The state’s demographics, geography, economy, and urbanization

According to the most recent census data, Louisiana has a population of about 4.6 million people. 62.5% of the population identify as white, 33% percent identify as Black, 5.8% identify as Hispanic / Latino, 1.9% identify as Asian, 1.9% identify as two or more races, and 0.8% identify as American Indian/Alaskan Natives. Nearly four out of every five residents were born in-state.1

Covering an area of 43,193 square miles along the Gulf of Mexico, Louisiana is the 33rd largest state in the country.2 The total area of Louisiana includes approximately 4,600 square miles of inland waters. Distinct geographic, cultural and economic regions of the state include the Northwestern Red River Valley region, the Northeast Mississippi Delta region, the Western Acadiana region, Eastern Acadiana/Lower Mississippi region, and the Greater New Orleans region.  Each of the regions have distinct histories, cultural characteristics, and economic contexts. 

Image One: Five Regions of the State of Louisiana3

Historically, Louisiana’s economy has been heavily dependent on agricultural and fisheries production. The state's principal agricultural products include seafood, cotton, soybeans, cattle, sugarcane, poultry and eggs, dairy products, and rice. Louisiana’s oil and gas industries constitute another significant segment of the economy. Louisiana's 15 oil refineries account for nearly one-sixth of the nation's refining capacity and can process about 2.9 million barrels of crude oil per day.4 Due to the abundance of oil and gas, Louisiana is home to more than 300 process manufacturing facilities supporting production of petroleum products and chemical manufacturing. The state's petrochemical plants are concentrated along the Mississippi River between Baton Rouge and New Orleans, a region referred to as Louisiana’s industrial corridor. 

Tourism, especially to the Greater New Orleans area, is another significant driver of the state’s economic production. In 2023, Louisiana attracted more than 43 million domestic and international visitors, who spent over 18 billion dollars.  Louisiana’s tourism and hospitality sector is the fourth largest employment sector in the state.5  

Of Louisiana’s 64 parishes (counties), 37 are considered rural. The largest urban centers include New Orleans, Baton Rouge, Lafayette, and Shreveport.

Challenges impacting the health of Louisiana’s MCH populations

Underlying challenges contributing to the persistently poor health outcomes of MCH populations in Louisiana include historical and present day systemic racism, persistent poverty, climate hazards, industrial pollution, low literacy and numeracy skills, lack of access to specialized health services including mental health services, and the state’s high incarceration rate.

Louisiana’s history of colonization, slavery, and legalized discrimination disempowered and oppressed portions of Louisiana’s population over multiple centuries. While laws and policies have changed over time, these historical inequities continue to take a significant toll on communities in the state and are perpetuated, consciously and unconsciously, in the ways people experience access to information and services differently across the state. The resulting persistent racial disparities can be best interpreted in light of the conditions in which people are born and live--conditions largely affected by historical and institutional structures and policies that uphold differential access to resources and systems of influence and authority.

Economic instability poses another major challenge to the attainment of health for many Louisianans. The overall poverty rate in Louisiana was 18.6% in 2022, the second highest in the nation.  24.4% of children in Louisiana are living in poverty, which is the third highest in the nation. At $55,416, the State’s median household income is the third lowest in the nation. Women are more likely to live in poverty than men (20.5% vs. 16.5%), and Black (29.4%), Hispanic (20.3%), and indigenous (18.8%) households are more likely to live in poverty than Asian (12.3%) or white (12.9%) households.6

Severe weather events create economic shocks that contribute to household and community financial instability. Severe weather events in the past decade include severe flooding in 2016; tornados and flooding due to Hurricane Harvey in 2017, Hurricanes Laura, Delta, and Zeta in 2020, and Hurricane Ida in 2021. Severe weather events are projected to increase in both frequency and severity due to climate change.  In 2023, historically low levels of rainfall combined with historically high temperatures contributed to large scale wildfires in multiple regions of the state and saltwater intrusion into the Mississippi river.  The intrusion of saltwater into Louisiana’s coastal communities and into the Mississippi river has the potential to threaten agricultural production and sources of drinking water for much of the greater New Orleans area. 

