Section III.B. Overview of the State  

 

The state’s demographics, geography, economy and urbanization; unique strengthens and challenges that impact the health status of the MCH population; and components of the state’s system of care:

 

North Dakota is a rural state located in the geographic center of North America, in the upper Midwest region of the United States (U.S.). It encompasses significant landmass (68,982 square miles) and is the 17th largest state by land area. According to the U.S. Census Bureau, North Dakota is the 4th least populated state in the nation (779,094 residents) with a population density of approximately 11.3 persons per square mile. Most North Dakota counties possess a population base below 5,000 residents, including 36 counties considered “frontier,” defined as having a population density of six or fewer residents per square mile. North Dakota’s health status is confronted by a variety of challenges, including the unique geography and climate, socioeconomic factors and demographics of the state.

 

North Dakota has traditionally been one of the leading agricultural producers in the nation. According to the U.S. Department of Agriculture (USDA), North Dakota ranked 9th in the nation for the value of crops sold (2017 Census of Agriculture). Energy development also plays a large role in North Dakota’s economy. Top industries for jobs in North Dakota include government (19.1%), education and health (15.4%), retail trade (10.7%), leisure/ hospitality (9.2%), professional/ business services (7.5%), and construction (7.0%) (June 2021, North Dakota Labor Market Information).

 

Over the last decade, North Dakota has had one of the fastest growing economies in the nation, as measured by Gross Domestic Product (GDP). The 2000-2019 compound annual growth rate for North Dakota’s real GDP of 4.2%, ranking 1st in the nation, slightly higher than the national average (2.0%) for this period (North Dakota Compass, 2020). From 2010-2020, oil and gas extraction and production taxes have raised approximately $21.3 billion for the state, which accounts for approximately 46.0% of total tax revenues collected by the state during that period. Over the last five years (2016 – 2020), oil and gas extraction and production taxes accounted for approximately 46.8% of all tax revenues collected by the state (North Dakota Office of the State Tax Commissioner: The Red Book, 2020).  

 

For decades, North Dakota experienced out-migration of its young adult population, leaving it an older-population state with about three-fifths of its population in the eastern half of the state. North Dakota has experienced a dramatic population change over the last several years. According to the U.S. Census Bureau, the state has grown by over 15.8% between 2010 and 2020, making it the 4th fastest population growth of all states during that time. The rapid population changes in the state are the result of an influx of people coming to work in energy development and related industries in the western part of the state. This influx of people has changed North Dakota from being an older-than-average state to one of the youngest. The median age was 35.5 in 2019, making North Dakota the 4th youngest state. The population growth in the state, especially among young adults, has strengthened North Dakota’s workforce and revitalized the state’s natural increase through more births. Age distribution data from 2020 estimates that approximately 7.1% of the North Dakota population is less than five years of age, 23.6% is under 18 years of age and 15.7% of the population is elderly (65 years of age or older) (U.S. Census Bureau, 2020).

 

Racial and ethnic diversity continues to grow in North Dakota. The increase in the non-White population from 2010 to 2020 was the greatest percentage of any state. The population of color saw a 68.0% increase from 2010 to 2019 compared to the U.S. population of color increase of 17.5% during the same time (ND Compass, 2020). Despite the increase in the population of color, North Dakota was less racially diverse than most states (42 out of 50 states). The White, non-Hispanic population was estimated to comprise 83.7% of all residents statewide in 2019, which is down from 92.4% in 2000. Among the racial and ethnic groups in North Dakota, the Black/African American population had the largest increase from 1.2% in 2010 to 3.4% in 2019. The Hispanic population increased from 2.1% in 2010 to 4.0% in 2019. The American Indian (AI) population continues to make up the largest minority population in North Dakota and was higher as a percentage of the total population at 5.4% in 2010 up to 5.6% in 2019 (U.S. Census Bureau, 2020).

