Overview of the State

Alaska is a large, sparsely populated state. The land mass of the state encompasses 570,641 square miles, averaging a population density of just 1.3 persons per square mile. This is the lowest population density of any state. The 2022 Alaska resident population was estimated at 736,556. According to the Alaska Department of Labor and Workforce Development, the size of Alaska’s population remained essentially unchanged from July 2021 to July 2022, growing by an estimated 451 people – the second consecutive year of small increase. Alaska’s 65-and-older population grew 5 percent and the 18-to-64 year-old group declined by 1 percent. There were 9,375 resident births in 2022. Alaska had 151,146 children less than 15 years of age (20.5% of the total population) and 146,355 women of childbearing age (15-44 years) in 2022 (19.9% of the total population).

Alaska has a trend of migration from rural to urban areas that has remained relatively stable over the past 20+ years. In 2022, approximately 17% of Alaskans lived in cities or places with populations of fewer than 2,500 people (down from 20% in 2019). Four areas with more than 20,000 people are home to 51% of Alaska’s population: the Municipality of Anchorage (population 289,810), the City and Borough of Juneau (32,202), the City of Fairbanks (31,843), and Knik-Fairview Census Designated Place (CDP) in the Matanuska-Susitna Borough (20,0098). Twenty-six of Alaska’s 30 boroughs and census areas lost population in 2022 compared to 2021. The Mat-Su Borough continued multiple years of increased population grown and had the largest growth rate among all economic regions, followed by the Kenai Peninsula Borough; 2020 was the first year when a Mat-Su CDP fell into the category of more than 20,000 residents. Fairbanks North Star Borough lost the most people in 2022 compared to 2021.

The industries with the greatest number of employees in Alaska include government, health care, retail trade, leisure, and hospitality. According to the Department of Defense, as of September 30, 2022, 20,206 active-duty military personnel were stationed in Alaska. Additionally, Alaska was home to 4,607 service members in the national guard/reserves and 5,033 permanently assigned civilian military personnel. Anchorage, Fairbanks, and Kodiak Island all have large active-duty military and dependent populations. Compared with other states, Alaska has the highest per capita number of veterans, with 71,454 veterans as of 2020, including 21,910 veterans under age 45, 20% of whom were women (a 1% increase compared to 2018). More than 2,000 female veterans under the age of 35 were living in Alaska in 2020. As of 2019, active-duty military represented nearly 3% of the state’s overall population while veterans were around 10%.

According to the Department of Labor statewide projections, Alaska’s statewide population is projected to increase from 734,323 in 2021 to 759,111 in 2050. As Alaska’s population ages in the coming years, annual growth is expected to slow. Alaska’s population aged 65+ is expected to grow at the fastest rate over the projection period, followed by the population aged 20-64. Recent declines in birth rates are projected to slow growth among the population aged 0-19.

In 2021, 65% of Alaska’s population was reported to be non-Hispanic White, 16% Alaska Native/American Indian, 7% Asian, 4% African American, 2% Native Hawaiian or Other Pacific Islander, and 8% two or more races (all percentages are for the race alone). Alaskans of Hispanic origin made up 7%. Cultural diversity among the non-Native population is increasing. The 2019 American Community Survey (ACS) indicates 8% of Alaskans were foreign-born. Pacific Islanders are the fastest-growing racial group in Alaska, largely due to immigration, and the largest immigrant group in Alaska are Filipinos (documented and undocumented) (Anchorage Daily News, 2019).

Diversity in Alaska is most apparent in Anchorage, which in 2020 had four census tracts with a census diversity index greater than 82%. More than half of the students in the Anchorage School District identified as non-White, speaking over 100 different languages. The top five languages spoken by families in the Anchorage School District after English in 2020 were Spanish, Hmong, Samoan, Filipino, and Korean. In October 2021, the racial group with the next highest percentage of students after White was Asian or Pacific Islander (18.5% of all students), while 15.9% identified as biracial/multiracial. In the 2018-2019 school year, 16 of the top 30 highest diversity public schools in the United States were in Anchorage. The Asian and Pacific Islander population has been increasing, growing from 6% of births in 2000 to 11% in 2020.