For families including children and youth with special healthcare needs (CYSHCN), poverty poses unique challenges including balancing employment and income generation with caretaking roles.  Regardless of insurance coverage, families that include CYSHCN face significant out-of-pocket medical expenses.  While these conditions can contribute to pulling families of children and youth with special healthcare needs into poverty, the effects of household poverty (including lack of sufficient nutrition, increased exposure to environmental risks/hazards, and decreased access to health information and services) contribute to increased prevalence of special healthcare needs. The bidirectional causal link, a vicious downward spiral, between poverty and special healthcare needs perpetuates both poverty and increased prevalence of CYSHCN in the state.  

While Louisiana’s oil and gas industry has been a significant contributor to the state’s economy, the air and water pollution created by petrochemical production sites present a significant hazard to workers and surrounding communities.  Families living in Louisiana’s industrial corridor, including communities along the Mississippi river between Baton Rouge and New Orleans, are at higher risk of multiple health conditions associated with exposure to hazardous air and water toxics.

According to the Program for the International Assessment of Adult Competencies (PIAAC), 27% of adults in Louisiana have a literacy rate below Level 1 (the lowest level) and 42% of the state had numeracy skills at or below Level 1.  Level 1 literacy rates were lowest in the Northwest Mississippi Delta region.  In East Carroll Parish, which borders both Mississippi and Arkansas, over 50% of the population had a literacy skills of Level 1 or below and 77% had numeracy skills of Level 1 or below.15 

Mental health care access remains a challenge for many in Louisiana. In February 2021, 47.5% of adults in Louisiana reported symptoms of anxiety or depression. 18.6% were unable to get needed counseling or therapy.12 Furthermore, of the 44,000 Louisianans age 12–17 who have depression, 62.3% did not receive any care in the last year.12 As of December 2023, Louisiana has 175 Mental Health Care Professional Shortage Areas as designated by the HRSA’s Bureau of Health Workforce. More than 3.6 million Louisianans live in areas without enough mental health services.15

Louisiana has one of the highest incarceration rates in the world. According to the Prison Policy Initiative, 1953 people per 100,000 are detained in prisons, jails, immigration detention, and juvenile justice facilities, compared to 565 nationally.16 This rate is impacted by sentencing laws for non-violent offenses, insufficient funding of jails and prisons, privatization of facilities, and a lack of investment in services and supports.

Assets supporting improvement of the health of Louisiana’s MCH populations

Key strengths and assets available to support improved health for Louisiana’s MCH populations include recent expansion of Medicaid, a long-standing commitment to children’s health and wellbeing, and continued investments in early childhood care and education programs. 

Historically, Louisiana had one of the highest uninsured rates in the nation. In July of 2016, Medicaid was expanded to all adults under 138% of the federal poverty line (FPL) (children were not part of this expansion population because children in that income range are already eligible for public insurance coverage). With that change in health policy, Louisiana experienced one of the largest reductions in the uninsured rate for any state. With the expansion of Medicaid, more than 516,000 adult men and women have gained health care coverage under public insurance. With the inclusion of the expansion population, Medicaid is now responsible for approximately 1.5 million child and adult participants in Louisiana.17 Furthermore, Medicaid expansion has had a significantly positive impact on Louisiana’s economy: within the first year of Medicaid expansion, more than 19,000 new jobs were created and $178 million in new state and local revenues were generated.18 Economic gains are expected to continue, with the state projected to save $1 billion by 2028 due to Medicaid expansion.19

Another strength in Louisiana is the long-standing commitment to facilitating healthcare coverage for children. Louisiana has achieved and sustained high rates of coverage for children. Between 2009 and 2016, the percentage of uninsured children decreased from 7% to 3%, and this decrease has been sustained for several years.17