 

There are five-federally recognized Tribes and one Indian community located at least partially within North Dakota. The five tribes include the Mandan, Hidatsa and Arikara Nation (Three Affiliated Tribes), the Spirit Lake Nation, the Standing Rock Sioux Tribe, the Turtle Mountain Band of Chippewa Indians, the Sisseton-Wahpeton Oyate Nation, and the Trenton Indian Service Area. As of 2017, the median age of North Dakota’s AI population was 27.9, approximately seven years younger than North Dakota’s overall median age of 35.1 years (U.S. Census Bureau ACS, 2015-2019). Unemployment and poverty continue to be a challenge on the reservations in North Dakota. Disparities facing the AI population include higher rates of diabetes, cancer, addiction, heart disease and other public health issues, including unintentional injuries. The average age at death for AI is 59.6 years, compared to 79.7 years for the White population (North Dakota Division of Vital Records 2020). According to the 2020 County Health Rankings, all 12 North Dakota counties identified as “least healthy,” are either within a tribal reservation or designated as rural/frontier.

 

Differences in poverty exist by race/ethnicity. Nationally, 23.0% of AI’s were estimated to be in poverty in 2019, compared to the overall national poverty rate of 10.5%. In North Dakota, the percent of poverty of AI’s was 32.2% during 2015-2019, compared to the overall poverty rate of 10.6% for the state in 2019, and the 2015-2019 national poverty rate for AI of 24.9%. The highest point during this timeframe for North Dakota’s AI poverty rate was in 2015, at 36.5%, and the lowest was in 2018, at 25.5%. In the nation, North Dakota ranks 17th for the lowest poverty rate among the states in 2019. Since 2015, both the U.S. poverty rate and the North Dakota poverty rates have trended downwards. In 2015, North Dakota had an estimated poverty rate of 11.0%, 9th in the nation. According to the U.S. Bureau of Labor Statistics, North Dakota is in a four-way tie for the 12th lowest unemployment rate in the nation at 4.0% (June 2021).

 

There is a direct correlation between the rate of poverty for a given area and the percentage of house­holds receiving public assistance. According to the 2015 “Growing North Dakota by the Numbers: Public Assistance Programs Tracked by the Census” report by the North Dakota Department of Commerce, from 2009-2013, the percentage of North Dakota households receiving Supplemental Security Income (SSI), cash assistance such as Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) benefits, ranged from over 57% in Sioux Coun­ty (AI reservation area) to 0% in Bill­ings County (an oil-producing county). Counties with the highest rates of public assistance all had a high AI population. These same counties had the highest rates of poverty in the state.

 

The health care delivery system in North Dakota consists of 52 hospitals – 36 smaller Critical Access Hospitals (CAHs) with 25 or fewer acute-care beds, six larger general acute-care hospitals located in the four largest cities, three psychiatric hospitals, two long-term acute-care hospitals, two Indian Health Service hospitals, and one rehabilitation hospital – and more than 300 ambulatory care clinics. There are 34 facilities or programs statewide that provide mental health services and 96 licensed substance abuse programs. There are 53 federally certified rural health clinics and four federally qualified health centers with 19 clinic locations between them. All hospitals, including all 36 CAHs, except for one Indian Health Service (IHS) hospital, are designated as trauma centers. Each of the “Big Six” hospitals, located in the four largest cities in North Dakota, are home to a Level II trauma center. Most emergency medical service support in the state is ground-based and provide basic services, which is under duress because of its dependence on volunteers and funding challenges. There has been an expansion across the state in the deployment and use of electronic health records, but financial and other barriers to full implementation remain (Health Issues for the State of North Dakota, 2021, University of North Dakota).

 

Local public health units also provide valuable health care in North Dakota. The public health system is made up of 28 single and multi-county local public health units; all are autonomous and not part of the Department of Health; although, a close partnership exists between the NDDoH and local public health units. Many programs, including the maternal and child health (MCH) programs contract services through local public health (e.g., physical activity and nutrition, breastfeeding). Services offered by each health unit vary, but all provide services in the areas of MCH (Health Issues for the State of North Dakota, 2019, University of North Dakota).

