II. A. Overview of the State
Indiana is nestled in the Midwestern United States. It is the 38th largest state by area and the 17th most populous state in the United States. It is bordered by Illinois, Michigan (including Lake Michigan), Ohio, and Kentucky. It has a diverse economy with a gross state product of $377 billion in 2019. Most of the state consists of farmlands, and Indiana leads the nation in its production of soybeans, poultry, and corn. Over half the state’s cropland consists of planted corn for animal feed and popcorn. In fact, Indiana produces more than 20% of the United States’ popcorn supply. Indiana is also home to the nation’s second-largest automotive industry, housing many workers in advanced manufacturing. Indiana is also well known for sports and is home to the NCAA. It’s known as the birthplace of baseball; home to the Colts, Pacers, Fever, Fuel, and Indy Eleven; and infamous for hosting the Indianapolis 500 race every Memorial Day weekend. The state is also known to host many other large events and conferences every year, bringing in visitors from around the nation.
Indiana is home to 6.8 million residents, known as Hoosiers. They live among 92 counties, including 16 metropolitan and 25 micropolitan areas. Its capital city, Indianapolis (Marion County), is located in the center of the state and is home to nearly 900,000 people. According to the U.S. Census Bureau in 2019, the Indianapolis Metropolitan Area is among the fastest-growing metropolitan areas in the US, with significant growth centering in the counties in and around Marion County. The population consists of 6% children under 5 years old, 23.3% youth under 18 years, and 50.4% female, with over 2.1 million women ages 10 – 59 years. By race and ethnicity, the population is 77.5% non-Hispanic white, 10.2% non-Hispanic Black, 2.7% Asian, 2.3% two or more races, and 7.7% Hispanic. Indiana has limited cultural diversity outside of its metropolitan areas, with over two-thirds of its counties reporting non-Hispanic white populations of more than 85%. This contrasts highly with Indiana's largest county, Marion County, which has a non-Hispanic Black population of 28.9%, Hispanic population of 10.6 %, and non-Hispanic white population of 64.0%.
The median household income is $58,235, with a per capita income of just $30,693 according to the 2020 census data. According to the Bureau of Labor Statistics, as of April 2022, the unemployment rate in Indiana was 2.2% Overall, the unemployment rate has steadily decreased over the past 2 years and is currently at its lowest rate in the past twenty years. Despite that statistic, it is estimated that almost 12% of the population across Indiana is living in poverty. Approximately 270,000 families living in poverty have a female head of household, 11% of children live in families where the head of household does not have a high school degree, and 14.7% of children in Indiana described having trouble accessing basic needs based on family income. Just under 7,000 Hoosier families receive Temporary Assistance for Needy Families (TANF), and 656,297 individuals receive Food Stamps. All schools offered free and reduced school lunches throughout the pandemic, but this will not continue in the 2022 – 2023 school year.
In 2019, there were more than 80,000 live births. Among Indiana live births in 2019, the majority (70%) were to White, Non-Hispanic women, followed by births to Black, Non-Hispanic women (13%) and to Hispanic women of any race (11%). The other 6% of live births were to mothers of another race (including women identifying as Asian, Pacific Islander, American Indian, or Alaska Native and those who indicated multiple races on the birth certificate) or where race and ethnicity were unknown. Most recent census data reveals that approximately 23.3% of Indiana’s population is under the age of 18, 6.3% are under the age of 5, and 16.1% are over 65. The life expectancy of Indiana residents is 77 years, and the population is 50.7% female and 49.3% male. Although only 4.5% of Indiana’s population are considered LGBTQ+, 34% of children and youth identify as a sexual minority.
The Indiana Department of Health
The Indiana Department of Health (IDOH) serves as the state’s central, standalone public health agency within the executive branch of government. Department employees work to improve the health of the population in a wide variety of ways, including health promotion programming, public health preparedness, data collection and dissemination, food protection services, health facility licensing, and many other infrastructure building programs. The agency supports Indiana's economic prosperity by promoting, protecting, and providing for the health of Hoosiers in their communities.