Strengths and challenges that impact health status

Special note: Throughout this section, comments from respondents to the Childhood Understanding Behaviors survey are included to provide voice to individual Alaskans with lived experiences relevant to the strengths and challenges being described.

Health disparities and health equity have large implications for the health status of Alaska’s MCH population. The most well documented and commonly studied differences in health status are between the Alaska Native and non-Native populations and between rural/frontier and urban populations. Alaska Native people experience disproportionate health outcomes in several domains. The causes of these disparities are multifactorial and include a long history of colonization, discrimination, and the loss of traditional lifestyles. As the Alaska Native population becomes increasingly urban or adopts western lifestyles and diet, whether by choice or not, chronic diseases such as diabetes and heart disease are of increasing concern. Living in remote communities with high unemployment rates, lack of stable employment opportunities and significantly higher costs for food, fuel, and supplies, as well as barriers to accessing health care services are also contributing factors. Increasing temperatures due to climate change are also affecting human health in Alaska, particularly in rural communities where there have been observed impacts on subsistence activities and resources and where melting permafrost has caused damage to physical infrastructure.

“[We need] better connection to our culture…learn our languages that have been almost forgotten” (2021 CUBS respondent)

Investments in rural infrastructure including housing, safe water and sanitation facilities, community health aide-staffed Tribal village clinics, and regional hospitals have contributed to improvements over the past 50 years in life expectancy, infant mortality and infectious disease. However, continuing and significant disparities remain, including in key MCH outcomes such as post-neonatal mortality; child, adolescent, teen (especially teen suicide), and maternal mortality; and oral health.

“I think subsistence activities/events/resources are very beneficial & crucial to our lively hood.  But if support cannot be provided financially, stories, projects & other creative ideas can be shared. Also, out in rural Alaska, our cost of living is not only high but we lack fresh produce [especially @ a reasonable price]. In the summer we do our best to harvest what we can but affordable & available heathy food year round is important & difficult for us to get @ times. Quyana” (2020 CUBS respondent)

Uninsured populations are less likely to access routine, preventive care and more likely to seek care when health problems are severe and require treatment. In 2021, 48.6% of Alaskans aged 0-64 years were covered by employer or other private health insurance and 27.6% were covered by Medicaid (Kaiser Foundation). Over one-third of children (38%) and 20% of women ages 15-49 are covered by Medicaid. According to the 2023 Scorecard on State Health System Performance by the Commonwealth Fund, Alaska ranks 39th in the nation for overall health system performance. The Commonwealth Fund highlighted that Alaska was one of four states that stands out as having lower access to both early prenatal care and postpartum care in the first four to six weeks after birth (25.5% of live births in Alaska did not have prenatal care in the first trimester and 15% of people with a recent live birth did not report having a postpartum checkup visit). Additionally, Alaska “ranked among the lowest overall on reproductive care and women’s health”, as well as “toward the bottom on two key measures for women of reproductive age: having a usual source of care and receiving a routine checkup visit.”

Poverty affects health both through decreased access to material resources, like health care and nutritious food, and through increased exposure to negative social and environmental factors, like violence, lead, and air pollution. It is associated with poor maternal health and birth outcomes such as infant mortality, low birth weight, and child maltreatment. According to the Spring 2021 Kids Count Alaska Economic Well-Being report, there are significant disparities in poverty indicators by race/ethnicity in Alaska. In 2018, the proportion of American Indian/Alaska Native children living in extreme poverty was more than double that of other racial/ethnic groups and more than four times the proportion of non-Hispanic White children. Rates of childhood poverty are highest in the Northern and Southwest regions of the state.