 

Like the rest of the country, North Dakota is facing a major health care delivery challenge – how to meet a burgeoning need for health care services now and in the future, with a supply of health care professionals that is not keeping pace with the growing demand; thereby, impacting the health status and needs of the MCH population. If the population increases to 796,000 by 2040 as predicted, 500 additional physicians will be needed in the state by 2025. If the population of North Dakota does not expand at an increased rate but at the slower historical rate, the rate of physicians per 10,000 population will increase slightly until 2020 and remain stable through 2045 (Biennial Report 2021, UND School of Medicine and Health Science). Part of the challenge in North Dakota is an inadequate number of providers; however, a larger portion of the challenge is a maldistribution of providers who are disproportionately located in the larger urbanized areas of the state. People in rural areas of the state are often older, poorer, have less or no insurance coverage than people in non-rural areas, all of which are challenges to providing adequate health care. Frontier areas of the state face greater difficulties than rural areas in maintaining their health care workforce. These thinly populated regions cannot easily compete with the wages and amenities offered to health care providers by hospitals and clinics in urbanized areas. Even communities that do have adequate staffing are often one doctor or nurse away from a shortage (Health Issues for the State of North Dakota, 2019, University of North Dakota). Census Bureau Health Insurance statistics break the population into major age cohorts: children under age 18, workforce age (18 through 64) and those age 65 and above. In 2019, an estimated 92.2% of children in the state had health insurance, compared to 94.3% national rate. The percentage of North Dakota children who are White have insurance is 94.2%, higher than the state’s average (92.2%), while AI children are insured at rates substantially lower that the state’s average, at 82.0% although this rate has increased from 76.0% in 2015.

 

According to the American Community Survey (ACS) for 2019, most North Dakotans have some form of health insurance. The ACS shows that 93.1% were insured in North Dakota, 62.8% are privately insured only, 12.0% are publicly insured only, and 18.3% are a combination of privately and publicly insured, leaving approximately 6.9% as uninsured. As of 2019, 8.2% of residents from the ages of 19 to 65 in North Dakota lacked health insurance coverage (91.8% had some form of health coverage). Out of the North Dakota residents lacking insurance, White residents had the lowest percentage at 5.0%, while AI’s had the largest at 20.9%. However, the AI population comprised 14.3% of North Dakota residents who are living at or below poverty, but only make up 5.6% of North Dakota’s population. Nonelderly adults between the ages of 19-64 were least likely to be covered by a type of health insurance, making up approximately 73.6% of the total uninsured population for the state, while only making up 60.5% of North Dakota’s population. Males tended to have lower rates of coverage than females in this age range, regardless of race or ethnicity. Due to Medicare coverage, 95.5% of residents aged 65 and over were estimated to have health insurance. (Kaiser Family Foundation estimates based on the United States Census Bureau ACS for 2019 provided insurance rates broken down by race.)

 

Approximately 7.2% of North Dakota adults under the age of 65 have a disability. North Dakotans with disabilities, compared to those without disabilities, were more likely to be of AI descent at 14.7%, than of white descent at 11.0% (ACS 2015-2019). According to the 2018-2019 National Survey of Children’s Health (NSCH), North Dakota provided slightly more coordinated and comprehensive care services within a medical home to children with special health care needs (CSHCN) (44.4%), compared to the national average (42.3%). Also, in the 2018-2019 NSCH, only 41.5% of North Dakota families with CSHCN felt they received effective care coordination if they needed it, and 16.5% of families with CSHCN, ages zero through 17, reported to have difficulty paying medical or health care bills in the last twelve months. These results indicate the dynamic need for medical homes and adequate health insurance within the state.