IDOH is an accredited department of health through the Public Health Advisory Board (PHAB). The department recently updated its strategic plan, the State Health Assessment, and the State Health Improvement Plan. These documents help guide the approach of the Title V team, and the entire agency, to improve the health and well-being of Hoosiers of all ages.
In 2020, IDOH adopted the following mission and vision:
- Mission: To promote, protect, and improve the health and safety of all Hoosiers.
- Vision: Every Hoosier reaches optimal health regardless of where they live, learn, work, or play.
IDOH also provides services guided by these Core Values:
- Health Equity: We place equity at the center of our work to ensure every Hoosier, regardless of individual characteristics historically linked to discrimination or exclusion, has access to social and physical supports needed to promote health from birth through end of life.
- Communication: We provide stakeholders and the public accurate and up-to-date scientific data and provide education and resources regarding utilization of evidence-informed practices in a timely manner.
- Innovation: We continue to learn, research evidence-informed practices, advance ourselves, and be open to new methods, ideas, and products that help build and expand upon the services we provide.
- Integrity: We are honest, trustworthy, and transparent. We uphold our standards and do the right things to achieve the best public health and safety outcomes.
Dr. Kristina Box, Indiana’s state health commissioner, was appointed by Governor Holcomb in the fall of 2017. Dr. Box has been a practicing obstetrician and gynecologist in Indianapolis for 30 years and has been an incredible advocate for maternal and child health while in this role. Other executive leadership includes: four Assistant Commissioners, the Chief Medical Officer, the Deputy Commissioner/State Epidemiologist, and the Chief of Staff. The department is organized into six commissions led by Dr. Box, including Health and Human Services, Public Health Protection, Laboratory Services, Consumer Services and Regulation, Epidemiology, and the Chief Medical Officer. In addition, IDOH’s Chief of Staff, Shane Hatchett, leads the various teams which provide internal, cross-agency support, such as the Office of Legal Affairs, Public Affairs, Technology, Data Support, and Finance.
The Maternal and Child Health (MCH) and Children’s Special Health Care Services (CSHCS) divisions both fall under the umbrella of the Health and Human Services (HHS) Commission at the Indiana Department of Health. This Commission encompasses multiple divisions: Fatality Review and Prevention; Trauma and Injury Prevention; the Division of Nutrition and Physical Activity; the Office of Chronic Disease, Rural Health and Chronic Disease; and the Office of Women’s Health. These teams regularly collaborate to further our mission and vision for the state of Indiana and carry out the work of the Title V Block Grant.
The Title V Maternal and Child Health Block Grant provides vital funding and infrastructure to IDOH by supporting the overall goals and strategies of public health and is an asset to improving maternal and child health outcomes in both the MCH and CSHCS divisions. Below is a description of each division and its responsibilities:
MCH: The Maternal and Child Health Division administers and houses many federal and state grant programs. The MCH Director oversees the Title V MCH Block Grant administration and works with the MCH Programs Director to fund community-based organizations across the state. The MCH team also administers the Maternal Infant Early Childhood Home Visiting (MIECHV) program, Newborn Screening, Early Hearing Detection and Intervention (EHDI), MCH epidemiology, State Systems Development Initiative (SSDI), the Sexual Risk Avoidance Education (SRAE) grant program, the Teen Pregnancy Prevention (TPP) grant program, administers the Youth Risk Behavior Survey (YRBS) and School Health Profiles Survey, as well as various other state-funded programs and projects. The team also oversees the Indiana Perinatal Quality Improvement Collaborative (IPQIC), hosts an annual Infant Mortality Summit, and uses other team expertise to reach our Title V goals. MCH provides a coordinated effort to eliminate health disparities, improve birth outcomes, and improve the health status of women, infants, children, adolescents, and families in Indiana. Using evidence-based and data-driven practices, we support the delivery of direct services, linkages and referrals, population-based supports, education, monitoring and quality oversight, and policy and systems development.