Louisiana's early care and education system has also undergone significant change in an effort to better serve the state's families. Child care licensing was unified with other early education programs under the Louisiana Department of Education in 2015 in order to create a cohesive early childhood system and improve school readiness. This system has continued to stabilize and mature, though access to childcare subsidies remains more limited than a decade ago.  According to the State of Babies Yearbook 2023, Louisiana lags behind the national averages for nearly every measure associated with positive early learning experiences.20

Other assets in the state include its strong communities of faith, diverse academic and social institutions, and culture of community gathering and festivity.  According to a March 2024 Household Pulse Survey, Louisiana has the highest rate of regular participation in religious services of any state in the country21. Louisiana is home to thirteen universities, including six Historically Black Colleges and Universities (HBCUs).

Roles and responsibilities of the various offices within the Louisiana Department of Health (LDH)

The Louisiana Department of Health includes the Office of the Secretary; Office of Aging and Adult Services; Office of Behavioral Health; Office for Citizens with Developmental Disabilities; Bureau of Health Services Financing (Medicaid); Office of Public Health; Office of Women’s Health and Community Health; five 24-hour healthcare facilities; Legal, Audit, and Regulatory Compliance; nine Human Services Districts and Authorities (HSDAs); Louisiana Emergency Response Network; and the Developmental Disabilities Council.