 

There are three major carriers that offer plans in the North Dakota exchange: Blue Cross Blue Shield of North Dakota (Noridian), Sanford Health Plan and Medica (healthinsurance.org). Enrollment and plan changes for individual and family health insurance is normally only available during the annual open enrollment period in the fall, or during a special enrollment period triggered by a specific qualifying life event. However, due to the ongoing COVID-19 pandemic and the American Rescue Plan’s additional premium subsidies a one-time enrollment window ran through August 15, 2021. North Dakota residents could enroll or make a plan change during this window, regardless of whether they experience a qualifying event. People who are uninsured or enrolled in a plan off-exchange (directly through an insurance company) could have used this window to enroll in a plan through the North Dakota exchange, as that’s the only way premium subsidies could be obtained. After August 15, 2021, North Dakota residents will need a qualifying event to enroll or make a plan change for 2021 coverage. Open enrollment for 2022 coverage will start on November 1, 2021, with plan selections effective January 1, 2022.

 

A record high 22,709 people enrolled in private plans or Qualified Health Plans (QHPs) through the North Dakota exchange during the open enrollment period for 2021 plans. Enrollment in North Dakota’s exchange had previously peaked in 2018, when 22,486 people enrolled. North Dakota was one of only a handful of states where exchange enrollment increased every year from 2014 through 2018. In most states that use HealthCare.gov, peak enrollment occurred in 2016, with declining enrollment from then through 2020. In North Dakota, the first decline came in 2019. Noridian currently holds most of the market share in the North Dakota exchange, with about two-thirds of the states’ enrollees.

 

The Family HealthCare Center has served as a navigator since 2015 and partners with Valley Community Health Centers to reduce the number of uninsured in North Dakota. They also provide outreach and education to seven northeastern and southeastern North Dakota counties with focus on consumers at or below 200% of the federal poverty level (FPL), new Americans and refugees, pregnant women and new mothers, AI’s, the justice-involved population, disabled consumers, and Medicaid-eligible populations.

 

Knowledge and awareness of CSHCN has been an asset in supporting access to affordable care for families. Navigators who were supported in the past with Affordable Care Act (ACA) funding were employees of organizations that understood programs that could assist families of CSHCN. When approached by a family for health care options, they still provide navigational support and link families to resources.

 

There are still gaps that exist, in that some children need services that are not available through current benefit plans. Service limits may also pose a challenge and lower income families may not be able to afford a plan that covers the needs of their children or the associated co-payments for services.

 

In addition to private plan enrollments, North Dakota expanded its Medicaid program under a provision of the ACA. In February 2012, Governor Dalrymple favored the expansion, and the state House approved the measure. Enrollment in North Dakota Medicaid increased by 30% from the end of 2013 to December 2018. There were approximately 21,000 people enrolled in North Dakota’s expanded Medicaid as of October 2019. North Dakota previously followed a unique public-private partnership model of Medicaid expansion, allowing private health insurance carriers to bid for the opportunity to provide health insurance coverage to the state’s newly eligible Medicaid population using federal Medicaid funds. The decision to bring North Dakota’s Medicaid expansion and Children’s Health Insurance Program (CHIP) in-house to North Dakota Medical Services was passed during the 2019 Legislative Session. This transition took effect on January 1, 2020.

 

North Dakota’s CHIP and North Dakota Medicaid have been effective public programs in reducing the number of uninsured, low-income children in the state. CHIP provides premium-free, comprehensive health, dental and vision coverage to uninsured children up to 19 years old who do not qualify for standard North Dakota Medicaid. The income eligibility limit is at 175% of the FPL. North Dakota Medicaid covers children ages 0 to 6 (thru the month they attain age 6) at 152% of the FPL and children ages 6 through 18 (through the month they attain age 19) at 138% of the FPL. North Dakota Medicaid has some limitations or restrictions for some covered services.