CSHCS: The Children with Special Healthcare Services Division (CSHCS) provides supplemental medical coverage to help families of children who have serious, chronic medical conditions, age birth to 21 years of age, who meet the program's financial and medical criteria, pay for treatment related to their child's condition. The supplemental coverage program is a payer of last resort, which means that participants must exhaust coverage from Medicaid and/or private insurance before the program will pay a claim. Title V funding ensures that the CSHCS division meets the state requirements in terms of policy and procedures for the program. The staffing areas covered by these funds include system developers, eligibility, nursing, care coordination, grant management, and claims staff. Currently, the CSHCS program has $14.7 million state funds that also support this work. This is an increase from past years due to increased prescription drug costs and a demonstrated need for the increase. In addition, the CSHCS division receives dedicated state funds for sickle cell and visual impairment. The visual impairment funds teachers who work directly with caregivers of children 0-3 throughout the state. The sickle cell fund is divided into two categories: 0-21 and over 21 population. The sickle cell funds multiple efforts throughout the state in terms of caring for the population, resources, and trainings. The funds also ensure that coordination occurs between all grantees.
The MCH and CSHCS Directors are responsible for the administration, coordination, and surveillance efforts of Title V and other federal and state grants that focus on promoting the health and well-being of mothers, infants, children, adolescents, youth with special health care needs, and families throughout the state of Indiana. Both teams collaborate with internal and external partners and stakeholders to prioritize health investments offered throughout the state; while ensuring all Title V grants are effectively allocated and maintained in a manner to continually achieve the values and priorities outlined in the five-year State Action Plan.
Current and Emerging Issues
Covid-19 Pandemic
In March of 2020, Indiana confirmed its first diagnosis of the novel Coronavirus. MCH and its colleagues pivoted quickly to ensure there were no gaps in services for women and children. As the number of cases grew, MCH worked closely with IDOH’s Office of Public Affairs to author and disseminate guidance pertaining to topics such as: breastfeeding, labor and delivery, home visiting, vision and hearing screening in schools, and others. MCH and IDOH also worked closely with the Indiana Hospital Association to co-host weekly web-calls with hospital staff and executives in order to ensure clinicians across the state heard the most up-to-date information and were able to ask questions and connect in real-time.
Many personnel in the MCH division who were deployed to serve in the COVID response including, Kate Schedel, MCH Programs Director, have transitioned back to full-time work within the division, and the Agency has ramped down its pandemic response. Programmatically, MCH has worked with subgrantees to ensure they have the needed resources to continue to deliver services to the women and families they serve. As of Spring 2022, subgrantees, for the most part, have transitioned from seeing participants virtually through telehealth, back to in person but have developed policies and procedures to be flexible to meet needs regardless of location. As of Spring 2022, much of the state is open for travel and in-person gatherings; however, the landscape and culture of meetings have changed. MCH continues to use technology to reduce travel, make meetings more open and inclusive, and reach additional partners. In short, the abrupt introduction of new methods of communication due to pandemic isolation has made it easier to connect.
On July 1, 2022, IDOH released its post-incident COVID-19 After Action Report (AAR) and Improvement Plan. This report is a culmination of interviews and workshops with hundreds of medical and public health professionals across the State of Indiana regarding COVID-19 response efforts. This included hours of discussions with key staff and personnel throughout the Indiana Department of Health (IDOH), partner agencies, local health departments (LHDs), as well as key stakeholders from the private and non-profit sectors. These discussions expanded on – and added clarity to – the significant amount of information collected by IDOH via stakeholder surveys conducted during the summer of 2021. For its evaluation and planning process, IDOH wanted to produce more than a simple report that checks off what went well and what did not. The goal was to take an in-depth look at strengths and areas of improvement, build on them, and ensure IDOH is better prepared to meet the challenges of any future event. The state is currently continuing its efforts for testing, vaccinations, and is working to immunize children under five.