• The Office of the Secretary (OS) is comprised of LDH’s Executive Management Team as well as the teams that handle centralized LDH functions, including internal and external communications; legislative and governmental relations; policy and QI; human resources; training and staff development; legal, audit, and regulatory compliance; finance; and budget.
• The Office of Aging and Adult Services (OAAS) develops, provides, and enhances services that offer meaningful choices for people in need of care in long-term care facilities and in-home and residential settings through home- and community-based services.
• The Office of Behavioral Health (OBH) manages and delivers the services and supports necessary to improve the quality of life for residents living with mental health challenges and substance-related and addictive disorders. This program office monitors and serves as subject matter consultant for the children’s Coordinated System of Care program and the Medicaid Healthy Louisiana managed care plans, which manage behavioral health services. OBH also delivers direct care through hospitalization and has oversight of behavioral health community-based treatment programs through the HSDAs. Services are provided for Medicaid and non-Medicaid eligible populations.
• The Office for Citizens with Developmental Disabilities (OCDD) serves as the single point of entry into the developmental disabilities services system, overseeing public and private residential services and other services for those living with developmental disabilities. This program office works to ensure individuals living with developmental disabilities and their families have access to a seamless services system that is responsive to both individual needs and desires. In addition, OCDD promotes partnerships and relationships which empower people living with developmental disabilities’ inclusion in family and community social and economic life.
• Medicaid provides government-subsidized medical benefits to qualifying low-income individuals and families. Although the federal government establishes the general rules for Medicaid, specific requirements are established by each state. In Louisiana, more than 1.8 million residents receive healthcare coverage through Medicaid.
• The Office of Public Health (OPH) is responsible for protecting and promoting the health and wellness of all individuals and communities in Louisiana. OPH accomplishes this through educational initiatives, promoting healthy lifestyles, preventing disease and injury, enforcing regulations that protect the environment, sharing vital information, and assuring preventive services to uninsured and underserved individuals and families. This office also monitors the food Louisiana’s residents and visitors eat; keeps our water safe to drink; fights chronic and communicable disease; ensures we are ready for hurricanes, disasters, and other threats; manages, analyzes, and disseminates public health data; ensures access to vital records like birth certificates; and improves health outcomes with an emphasis on preventive health services.
• The Office of Women’s Health and Community Health (OWHCH) was created by Act 676 (SB 116) of the 2022 Regular Legislative Session, and signed by Governor John Bel Edwards on June 18, 2022. OWHCH will serve as a clearinghouse, coordinating agency, and resource center for women’s health data and strategies, services, programs, and initiatives that address women’s health-related concerns. This office will focus on health needs throughout a woman’s life, including chronic or acute conditions that significantly affect women, access to healthcare for women, and women’s health disparities. OWHCH also includes the Bureau of Community Partnerships and Health Equity (BCPHE), which is charged with developing and implementing agency-wide health equity plans, protocols, and tools that support the implementation of health equity and community engagement practices and standards across LDH.
• LDH also operates five 24-hour healthcare facilities. These facilities include the Central Louisiana State Hospital, Central Louisiana Supports and Services Center, Eastern Louisiana Mental Health System, Pinecrest Supports and Services Center, and the Villa Feliciana Medical Complex. Together, these facilities provide behavioral health, developmental disability, and long-term care services for over 1,400 Louisiana residents.
• Legal, Audit, and Regulatory Compliance (LARC) includes the Bureau of Legal Services, Internal Audit, Program Integrity, and Health Standards sections of LDH. The Bureau of Legal Services is the legal arm of the Department and is responsible for handling all legal matters including procurement and the provision of legal advice around state and federal regulations applicable to all Department offices. The Internal Audit Section is responsible for conducting internal audits of various Department programs to ensure efficient operations and appropriate controls geared at maintaining programmatic integrity. The Internal Audit section additionally acts as the liaison for the Department with the Legislative Auditor, and other audit entities, regarding external audits of the Department’s programs. The Program Integrity section is responsible for ensuring programmatic and fiscal integrity of the Department’s Medicaid program, along with other Medicaid-funded programming provided by other departments. Program Integrity is responsible for monitoring Medicaid-funded programs for provider and/or recipient fraud, waste, or abuse. Finally, the Health Standards Section is responsible for the licensing and certification of various healthcare facilities in Louisiana, which includes ensuring that facilities are maintaining compliance with applicable standards, statutes, rules, regulations, and policies. This is accomplished through periodic surveys and inspections, including complaint investigations of providers that are subject to licensure and/or certification by the Department.
• Human Services Districts and Authorities (HSDAs), also known as local governing entities (LGEs), are established by Louisiana state law to direct the operation and management of community-based programs and services relative to mental health, intellectual/developmental disabilities and challenges, and substance-related and addictive disorders. HSDAs were established by Louisiana state law beginning in 1989 with the last entity authorized in 2013.
• The Louisiana Emergency Response Network (LERN) is responsible for developing and maintaining a statewide system of care coordination for patients suddenly stricken by serious traumatic injury or time-sensitive illness (such as heart attack and stroke). It is a system also designated to serve as a vital healthcare resource in the face of large-scale emergencies and natural disasters.
• The Developmental Disability Council’s mission is to increase independence, self-determination, productivity, integration, and inclusion for Louisianans with developmental disabilities and challenges by engaging in advocacy, capacity building, and systems change.
• During the 2021 Regular Session of the Louisiana State Legislature, Act 676 was signed into law to establish an Office on Women's Health and Community Health within the Louisiana Department of Health. The new Office is charged with “leading and coordinating efforts within the Louisiana Department of Health that are intended to improve women’s health outcomes through policy, education, evidence-based practices, programs, and services.” The law also establishes a new Assistant Secretary position and states that “the department may consolidate efforts on women's health and community health within the department as deemed appropriate by the secretary of the department.” At the time of this submission, it is unclear how Title V programs and services will be impacted. While it is likely that women-serving Title V programs and services will be impacted, the manner of and extent to which they will be is not defined in the legislation. As planning and implementation for the new Office commences, the Title V Director will work with LDH leadership to ensure any impacted Title V programs and services are adequately supported throughout the transition. (Please refer to the Title-V supported assessment of women’s health activities across LDH, completed in 2022). 