 

As of February 2021, a total of 108,342 individuals were enrolled in both North Dakota Medicaid and CHIP combined (Medicaid.gov). Out of all North Dakota Medicaid/CHIP enrollment, 106,090 were Medicaid enrolled and 2,252 were CHIP enrolled. The total Medicaid child and CHIP enrollment was 50,376.

 

1-877-KIDS-NOW is a toll-free resource line that helps uninsured families learn about low-cost and free health care coverage programs. A seamless eligibility process for health coverage programs has helped to assure coverage for North Dakota’s children. In February 2021, the Kaiser Foundation indicated that out of all the monthly North Dakota Medicaid/CHIP enrolled residents, 46% of those were children. This is comparable to the national average of 49%.

 

Program data from the North Dakota Department of Health (NDDoH), Division of Special Health Services (SHS), indicated that in Federal Fiscal Year 2020, 85% of the 1,782 children served by SHS had a source of healthcare coverage. Of these, about 57% were privately insured (1,010); 29% were insured by North Dakota Medicaid or CHIP; 6% had no source of coverage, and 8% were unknown. 

 

Roles, responsibilities and targeted interests of the state health agency and the influence of the delivery of Title V services:

 

Legislative activity serves to determine priorities and to identify current and emerging issues. The NDDoH leadership is supportive of having program content expert staff provide testimony on key public health issues. Title V staff monitored, tracked and/or testified on over 70 bills during the 2021 Legislative Session. A list of the bills can be found at:  https://www.health.nd.gov/sites/www/files/documents/Files/HSC/2021_Legislative_Tracking_Grid.pdf

 

Highlights of bills of interest and/or involvement for Title V staff included:

• House Bill (HB) 1105 – relating to breastfeeding (to remove discreet and modest language in the current law). The NDDoH MCH Nutritionist was available during hearings for questions. The bill passed. 
• HB 1148 – relating to electronic bicycle regulations. The NDDoH’s Child Passenger Safety Director provided neutral testimony about the risks of speed and safety of e-bikes with no age or helmet regulations. The bill passed. No age limitations were included in the bill, but a helmet requirement for anyone under the age of 18 was included.   
• HB 1205 – relating to establishing a maternal mortality review committee; to provide for a continuing appropriation; and to provide for a report to the legislative management and other agencies. The NDDoH’s Public Health Specialist testified in favor of the bill. The bill passed.  
• HB 1257 – a bill for an act to amend and reenact section 3-21-51.4 of the North Dakota Century Code, relating to safety belt use. This bill would have repealed all seat belt laws. The NDDoH’s Child Passenger Safety Director provided testimony in opposition, along with 10 other people/agencies. The bill failed.  
• HB 1288 – relating to Medicaid coverage of continuous glucose monitoring devices. The bill passed; thereby, providing increased covered to families.    
• Senate Bill (SB) 2121 – relating to secondary enforcement of safety belt requirements (primary seatbelt law). Supportive testimony was provided by the NDDoH’s Child Passenger Safety Director and by many other partners (e.g., Department of Transportation, Highway Patrol, North Dakota Safety Council, Motor Vehicle Carriers Association); however, the bill failed.
• SB 2224 – relating to medical assistance coverage of metabolic supplements. The SHS Division Director was available for questions during hearings and SHS staff prepared a document detailing the usage, availability, and cost of metabolic supplements. The bill passed; thereby, providing increased covered to families.     
• SB 2232 – relating to the annual observation of Juneteenth. The bill passed.
• SB 2235 – relating to a school nurse grant program and to provide an appropriation. The NDDoH’s State School Nurse Consultant was available for questions during hearings and responded to questions about the number of school nurses and how many districts and students those nurses served. The bill failed.    
• Senate Concurrent Resolution (SCR) 4002 – a concurrent resolution declaring September 23, 2021, as Fourth Trimester Care Day in North Dakota. The NDDoH’s Public Health Specialist provided supportive testimony; however, the resolution failed.