“My mobile home is full of mouses. I wish I had help to be able to afford a real house so my children can live, learn, and play better. Sometimes I feel nervous going to sleep because mouses running on our bed. Or they will leave droppings and urine behind. Not safe for my children to play and crawl on floor.” (2020 CUBS respondent)

Survivors of violent crimes are at risk for posttraumatic stress disorder, major depressive episodes, and drug abuse/dependence. Youth exposed to community violence have increased rates of anxiety, aggression, and future violent behavior. The 2020 Alaska Victimization Survey results showed that 58% of Alaskan women experienced intimate partner violence, sexual violence, or both. In 2020-2021, 64% of Alaskan children lived in a safe neighborhood (based on parental opinion, NSCH). Adverse Childhood Experiences (ACEs) are major risk factors for leading causes of illness and death as well as poor quality of life. The higher the number of ACEs a person has, the more likely they are to experience poor health. The 2013-2015 Alaska BRFSS found that 65.7% of Alaskans had one or more ACEs, while 19.5% reported four or more.

“I wish more mental health assistance was available to parents. Trying to be a healthy, positive parent is a lot of work and mental health can change the way someone parents. I am lucky to have other support but can't afford mental health services.” (2021 CUBS respondent)

According to the 2021 Primary Care Needs Assessment by the Alaska Division of Public Health: “Alaska’s healthcare system is comprised of multiple public and private systems, including tribal healthcare, large and small regional hospitals, community health centers, military systems, and private facilities. While there is no commercial managed care in Alaska, there are several federal systems of care with some managed care characteristics, such as a commitment to prevention and wellness, employed physicians, and essentially closed populations. The tribal and governmental systems represent a larger portion of both facilities and service providers in Alaska than in other states, over 16% of the population is eligible for services in the tribal system and 12.5% are covered by the military system. (By way of comparison, in the U.S., the proportions are 2% tribal and 4.8% military.)”

The Alaska Native Tribal Health Consortium (ANTHC) is a consortium of Tribal entities that provides several levels of medical care: primary care at village clinics, primary and secondary care at regional hospitals, and tertiary care at the Alaska Native Medical Center hospital in Anchorage. ANMC receives some funding from the Indian Health Service but is supported to a greater extent by the various regional corporations. Publicly funded health care agencies serve the largest portion of low-income, uninsured individuals and families in Alaska. There are 58 Tribal health centers, 160 Tribal community health aide clinics and five residential substance abuse treatment centers within the Tribal Health System. Many clinics operate as community health centers and treat both beneficiaries and non-beneficiaries. In addition to CHCs, the state government operates 16 Public Health Centers that provide population-based health services, disease screening and referral, and extensive collaboration with other community providers to assure coordinated care and access to services for vulnerable populations. On the private side, there are private non-profit and for-profit secondary and tertiary care hospitals, as well as self-employed and private practice health care providers. The military system is expansive, with clinics and hospitals in some of the larger population areas of the state, as well as a relationship with the Veteran's Administration supporting the active duty and retired armed forces.

Geographic isolation means significant challenges in assuring all MCH populations have access to routine preventive care, and acute medical and specialty care. Approximately 75% of Alaskan communities, including the capital city of Juneau, are not connected to a road system. Accessing "nearby health services" or specialized health care means travel by commercial jet, small plane, the marine ferry system, all-terrain vehicles, small boats, or snow machines. Some residents may travel distances equivalent to Washington, D.C. to New Orleans for even routine medical care. Severe weather can render travel impossible, creating especially critical situations in medical emergencies.

“I am concerned about my son, and I feel that meeting with a doctor is a big hassle because we live in the village and they do not come out anymore.” (2021 CUBS respondent)

Specialty care, even in urban areas of the state, is limited. Many communities have no facilities equipped for childbirth, so pregnant people must leave their homes four weeks before their due date and travel to a larger community with a hospital that performs births. All high-risk pregnancies are delivered in Anchorage which requires travel away from your family, job, and community. Well-child check-ups, prenatal exams, and regular dental exams are even difficult to provide. Recruiting and retaining physicians and primary health care providers for non-urban practices is an ongoing barrier to providing health care services. The majority of physicians in Alaska (69%) are located in the Anchorage/Mat-Su region.