Formula and Tampon Shortages
IDOH MCH has also been working to address two critical shortages that impact the maternal and infant population around the state. In the spring of 2022, Indiana recognized an ongoing formula shortage across the state caused by nationwide supply chain issues as well as the Abbott plant in Michigan shutting down. In partnership with Department of Health leadership, Women Infants and Children (WIC) Division, and state and federal partners, the MCH team provided proactive and actionable communications to our external partners, including WIC, delivery facilities, funded programs through all federal and state programs (including Title V). The MOMs Helpline number was provided as a resource for families to call to get the latest information and connected to resources. The Helpline fielded a number of calls on this topic; however, the WIC division bore the brunt of the communication and coordination.
In June 2022, IDOH issued a survey to all partners and contacts across the state to assess the tampon shortage and its impact on the populations they serve. As of the beginning of July, 22% of survey respondents stated that the women they serve reported challenges meeting their needs due to the tampon shortage. According to the survey, nearly a quarter respondents have initiatives in place or in progress that connect women to sanitary products. It was recommended that Indiana’s Title V program assist women of childbearing age in accessing tampons in several different ways. Some suggestions included distributing sanitary products through OB/GYN offices, clinics, middle schools and high schools, food pantries, and through diaper banks around the state.
Staffing & Infrastructure
The Title V program, as well as the health department in general, has seen increased turnover due to the other industries offering flexible work options and increased pay in the past two years. And as described in the most recent Public Health Workforce Interest and Needs (PHWINS) survey, the public health workforce is in jeopardy of burnout. Government public health lacks the capacity needed to meet increasingly complex public health issues.
The state Title V leadership team is comprised of six programmatic staff, three of whom are new within the past year. This includes a new Title V Coordinator and Federal Programs Manager in MCH and a new Integrated Community Services Manager in CSHCS. In addition, MCH has a whole new team of subject matter expert staff.
The Holcomb administration has also implemented significant staffing policies aimed at making the State of Indiana a more competitive employer. These include a salary review adjustment, flexible work schedules, bonuses for referrals of new employees, community service incentives, and education reimbursement. State staff is excited to see how these policies impact morale and reduction in turnover.
Public Health Landscape in Indiana
As a response to identified challenges exposed during the pandemic, Governor Holcomb and his administration passed a bill calling for an official commission examining the public health infrastructure in the state. The Public Health Commission, chaired by State Senator Luke Kenley and CDC Foundation CEO Judy Monroe, meets quarterly to review the critical aspects of public health within the state.
One of the major outcomes from the Commission is more sustainable way to support Indiana’s 94 local health departments, each led by a local health officer and an administrator. Public health is ‘home ruled’ in Indiana, meaning that IDOH does not have oversight or control over local health departments. Local health departments are also limited to funding from tax revenues, which means they vary significantly in the services they provide residents in their jurisdiction, with many of them having just a handful of employees. While a few local health departments receive Title V funding, there is not enough funding to support every health department that is already underfunded.
The Commission has also noted that the state persistently ranks among the bottom 20 states, and other the bottom ten on key public health metrics. Even before the pandemic, Indiana struggled to address health challenges and health disparities, and will put forth recommendations related to the following areas: governance, infrastructure, and services; public health funding; workforce; data and information integration; emergency preparedness; and child and adolescent health. The Commission is currently authoring recommendations to be submitted to the legislature and the Governor to inform priorities for the 2022-2024 state budget cycle.
Health Status and Health Needs of Hoosiers
Indiana has struggled over the years with generally poor health outcomes. Consistently ranked near the bottom for critical health measures, Hoosiers have high rates of chronic disease, tobacco use, and poor access to healthcare. Obesity continues to increase in both adolescents and adults. Substance use disorder and mental health challenges continue to impact our state. Indiana has seen an increase in deaths due to substance use disorder and suicide. As noted in the 2021 Youth Risk Behavior Survey, adolescents in Indiana are experiencing exponentially higher rates of depression, suicide ideation, and isolation as well. Many of these health needs have been exacerbated by the pandemic. Below are some key factors IDOH must consider when addressing the needs of maternal and child health around the state.