 

In addition to the above bills, SB 1247 was past – relating to merging the state of health and the department of human services. The bill passed with an effective date of September 2022. The two agencies will form the Department of Health and Human Services (DHHS). Benefits of the integration to elevate and enhance the citizen experience include:

• Deliver one streamlined path to programs and services.
• Help North Dakota become the healthiest state in the nation.
• Continue to deliver quality, effective, and efficient health and human services.

 

Opportunities for DHHS team members include:

• Improve the loves or more North Dakotans.
• Embrace breakthrough thinking.
• Drive innovative and risk-taking.
• Play a role in the biggest reinvention project.
• Build a new one-team culture.
• Explore additional career paths. 

 

The Title V Director has been involved in NDDoH and North Dakota Department of Human Services (NDDHS) senior leadership team meetings to discuss aspects of the integration. An emphasis on the Prosci Change Management trainings for senior leaders and mangers has been occurring over the past two months – focusing on the people side of change. Through a Request for Proposal (RFP) process, a consultant to assist with the integration process is expected to be contracted by the end of August 2021.  

 

Behavioral health is a critical issue for the NDDoH, and partnership with the NDDHS, Behavioral Health Division, along with other key partners (e.g., Sanford Health, Family Voices of North Dakota, Children’s Advocacy Center, medical systems), is essential to address these issues. In September 2018, North Dakota was awarded the Pediatric Mental Health Care Access (PMHCA) grant. The primary goals/objectives of North Dakota’s PMHCA Program are to: 1) increase tele-behavioral health services to children and adolescents living in underserved areas of the state; 2) to extend knowledge to pediatric primary care professionals across the state for the early identification, diagnosis, treatment and referral of mental health disorders; 3) to include direct school-based delivery of tele-health services due to the shortage of healthcare providers and the lack of an infrastructure for primary care clinics, and 4) to enhance existing partnerships and develop new relationships with entities that have similar goals and expectations to this program.

 

The PMHCA program is committed to increasing access to providers who can offer services including screening, referral, and treatment across our rural state. In response to this, the PMHCA grant will host the 2021 Pediatric and Primary Care Behavioral Health Symposium on September 23, 2021 – “Trauma Treatment, Suicide Intervention and Behavioral Health Clinical Skills to Enhance Patient Care”. This one-day event will bring together pediatric, primary care and behavioral health providers, and experts in trauma and suicide intervention to share strategies and skills that influence pediatric patient care. The symposium will be a virtual only event.

 

In addition, the North Dakota PMHCA Consultation Line was operational in March 2021. This consultation line connects primary care providers treating children and adolescents with a child and adolescent psychiatrist for consultation during daytime business hours. The consult line is funded by the PMHCA grant and there is no cost to providers or families for this service. 

 

The NDDoH engaged in a strategic planning process on December 10, 2018. Because of this effort, the department's mission, strategic initiatives, key objectives and indicators have been updated. The NDDoH’s Strategic Plan Map (2019-2021) can be found at: http://www.ndhealth.gov/ch/Strategic_Map_2019-2021.pdf.

 

The strategic plan is reviewed and revised annually and assists the department in communicating with partners, setting direction, motivating employees, making decisions, determining priorities and budgets, and monitoring progress and impact. The Title V Director and Health Equity/MCH Grant Coordinator are members of the Strategic Planning Committee. All department programs have been linked to the strategic plan goals and objectives.