Innovative systems have been created to overcome barriers to health care delivery related to high transportation costs and lack of skilled resources in the small communities. The Community Health Aide Program is a network of about 550 Community Health Aides/Practitioners (CHAPs) who work in over 170 rural Alaska villages to provide basic health care services and referrals. The CHAP program is a vital link in the Alaska Tribal Health System. The Alaska Dental Health Aide Therapist Initiative, another ANTHC program, is conducted in collaboration with the University of Alaska-Barrow and various established sites in Bethel and Anchorage to train Alaska Native dental health aides for community-level dental disease prevention in underserved Alaska Native populations. The Behavioral Health Aide Project aims to develop village-based behavioral health service capacity, focusing on prevention, early intervention, and case management.

Title V in the Context of the State Health Agency

The Alaska Department of Health and Social Services (DHSS) was originally established in 1919 as the Alaska Territorial Health Department. With the proclamation of statehood on January 3, 1959, the department’s responsibilities were expanded to include the protection and promotion of public health and welfare. In 2022, Alaska’s Governor proposed Executive Order 121 to restructure the Department of Health and Social Services into two departments. EO 121 became law in March 2022, with the reorganization becoming effective July 1. The two new departments are the Department of Health (DOH) and the Department of Family and Community Services (DFCS). The purpose of the restructuring is to better align Divisions with similar missions and allow time for leadership of each department to focus on long-term system improvements.

Programs for the MCH and CYSCHN populations in Alaska are primarily managed within Sections of the Division of Public Health (DPH), which is in the new Department of Health. The Section of Women's, Children's, and Family Health (WCFH) is the designated Title V and CYSCHN agency. WCFH programs are described in the WCFH Program Descriptions (attached as a supporting document, in addition to the WCFH organizational chart). The Section of Chronic Disease Prevention and Health Promotion (CDPHP) manages the following programs that serve the MCH population: Physical Activity and Nutrition (which includes breastfeeding promotion); Youth Risk Behavior Survey (YRBS); Tobacco Prevention and Control; and Injury Prevention. CDPHP also contain programs related to FASD and other substance misuse, addiction, and prevention activities. In FY22, WCFH partnered with CDPHP and the Department of Education & Early Development to create the Office of School Health & Safety. The Office is now a Unit within WCFH. The Section of Epidemiology (SOE) manages the Alaska Immunization Program and conducts injury surveillance.

Other MCH programs are managed in other Divisions of DOH: EPSDT Outreach – Division of Health Care Services (Medicaid agency); Early Intervention/Infant Learning Program – Division of Senior and Disability Services; WIC/Nutrition Programs – Division of Public Assistance. The Office of Children’s Services (OCS), Alaska’s child welfare agency, is in the Department of Family and Community Services. OCS manages the Alaska Strengthening Families program.

Over the past decade, the Department faced significant budget cuts in its share of state general fund dollars and eliminated or reduced programs while trying to live within a budget that depends entirely on the price of oil and federal funding. Prior to the pandemic, DPH was frequently the target of across-the-board cuts. Cuts to administrative services largely funded by state funds, such as information technology, human resources, and financial/procurement, have had a significant impact on public health program operations. The past three years have seen an influx in COVID-related funding for public health through the American Rescue Plan Act and other legislation, as well as funding specifically to address health equity. There have been no cuts to DPH since 2020.