- Racial and ethnic disparities
Minority populations make up more than 20% of the population in Indiana. Like the rest of the United States, Indiana is growing more culturally, racially, and ethnically diverse and has started to see a decrease in the non-Hispanic white population with a corresponding increase in other racial and ethnic groups. Specifically, Indiana has experienced growing populations of families from Haiti, Central American communities, and Burmese refugees. In 2021, Indiana hosted guests evacuated from Afghanistan on an Army base in the south-central part of the state. While many of these families settled out to state, some did choose to say in Indiana. Census data estimates that 5.3% of Hoosiers are foreign-born.
In Indiana, the Non-Hispanic Black population has consistently poorer health outcomes than the white non-Hispanic population. The 2020 infant mortality rate for Non-Hispanic Black individuals (13.1 per 1,000 live births) is almost two times that of the white non-Hispanic population (6.1 per 1,000 live births). The 2020 percentage of low-birth-weight infants for Non-Hispanic Black infants (14.2%), is nearly double that of the Non-Hispanic White infants (7.2%). The 2020 Maternal Mortality Review Committee found that the mortality ratio of non-Hispanic Black women was 20% higher than non-Hispanic white women. The percentage of mothers receiving early, and adequate, prenatal care is 69.3% in 2020. The discrepancy is considerably more evident among Black women (56.3 %) than white women (74.1 %). The percentage of Non-Hispanic Black mothers in 2020 who are breastfeeding at hospital discharge (73.3 %) is well below that of the non-Hispanic white mothers (83 %). In the 2021 Youth Risk Behavior Survey, 4.5% of Hoosier children have been treated or judged unfairly due to their race or ethnicity. This information has helped guide the development of the newly revised State Performance Measures and has been used to determine the judicious allocation of scarce Title V resources. According to data compiled by HRSA for Region V, if Indiana continues the current trends for Non-Hispanic White and Non-Hispanic Black infant mortality rates, Non-Hispanic Black infants will have to wait 38 years to achieve the 2019 Non-Hispanic White infant mortality rate. In other words, even though the rates continue to decline, Indiana must do more to close the wide gap between population groups.
An increasing Hispanic population faces barriers to care. Most notably, this population suffers from scarcity of interpreters and materials in Spanish and is least likely to have health insurance, as seen in our Social Determinant of Health analysis in 2020. To alleviate some of the interpretation needs, the MCH division has hired Spanish-speaking staff to provide interpretation and translation support for the division and often for the whole department of health. With 10.3% of Indiana families speaking languages other than English in the home and nearly 27,000 children having no one over age 14 who speaks English “very well,” these professionals are vital to the health and well-being of Hoosiers. It is estimated that over 260,000 Hoosiers speak languages other than English or Spanish. Other commonly spoken languages include Arabic, Burmese (including multiple dialects such as Chin and Karen), and Mandarin. Currently, there is a disparity in Indiana translators who speak languages other than Spanish. This leaves that portion of the population increasingly vulnerable. Language and access to language resources has also been shown to impact educational attainment. Indiana’s Commission to Improve the Status of Children is co-chaired by MCH Program Director, Kate Schedel, who has a team of individuals working to increase healthcare coverage and insurance to legally residing citizens and their families, which will help increase access to healthcare for many of the state’s immigrants.
Indiana is home to 35,000 individuals from Burma—the most in the United States, with Indianapolis having the largest community at 24,000. Neighborhoods, health departments, schools, and other non-profits have been quickly working to improve access to culturally relevant services. Most work with the Burmese population has been slow due to lower literacy levels and many different dialects. MCH has partnered with its internal team of refugee health experts as well as organizations that work directly with the Burmese population to understand the health needs of families, create educational materials and resources, and incorporate them into existing platforms such as the Liv Pregnancy Mobile App, home visiting, and MOMS Helpline.
Indiana has the third-largest Amish population in the world, yet it accounts for less than 1% of its population. The Amish communities span across rural areas of 32 counties in Indiana. Communication barriers exist as they do not have telephones in the home, English is often a second language, and health literacy is low. The Amish also experience financial barriers and transportation barriers. They are often reluctant to obtain health insurance or drive vehicles. Therefore, they often opt for alternative medical practices. While services are available and MCH has partnered with clinics to address these barriers, more work to address health disparities is needed.