 

Title V programs align with the following NDDoH goals and objectives:

 

Goal: Create Healthy and Vibrant Communities

• Reduce the risk of infectious disease
• Prevent and reduce chronic disease
• Support communities in building resiliency
• Promote community driven wellness
• Increase healthy lifestyles and behaviors

 

Goal: Enhance and Improve Systems of Care

• Improve access to care in underserved and rural areas
• Enhance healthcare through technology
• Ensure access to and affordable health and preventative services
• Appropriately regulate and educate workforce to enhance quality and safe care
• Drive health-in-all policy agendas
• Establish system level partnerships across continuums of care

 

Goal: Strengthen Population Health Actions

• Prevent and reduce tobacco and other substance misuse
• Prevent violence, intentional and unintentional injury
• Reduce the risk of vaccine preventable diseases
• Reduce adverse health outcomes through early detection of disease
• Achieve a healthy weight for children and adults

 

Overarching Goal: Improve Health Equity and Assess Impacts of Social Determinants of Health

Overarching Goal: Manage Infrastructure for Optimal Outcomes

Overarching Goal: Integrate a Data-Driven Best Practices Approach

 

In addition to the core mission of the agency, the NDDoH is engaged in Governor Doug Burgum’s Five Strategic Initiatives for North Dakota: Main Street Initiative, Behavioral Health and Addiction, Transforming Education, Tribal Partnerships and Reinventing Government. A description of the partnership and leadership role of the NDDoH and Title V in these initiatives can be found in III.E.2.a State Title V Program Purpose and Design.   

 

The NDDoH recognizes the importance of public health accreditation and the alignment of accreditation efforts throughout the public health system to strengthen performance across the state. In April 2021, the NDDoH celebrated four years as a nationally accredited health department through the Public Health Accreditation Board (PHAB). Efforts are currently in process for re-accreditation in 2022.  

 

To increase the effectiveness of strategic planning and accreditation, the NDDoH has developed and implemented a performance management system and continuous quality improvement (QI) process. These efforts assist to systematically monitor and improve the quality of programs, processes and services in order to achieve high levels of efficiency and effectiveness, as well as internal and external customer satisfaction.

 

Title V program staff have varying roles and responsibilities within the department’s priorities and initiatives. The Title V Director holds a senior management position within the NDDoH and is actively involved in strategic planning and accreditation activities. As a result, Title V issues are included in department discussions, planning and decision-making processes. In addition, the Title V, CSHCN Director and the Health Equity/MCH Grant Coordinator provide regular updates to staff to seek input and feedback on department issues.

 

The COVID-19 pandemic has impacted North Dakota; as it has in the rest of the country. Most Title V staff had been assisting with COVID-19 response efforts at some level since March 2020 (e.g., public health hotline, case work, school response, data, grant writing). Department wide, most staff were also involved in COVID-19 response efforts. These efforts were critically important in promoting and protecting the health and safety of mothers and children, including CSHCN – and of all North Dakotans. At the end of July 2021, most MCH staff had returned to their normal job assignments. However, the Title V Director continues to serve as the NDDoH’s Executive Sponsor on the COVID-19 Healthy Return to Learning (HRTL) Team along with the Superintendent of the North Dakota Department of Public Instruction and Executive Director of the North Dakota Department of Human Services. The HRTL Executive Sponsor Team provides guidance and expertise to the NDDoH’s School Response Team.  In addition, the Title V Director facilitates the bi-weekly NDDoH Incident Command and Planning meetings. With increasing COVID-19 cases currently increasing, some MCH staff may once again be asked to assist with COVID-19 response efforts depending on need.    

 

To assist in translating data to action, the NDDoH has created a dashboard which provides COVID-19 state and county level data on active cases, positive test rates, demographics, source of exposure, hospitalizations, deaths, etc.:  https://www.health.nd.gov/diseases-conditions/coronavirus/north-dakota-coronavirus-cases.

       

State Specific Statues:

Priority setting also is determined by state mandates; see Supporting Document – Title V-MCH State Mandates. A State Performance Measure has been developed to address the Title V responsibilities related to these mandates titled “Implement North Dakota State Mandates Delegated to the North Dakota Department of Health Title V/Maternal and Child Health Program.” Information regarding these mandates is discussed in III.E.1. Five-Year State Action Plan Table and III.E.2.c State Action Plan Narrative by Domain – Cross-cutting/Systems Building.

 

The NDDoH’s organizational chart can be found in Section VI. Organizational Chart.