Three local governments, the Municipality of Anchorage, North Slope Borough, and Maniilaq Association, operate local health departments as grantees of the State Public Health Nursing (PHN) section. Alaska DOH offers a wide range of health assessment and disease prevention services through Public Health Centers (PHC) and itinerant nursing services that reach approximately 280 communities statewide. However, since 2015, many public health nursing positions have been cut in addition to the closure of six community PHC’s across the state. FY23 noted an increment in State General Funds to PHN after several years of cuts. During the pandemic, PHN experienced a lot of staff turnover. While there were previously age restrictions on same services, such as immunizations and sexually transmitted infection treatment, those have now been removed. They are working to get back to “normal” operations and functions since the COVID-19 response. PHN is currently faces higher cases of syphilis and tuberculosis which has also impacted capacity. 

State Priorities

The mission of the Alaska DOH is to promote the health, well-being, and self-sufficiency of Alaskans. The new DOH logo effective July 1, 2022 is pictured here.

In 2019, the Department, in partnership with ANTHC, conducted the Healthy Alaskans 2030 State Health Assessment and developed new leading health indicators for Healthy Alaskans 2030 (HA2030). The 30 health priorities identified for HA2030 include reducing the rates of cancer, suicide and poor mental health, child maltreatment and interpersonal violence and sexual assault. Alaskans also wanted to see alcohol, tobacco and drug use curtailed, and an increase in disease prevention through vaccines, improved community access to in-home water and sewer services and optimally fluoridated water and increasing the percent of children at a healthy weight. As well, there are goals for improved healthcare access, protective factors for adolescents and social determinants of health. WCFH staff members participate in several ongoing HA2030 workgroups.

The Alaska DPH mission is to protect and promote the health of Alaskans, with a vision of healthy Alaskans today and tomorrow. In 2019, DPH conducted a strategic planning process to update the Division’s Strategic Plan, and the 2020-2025 Strategic Plan was completed in April 2020. Although delayed due to the pandemic response, in 2021, the Division began to re-visit the Plan and reconvene workgroups. The division is continuing to work to get back into non-COVID-related priorities.

DPH submitted documentation to apply for accreditation with the national Public Health Accreditation Board (PHAB) in January 2023, and is currently planning for an upcoming site visit with PHAB. The process of obtaining initial accreditation status is giving DPH the opportunity to assess its performance against a set of nationally recognized standards and measures based on the 10 Essential Public Health Services.  WCFH staff are represented on the core team leading this effort as well as domain-specific teams such as workforce development.

Components of Alaska’s System of care for meeting the needs of underserved and vulnerable populations

Alaska’s health care system performance varies by race and ethnicity, as demonstrated in the  Commonwealth Fund’s 2021 Scorecard on Achieving Racial and Ethnic Equity in U.S. Health Care. This scorecard ranked health system performance by race and ethnicity in all states based on 24 measures of health care access, quality and use a of health care services, and health outcomes. Racial and ethnic health inequities nationwide are driven by factors both inside and outside the health care delivery system, including issues around cost, affordability, and access to care, as well as experiences of interpersonal racism and discrimination when dealing with clinicians. Overall, the Alaska White population was placed in the 63rd percentile compared to the White population in all other states, while the American Indian Alaska Native population was in the 7th percentile. On health care quality, the Alaska White population ranked 49th of 51 states, the Asian American, Native Hawaiian, and Pacific Islander population ranked 41 of 41, and the American Indian Alaska Native population ranked 11 of 16. While the Alaska AIAN population had better health care access compared to most other states with measurable AIAN populations (4 of 16), Alaska White people ranked 45 of 51 states for health care access.

There are two hospitals in Anchorage that offer a wide variety of inpatient and outpatient services for children. The state’s only Level III NICU is at Providence Alaska Children’s Hospital in Anchorage, while the Alaska Native Medical Center and Alaska Regional Hospital in Anchorage and Fairbanks Memorial Hospital have Level II NICUs. Increasing NICU services has been discussed at some hospitals. WCFH continues to monitor this in terms of any effects to regionalization of care.