Strategic planning frameworks of the Louisiana Department of Health

• State Health Assessment/State Health Improvement Plan: In 2019, LDH OPH earned accreditation through the Public Health Accreditation Board. As part of OPH’s ongoing efforts to maintain accreditation, OPH conducted a State Health Assessment (SHA) from June 2021 and April 2022. This process reached nearly 6,000 Louisiana residents via two sets of meetings in each of Louisiana’s nine public health regions, a statewide electronic survey, community leader interviews, and public health system representative interviews. A report on the findings was published by OPH in July 2022. The following priority areas were identified for inclusion in the State Health Improvement Plan (SHIP): Behavioral Health, Chronic Disease, Community Safety, and Maternal & Child Health. BFH has been represented on the core SHA/SHIP steering committee since the beginning of the SHA process. In addition to representation on the steering committee, other BFH staff participated in the implementation of the assessment activities. In 2022, OPH established a Maternal and Child Health Workgroup, which is open to all residents of Louisiana, to facilitate the development of the MCH portion of the SHIP.
• LDH Business Plan: Since 2020, the Secretary of LDH has charged Office and Bureau leadership across the Department to develop a comprehensive annual LDH Business Plan to promote coordinated strategy and accountability across the Department. Most recently, Louisiana Title V, WIC, and Medicaid worked together to develop new strategies for SFY 2023 related to improving health outcomes from pregnancy through childhood, strengthening, expanding, and diversifying Louisiana’s healthcare workforce; and improving systems to support people living with Sickle Cell Disease. Most of these strategies directly align with those outlined in the FFY 2024 Title V State Action Plan.

State-specific statutes relevant to the MCH block grant authority and its impact on LA’s MCH and CYSHCN systems of care

Maternal and Child Health

• LA Children’s Code (CC) 609:Mandatory and permitted reporting
• LA R.S. §22:1059.1: Establishes the LA Doula Registry Board.
• LA R.S. §36:251(C)(1); R.S. §36:258(E); R.S. §46:2526: Establishes the Office of Women’s Health and Community Health.
• LA R.S. §40:31.3: Establishes an Adolescent School Health Initiative in public middle and secondary schools in LA and creates the Adolescent School Health Initiative Coordinating Council.
• LA R.S §40:31.41-48: Establishes the LA Birth Defects Surveillance System and the LA Birth Defects Monitoring Network Advisory Board.
• LA R.S §40:1075.1-1075.6: Establishes the Emergency Medical Services for Children Program.
• LA R.S. §40:1086.1-1086.4: Recognizes shaken baby syndrome and sudden unexpected infant death (SUID) prevention as major public health priorities. Requires LDH to designate the compendium of SUID resources approved for use by birthing centers, hospitals, and licensed midwives. Authorizes LDH to conduct public awareness activities.
• LA R.S. §40:1123.1-1123.4: Enacts the Perinatal Mood and Anxiety Disorders Act, which includes requirements related to the provision of maternal mental health services.
• LA R.S. §40:1262: Relates to equity in health care services and provides for LDH to be responsible for leading, consolidating, and coordinating efforts across the state geared toward improving women's health outcomes through policy, education, evidence-based practices, programs, and services.
• LA R.S. §40:2018: Establishes the Commission on Perinatal Care and Prevention of Infant Mortality (Perinatal Commission).  
• LA R.S. §40:2019: Establishes a Child Death Review (CDR) Panel, along with protocols and criteria for reporting and investigations for the unexpected deaths of children below the age of fifteen and the ability to suggest recommendations within the agencies presented on the state panel.
• LA R.S. §40:2024.3: Establishes the LA Domestic Abuse Fatality Review (DAFR) Panel.
• LA R.S §46:447.1: Establishes a program to provide information to public assistance recipients regarding family planning, including information regarding abstinence, but excluding abortion. Requires LDH secretary to promulgate a list of contraceptive methods and devices, excluding abortifacients that have been approved by the secretary based on their safety and effectiveness. 
• LA R.S §46:447.2: Calls for early, high quality, comprehensive prenatal care to reduce infant mortality rates. Provides that certain pregnant women and infants shall have access to appropriate healthcare services. Requires LDH to expand Medicaid eligibility for all pregnant women up to 185% of applicable federal poverty guidelines published in Federal Register by U.S. Department of Health and Human Services.
• LA R.S §46:973-974: Requires OPH to provide a special program of preventive, health, and medical care and health education services for adolescents that concentrates on adolescent pregnancy and pregnancy prevention. Establishes the LA Prenatal Counseling system within OPH to coordinate and utilize where practicable the educational, health, and supportive services adopted by the adolescent pregnancy and pregnancy prevention program. Requires the maintenance of a toll free number accessible throughout the state and publish information as to its availability, to advise pregnant women on the existence and availability of counseling services under this program.
• LA R.S. 46:1216.1: Provides for procedures for victims of sexually-oriented criminal offenses and requires all licensed hospitals and healthcare providers to provide victims information regarding emergency contraception and following negative pregnancy test, to provide emergency contraception at victim’s request.
• LA R.S. §46:2351-2355: Establishes the LA Commission for the Deaf (LCD) within LDH. Creates the LCD Board to support the work of the commission and to advocate on behalf of d/Deaf, DeafBlind, and hard of hearing communities and their families. Permits receipt of money from any source for credit and deposit into the Telecommunications for the Deaf Fund. LA R.S §7:1061 levies a tax of five cents per month to be assessed per wireless and landline phone collected from each residential and business customer and designates a special fund “the Telecommunication for the Deaf Fund” within the state treasury.
• LA R.S. §46:1451-1455: Establishes a continuum of care program for certain pregnant women and parents of young children and to create a statewide telecare support network.
• Act 739 of 2024 Regular Session: Create the Office of the Surgeon General with LDH.