Indiana has no federally recognized tribe within its borders. However, IDOH recognizes the importance of working with the citizens of tribes residing within the state. Specifically in the northern region, where the Potawatomi Tribe has recently built a casino and new housing, including a health center. The Title V program looks forward to engaging with this community in conjunction with other IDOH staff and local partners.
- Geographical Disparities
In Indiana, 70% of the population lives in a metropolitan area, while 30% reside in a rural area. Currently, 63% of Indiana’s counties are considered rural; this is equivalent to two-thirds of the state’s counties. According to the Indiana Rural Health Association, rural communities have higher rates of chronic illness, disability, and poorer overall health status than urban communities. Rural residents also tend to be older and poorer than urban residents. Eighteen percent of rural residents are over 65 compared to 15% of urban residents, and more rural residents live below the poverty level compared to urban residents. Injury-related deaths are 40% higher in rural communities than in urban communities. Cancer rates are higher in rural areas. People living in rural areas are less likely to use preventive screening services, exercise regularly, or wear safety belts. These disparities among rural and urban Hoosiers may be due to several factors, including:
Lack of Transportation
Over 6% of Indiana households do not have a vehicle, including an estimated 30,000 households in Indianapolis (Marion County) alone. Public transit outside of Marion County is sparse, and inside Marion County there are still obstacles for people who need to commute to work: bus lines do not go everywhere. Many individuals must choose jobs they can access with public transit or within walking distance, which may not provide adequate health coverage. In addition, families are limited with lack of access to medical care and treatment because of cost prohibiting factors, weather, hours of operation, unable to get to a specific geographic area, and/or because the patient is too sick to use available options. Lack of transportation also limits access to nutritious foods and acts as a barrier to earning a stable income, this barrier is especially prevalent in rural communities.
Differences in Urban vs. Rural
Within Indiana, metropolitan areas experienced population gains, while other areas experienced population declines. Differences in health outcomes by rural vs urban:
- The MCH Epidemiology 2015-2019 linked data analysis showed that residents in counties that are considered rural made up a slightly higher percentage of infant deaths (23.0%) compared to their share of the births (21.9%), while residents of urban counties made up a slightly lower percentage of infant deaths (77.0%) compared to their share of the births (78.1%).
- In an attempt to look further than only rural/urban designation, the MCH Epidemiology Team also assesses births and infant deaths by categorizing counties by presence of OB services, lack of inpatient services, or no hospital. When looking at these designations, there are minimal differences in infant death percentages. While these designations did not have a high influence on infant death distribution, infant morbidity may likely be more impacted than infant mortality.
- While birth rates in Indiana have been steadily declining for years, the rural teen birth rate (22.9 in 2020) continues to be several percentages higher than the urban teen birth rate (17.6 in 2020). This trend has been consistent for ten years. These rates are for female teens aged 15-19 and calculated per 1,000 live births.
The MCH division notes, however, that populations cannot be placed in to ‘clean and simple’ categories, and individuals are multi-layered, and identities intersect.
- Healthcare Workforce & Coverage
Limited Providers & Services:
Indiana does have 27 Federally Qualified Health Centers (FQHCs), eight Federally Qualified Health Center Look-a-Likes, and eight Rural Health Clinics that are Auto-HPSA designations (only for facilities). However, Indiana is still facing a severe shortage of providers. In 2021, 47.3% of Hoosiers lived in areas where there was a physician shortage, and Indiana is in the 90th percentile for its primary care physician ratio. As of today, 67 of Indiana’s 92 counties have a Medically Underserved Area or Population Designation. Fifty-four counties do not have enough dental/oral health providers, 64 counties have primary care shortages, and 83 counties have mental health provider shortages. There is also a critical shortage of physicians who provide substance use treatment for pregnant individuals, and treatment centers are only located in select parts of the state. According to the Bowen Center for Health Workforce Policy and Research, 34 counties (two-thirds of the state) lack a delivery hospital, and 20 counties have no prenatal care providers. The number of delivery hospitals decreased to 84 (down from 86 in 2021), and a large swath of residents, especially in the western part of the state are located outside of a thirty-minute drive time to a delivery hospital or prenatal care provider. Approximately two out of every five infant deaths can be tied to lack of prenatal care, making access to these services vital to infant health.