Access to healthcare is extremely challenging due to high vacancy rates for primary care physicians, and shortages of specialized care providers. Underserved Areas/Medically Underserved Populations (MUAs/MUPs) cover 98% of Alaska’s land mass and 98% of the state’s population. Approximately three in every ten (39%) Alaskans live in areas designated as HRSA Health Professional Shortage Areas (HPSAs) based on the lack of primary care physicians, dentists, and psychiatrists. There is a chronic shortage of pediatric subspecialists in the state. While Providence Children’s and ANMC have been successful in recruiting subspecialists to the state, some are represented by only one clinician in that specialty. Alaska has had success in recruiting five pediatric neurodevelopmental specialists. Pediatric endocrinology services are provided by a private practice physician, a full-time endocrinologist at ANMC, and some locums positions. A private oncology group provides statewide pediatric oncology services. Recruitment to replace pediatric specialists who retire or leave the state is difficult due to the small population size, the lack of a large number of partners to provide back up for a subspecialist provider, and no ties to a major children’s hospital. 

In July 2019, Providence Alaska discontinued their pediatric diagnostic genetics clinic. This was the clinic serving both children from the public and private sector and Tribal health populations. The contractors providing these services previously (Oregon Health & Science University) no longer had the staffing capacity to travel to Alaska. When this clinic ended, Alaska families were required to travel out of state for diagnostic services. Genetics clinics in Seattle and Portland continue to experience long waiting times for an appointment. ANMC entered into an agreement with the University of Utah to provide diagnostic genetics services to Tribal health beneficiaries that started in January 2021. While this does provide services to the Alaska Native population, there remains a gap for children who are not beneficiaries. One of the main concerns regarding sponsorship of genetics in Alaska is the cost. There are ongoing concerns regarding Medicaid reimbursement for genetic testing due to denials. The Title V Director, VP for Specialty Services at Southcentral Foundation (SCF), and Medicaid Medical Director have been part of a working group to change the reimbursement policy for genetic testing. While it has not received final approval, we anticipate there will be a positive change in this area.

In addition to the neurodevelopment clinic located at Providence, there is also a neurodevelopment center at ANMC that serves Alaska Native beneficiaries on a statewide level. In 2023, they also brought on a second neurodevelopmental physician which is increasing capacity. With this added capacity, they plan to implement their own outreach clinics in hub communities. WCFH and SCF will continue to partner on coordinating these services and avoid duplication. WCFH will adjust community clinic locations based on services provided in the community to continue serving as a gap filler. The clinic located at Providence has a very long waitlist as of July 2023 and is down to one provider at this time. There is also screening and diagnostic services now provided in the Mat-Su Borough through a private pediatric clinic.

While there were many negatives associated with the COVID-19 pandemic, one bright spot was the rise in opportunity to offer healthcare services to patients via telehealth, both within Tribal health and in the public and private sectors. Many of the existing resources for specialty care in Alaska are concentrated in the large population centers. The majority of the state’s pediatricians and neonatal and maternal specialists are primarily based in Anchorage, Fairbanks, and Juneau. Access to these resources from other areas often entails high transportation costs, many times borne by the Medicaid program. When the Public Health Emergency Order was enacted in March 2020, it allowed for changes in the rules for telehealth around reimbursement for services and the location where patients could receive services and providers could offer them. For those receiving care through the State run Metabolic and Neurodevelopmental Outreach Clinics access to services increased as healthcare professionals were no longer limited to only providing care when present in a community. For those diagnosed with a metabolic condition through the Newborn Bloodspot Screening Program, parents and caregivers were often able to meet virtually with the metabolic consultant to discuss the newborn’s prognosis within a few days of birth. While for a child with behavioral needs, parents and caregivers were no longer forced to have a child travel to a strange place for an evaluation. Providers also expressed how to assess a child in their home environment improved the experience and outcome of autism diagnosis for many children receiving their services. As a result, the plan moving forward is to continue offering a telehealth option, where the practitioner can determine whether the child should be seen in-person or via telehealth. This will be possible because the Alaska Legislature has made permanent the option that providers who have Alaska licenses can see patients via telehealth, even if they have never been seen previously in person. While providers who are licensed in another state can continue to see patients via telehealth if they have previously seen the patient in person or if they are referred to be seen by an Alaskan provider for a condition deemed life threatening. Continuing to offer these services increases access and equity to services, while being appropriately sensitive to the needs of those in need of care.