Children and Youth Special Healthcare Needs (CYSHCN)

• LA R.S. §40:1071-1071.5: Designates OPH as the state agency to operate the "Children's Special Health Services"; to cooperate with Title V of the Social Security Act; to receive and expend federal funds for services to extend and improve services for children with special health care needs.
• LA R.S. §40:1081.1-1081.4: Authorizes and directs the LA Department of Health to establish, maintain, and carry out programs designed to reduce mortality and morbidity from sickle cell disease and to prevent central nervous system damage in children with phenylketonuria, congenital hypothyroidism, biotinidase deficiency, galactosemia and other genetic conditions
• LA R.S. §40:1081.9: Establishes a program for the care and treatment of persons living with hemophilia.
• LA R.S. §40:1122.1: Establishes the Rare Disease Advisory Council.
• LA R.S. §40:1125.1: Establishes the LA Sickle Cell Commission.
• LA R.S. §40:1125.11-1125.16: Requires LDH to establish and maintain a sickle cell disease (SCD) registry (i.e., the Skylar-Cooper Database).
• LA R.S. §40:1125.21: Establishes the Sickle Cell Patient Navigator Program to increase statewide access to the types of specialty care that are critical to the health and well-being of individuals living with SCD.
• LA R.S. §40:1125.31-1125.33: Authorizes and directs LDH to establish and operate sickle cell clinics and local program.
• LA R.S §40:2262-2267: Establishes a program to provide for the early identification and follow-up of infants susceptible to a hearing disability, of deaf or hard of hearing infants, and of infants who have a risk factor for developing progressive hearing loss; establishes an advisory council within the OPH (i.e., Early Hearing Detection and Intervention (EHDI) Program). Creates an advisory council for the program of early identification of deaf or hard of hearing infants (i.e., EHDI Advisory Council).

State-specific regulation relevant to the MCH block grant authority and its impact on LA’s MCH and CYSHCN systems of care

• LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 17. Children’s Special Health Services Chapters 49 - 59 
• LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 55. Birth Defects Surveillance System Chapter 161-163
• LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 19. Genetic Diseases Services Chapter 63 Neonatal Screening; 6303.
• LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 18. Disability Prevention Program Chapter 70. Lead Poisoning Prevention Program; 7001-7009
• LAC Title 48, Public Health-General, Book 2 of 2; Part I; Subpart 13. Family Planning Chapter 35-37
  LAC Title 5, Chapter 65, 6501, 6503: Authorizes LDH to operate Regional Genetic Clinics
• LAC Title 5, Chapter 69, 6901, 6903: LDH establishes Genetic Diseases Program Advisory Committee