Analysis, Findings from the 2019 MA Health Insurance Survey
[21] America’s Health Rankings, 2021 Annual Report
[22] US Census Bureau, 2016-2020 American Community Survey 5-Year Estimates
[26] COVID-19 Vaccine Equity Plan, March 14, 2022
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