The pandemic also led to a substantial increase in provision of health care services using telehealth modalities for the adult population. Anecdotal reports from mental and behavioral health care providers around the state showed that broader use of telehealth platforms allowed people in rural areas of the state in particular, greater access to timely counseling services than was the case pre-pandemic. Some women’s health partners were able to modify their service delivery models to offer other preventive health services via telehealth or other options, including contraceptive quick starts for low-risk clients, at-home test kits for Chlamydia and other STIs, and screening and management of some health conditions. As a result of these experiences, many providers are advocating to permanently adopt these service delivery modifications and more flexible reimbursement structures.

Medicaid and Denali KidCare (CHIP) serve a large share of Alaska’s at-risk and vulnerable child population. In 2021, Alaska ranked 46th in the country for rate of uninsured children at 7.9%. This rate has decreased from 9.4% in 2019 (Georgetown University Health Policy Institute), however, this may be due in part to the COVID-19 pandemic and the decision not to check recipients eligibility during the pandemic. Now the Public Health Emergency is over and Medicaid/ Denali KidCare have begun the redetermination process, it is anticipated the uninsured rate will again rise, in part because not all who are eligible have updated contact information with Medicaid/ Denali KidCare. In 2019, 89.9% of all eligible children participated in Medicaid/CHIP. The American Indian/ Alaska Native population continue to have the highest uninsured rate with 14.2% for 2021, which is similar to the uninsured rate of 14.4% in 2019. While Other race (9.3% in 2021 down from 12.2% in 2019) and white (4.9% in 2021, down from 6.5% in 2019) have both seen a reduction in the rate of uninsured for these populations. Additionally, 7.8% of 6 to 18 years-olds and 8.1% of under 6-years-olds are uninsured. Medicaid coverage for pregnant women and children was broadened in the 1980s with an expansion of eligibility based on higher income standards and the addition of EPSDT, which broadened specific services that the state was required to provide children. Alaska implemented Medicaid expansion under the Affordable Care Act in September 2015, extending coverage to childless adults up to 138% FPL.

Alaska is one of five remaining states with 100% of the Medicaid population covered under a fee for service model (Connecticut, Maine, Vermont, and Wyoming are the other four). Because of this, CYSHCN and their families are only able to access care coordination at two points within our system of care. The first is if they are eligible for Part C Early Intervention services, where the child must be under 36 months of age and have a documented 50% developmental delay. The second is if they are eligible for either a Children with Complex Medical Needs or Intellectual or Developmental Disability waiver. To contain costs, Senior and Disability Services limits the number of new care coordination waivers by using a numerical assessment of need and then placing individuals on a registry. The program has a 600-person capacity, and once that number is reached the rest are put on a waiting list. There are close to 800 individuals on the waiting list and in 2021, 66% of these are children 0-21. The average length of time on the waitlist is 54 months.

Specific state statutes and other regulations that have relevance to title v

Alaska state law directs DOH to promulgate regulations for the control of conditions or diseases of public health importance. Alaska statutes authorize the Department to (among other activities) collect, analyze, and maintain databases of confidential information related to conditions of public health importance and any data needed to provide essential public health services and functions. Alaska regulations mandate reporting of certain conditions of public health importance to the Division of Public Health, including birth defects, which are reported to WCFH.  Additionally, the Department may identify, assess, prevent, and ameliorate conditions of public health importance through:

1. Surveillance—WCFH surveillance programs include the Pregnancy Risk Assessment Monitoring System (PRAMS), Childhood Understanding Behaviors Survey (CUBS), Alaska Birth Defects Registry (ABDR), and Maternal Child Death Review (MCDR);
2. Epidemiological tracking, program evaluation, and monitoring—in WCFH this includes the Title V Maternal-Child Health Indicators Program;
3. Testing and screening programs—in WCFH these programs include Breast and Cervical Cancer Screening; Pediatric subspecialty clinics; and newborn bloodspot, hearing and critical congenital heart defects screening;
4. Treatment;
5. Administrative inspections; or other techniques.