Children and youth with special health care needs are greatly impacted by limited providers. Families must often travel to Indianapolis or out-of-state to receive their specialty care. General primary care physicians and pediatricians have limited time and knowledge to coordinate effective care coordination for this population. This results in ineffective care and inadequate resources. Another issue is lack of knowledge about specific diagnoses. Many physicians statewide are not adequately trained to meet the needs of their patients with complex medical needs. This causes poor service delivery and frustration for caregivers. Indiana also has 14 autism hubs throughout the state to ensure that young children can be diagnosed before age three and offer early intervention services. However, due to the increase in physician and parental awareness, all hubs are currently operating on a waitlist. In addition, the demand for early intervention service providers is not proportionate to the need. The increase in fuel has made it difficult for part C providers to complete their visits in the homes.
Medicaid Providers
Indiana has a risk-based managed care system for all MCH populations on Medicaid. Providers in some counties have refused to participate in Medicaid reimbursement for pregnancy and infant care until the infants are on the Children’s Health Insurance Program (CHIP). These counties tend to have poorer pregnancy outcomes. Currently, there are just under 140,000 children enrolled in CHIP, and this number decreased in 2019 for the first time in four years. Over the past few years, a serious challenge has been not only the number of physicians who do not accept Medicaid reimbursement but also challenges for Medicaid enrollment among pregnant people.
To overcome the noted enrollment challenges for pregnant people, Indiana Medicaid began Presumptive Eligibility (PE) on July 1, 2009. Even so, there are areas of the state where providers are less likely to accept Medicaid reimbursement. Per Indiana Medicaid’s directory website (http://www.indianamedicaid.com/ihcp/ProviderServices/ProviderSearch.aspx), seven of Indiana’s 92 counties are without a single provider participating in Presumptive Eligibility. Furthermore, although the remaining 85 counties have PE-qualified providers, MCH has found that by comparing the MOMS Helpline extensive database records and speaking with individual callers, certain providers that are listed as accepting PE do not, and some no longer have OB/GYN staff. IDOH is partnering with providers across the state to clarify the intent of PE is to bridge the gap until Medicaid is in place and that they will be paid for services rendered.
In a positive move, as of April 2022, Indiana Medicaid made permanent the ability for postpartum individuals to stay enrolled for 12 months after delivery. MCH is hopeful this extended timeline will enable individuals to receive care for critical health needs such as substance use treatment, mental health consultations, chronic disease, and inter-conception care. This is also critical to address preventable maternal mortalities across the state.
Insurance
In comparison to other states, the health insured status of Hoosiers is below average. In 2019, 9.7% of Indiana adults, ages 18 to 64, lacked health insurance. Additionally, 7.5% of Indiana children under the age of 18 lacked health insurance coverage. From 2019 to 2020, just 79.3% of insured children received preventative care. Although Indiana’s children and youth rank higher in insurance coverage, there is still more work to ensure they are properly covered. Children and youth with special health care needs require specialized care and equipment that often place caregivers in financial hardships due to lack of proper preventative coverage.
Looking Ahead
Indiana has many strengths; however, MCH & CSHCN recognizes the need for continuous improvement when it comes to the overall well-being of Hoosier infants, children, children with special healthcare needs, adolescents, mothers, and families. We reaffirm our commitment to all current NPMs and SPMs and the Title V program; however, we will continue to assess the needs of the population and target areas for improvement, including evolving social factors and societal determinates of health. Changing circumstances (such as a pandemic or material shortages) for families require quick interventions and new partnerships. Relying on the nimble and flexible Maternal and Child Health Block Grant is essential for not only remaining steadfast in long-term population health improvement, but also providing support for families’ current and emergent needs. Indiana is excited for the future of Maternal and Child Health.
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