During 2018, regulations that affect the newborn bloodspot screening and Alaska Birth Defects Registry programs were revised. On July 1, 2018, Alaska became a one-screen state for bloodspot screening and now funds and coordinates a courier system for transport. Fee regulations for bloodspot screening were updated in fall 2022 to include screening for spinal muscular atrophy (SMA). The updated birth defects registry regulations expand the list of organizations required to report and includes private or public health insurance organizations and diagnostic laboratories operating in Alaska, and requires infant/child and maternal identifiers to be reported.

The following is a full list of Alaska state statutes (AS) and Alaska administrative code (AAC) regulations of relevance to Title V. Items that are bolded have direct relevance to programs in WCFH.

AS 08.65 Direct-Entry Midwives

AS 08.68 Board of Nursing

AS 11.41.434-440 Sexual Abuse of a Minor

AS 14.07.020 Duties of the Department of Education and Early Development

AS 14.12.115 Indemnity to School Staff

AS 14.20.680  Required Alcohol and Drug Related Disabilities Training

AS 14.30.045 Tuberculosis screening

AS 14.30.065-127 Physical Examinations and Screening Examinations

AS 14.30.141 Self-administered Medication in School

AS 14.30.231 Assure appropriate programs & services for children with disabilities

AS 14.30.355-356 Sexual Abuse and Sexual Assault Awareness and Prevention

AS 14.30.362 Suicide Awareness and Prevention Training

AS 14.33.100  School Crisis Response Plan

AS 14.33.200 Harassment, Intimidation, or Bullying Prohibition Policy

AS 18.05 Administration of Public Health and Related Laws

AS 18.15.010-900 Disease Control & Threats to Public Health

AS 18.15.200 Screening for Metabolic Disorders

AS 18.16.010 Regulation of Abortions

AS 18.50.010-040 Vital Statistics Act

AS 18.66.310 Continuing Education for Public Employees

AS 25.20.010 Age of majority

AS 25.20.025 Examination and Treatment of Minors

AS 40.25.125 Public Record Disclosures

AS 44.29.020 Duties of the Department of Health & Social Services

AS 47.07.030 Medical Services to be Provided for Pregnant Women

AS 47.07.067 Payment for adult dental services

AS 47.17.010-290 Child Protection

AS 47.20 Services for Developmentally Delayed or Disabled Children

AS 47.20.300-390 Newborn and Infant Hearing Screening, Tracking and Intervention Program

04 AAC 06.055 Immunizations required for school entry

04 AAC 52.250  Special Education Aides

07 AAC 12.401-.449 Free Standing Birth Centers

07 AAC 23.010-.900 Programs for Children with Disabilities

07 AAC 27.007 Reporting by laboratories

07 AAC 27.012 Birth Defects Registry

07 AAC 27.110-.111 Prophylactic treatment of newborn's eyes

07 AAC 27.510-590 Screening of newborn children for metabolic disorders

07 AAC 27.600-650 Newborn Hearing Screening

07 AAC 27.890-.900 Confidentiality, authorized users, and security standards; definitions

07 AAC 78 Grant Programs

07 AAC 80 Fees for Department Services

12 AAC 02.280-282 Board of Nursing - licensing fees

12 AAC 44 Board of Nursing, including Advanced Nurse Practitioner

14 AAC 12-14 Renewal & Continuing Competency Requirements for Certified Direct-Entry Midwives

CH. 56 SLA 13 Critical Congenital Heart Defect Screening