Principal Demographics and Geography of Iowa

Iowa is a rural state with approximately 3.2 million people according to the United States Census Bureau. Iowa typically has had a healthy economy with an unemployment rate of 2.8% (Feb. 2020, Iowa Workforce Development), a figure significantly below the national average. The unemployment rate during the COVID-19 pandemic rose to 8% (June 2020, Iowa Workforce Development). June 2021 the unemployment rate has reduced to 4% with more Iowans reentering the labor force (July 2021, Iowa Workforce Development). While agriculture and related industries contribute significantly to Iowa’s economy, other industries are pivotal as well, such as, advanced manufacturing, biosciences, insurance, and financial services. While the unemployment rate is low, 2019 data shows the percentage of Iowans living below the federal poverty level was 11.2% this is a slight increase from the 2017 data.

Ten of Iowa’s 99 counties have a population of 65,000 or more, 21 counties have between 20,000 and 64,999 people, 66 counties have between 5,000-19,999 people, and two counties have under 5,000 (State Data Center, 2019 population estimates). With the state’s predominantly rural population, a lack of transportation is one of the state’s most widespread and persistent concerns with regard to access to health services of all types.

Providing access to maternity care is a challenge in rural communities. According to 2017 data from Rayburn and colleagues, the United States has a rate of 4.5 obstetricians/gynecologists per 10,000 women of reproductive age. In the same publication, Rayburn reported that there were 3.3 obstetricians/gynecologists per 10,000 women of reproductive age in Iowa.  Between the years 2000 and 2020, forty community level hospitals have discontinued their maternity services. IDPH in partnership with University of Iowa-Carver College of Medicine-Office of Statewide Clinical Education Programs (OSCEP) and the University of Iowa Department of Obstetrics and Gynecology (UI) has begun to examine Iowans’ access to maternity and prenatal care. Provisional results suggest that women’s prenatal care access is generally preserved and a high proportion of women have obtained adequate prenatal care, based on an index of prenatal care adequacy. Of concern is a rising number of rural-residing women at risk to deliver outside of a labor and delivery unit and the high rates of maternal transfers. We will continue to monitor these trends and develop strategies to address the trends. Additionally, Iowa is one of the the most inclusive state in the US in terms of Medicaid income eligibility for pregnant women and infants (up to 375% FPL). However, undocumented women rely on Emergency Medicaid for Non-Qualified Immigrants for delivery when their presumptive eligibility expires.

Overall, Iowa children are in good health. According to the Iowa Children’s Health Care Report Card from Georgetown University, 2.9% of children under the age of 19 were uninsured in 2019. This rate places Iowa in 7th in the nation for lowest rates of uninsured children. According to the US Census Bureau, the 2019 estimates show 6.2% of Iowa’s total population is under the age of five. In 2018, the percent of families with related children under 18 years old living below the poverty level was 11.2%. According to the 2016 National Survey of Children’s Health, it is estimated that 128,000 Iowa children and youth have, or are at risk of having, a special health care need. Access to pediatric specialty health care services remains a challenge for children and youth with special health care needs and their families, especially in rural areas.

The state is 90.6% White (American Community Survey, 2019); however, racial and cultural diversity is increasing. The Hispanic population increased from 2.8% in 2000 to 6.3% in 2019. Live births to Hispanic women made up 3,877 which is a rate of 19.5 of all births (2019 Vital Statistics of Iowa). Other key demographic data that paint the picture of Iowa includes 31.7% of families are single parent families. In 2019, the percentage of children in families where the head of household lacks a high school diploma was 7 percent; this is better than the 2010 rate of 9 percent.

Iowa’s MCAH Population

The Bureau of Family Health’s (BFH) Maternal, Child, and Adolescent Health (MCAH) programs promote the health of Iowa’s women, mothers, infants, children, youth and adolescents through public and private collaborative efforts. The BFH contracts with local agencies to serve as the community utility to link individuals and families to care and services in all of Iowa’s 99 counties. Agencies eligible to apply to become MCAH providers include private nonprofit and public entities. Each local agency serves a grouping of counties, ranging from one to 15 counties. Most local agencies provide maternal, child, and adolescent health services; however, a small number of agencies provide only maternal health services or only child and adolescent health services, so some counties have two different agencies that work together to ensure that the MCAH population receive services. The maps below show the current county assignments by agency.

Women/Maternal/Prenatal/Infant Health:

In FFY20, 23 local maternal health agencies provided maternal health services to approximately 4,493 low-income pregnant women. A wide range of health education and support services are available to low-income pregnant women, such as risk assessment, psychosocial screening, oral health screening, delivery planning and presumptive eligibility. The maternal health agencies also provide care coordination to promote early entry into care.

Women/Maternal Health Agency Service Areas*:

Child and Adolescent Health:

In FFY20, 23 local child health (CH) agencies provided child health services to approximately 94,276 children, ages 0 to 22 years. Through dental care coordination services, the child health programs help families access dental education and referral through Iowa’s I-SmileTM program. CH agencies may also provide gap filling services, such as immunizations; developmental, nutrition and psychosocial screenings; and laboratory tests including blood lead testing. Child health agencies also provide informing and care coordination services for the Medicaid population.

Child and Adolescent Health Agency Service Areas*:

* Service Area maps with local agency information are included in the Attachments.

Children and Youth with Special Health Care Needs:

The University of Iowa Division of Child and Community Health (DCCH) administers Iowa’s Title V program for Children and Youth with Special Health Care Needs (CYSHCN), overseeing systems building, enabling, and direct services. DCCH has administrative offices in Iowa City, a network of 13 Child Health Specialty Clinics (CHSC) Regional Centers, and 7 satellite locations across Iowa, employing nearly 100 public health professionals, clinical providers, and Family Navigators. DCCH provides direct clinical care (in-person and via telehealth), care coordination, and family-to-family support to CYSHCN ages 0-21 and their families. In FFY20, DCCH provided services and supports to over 6,500 Iowa CYSHCN and their families.

DCCH Regional Center Locations:

DCCH’s vision is to ensure a systems-oriented approach to care for Iowa’s children and youth with special health care needs and their families, and is guided by the Standards for Systems of Care for CYSHCN 2.0. The mission is to improve the health, development, and well-being of children and youth with special health care needs in partnership with families, service providers, communities, and policymakers. The current priorities for Iowa’s CYSHCN program are Access to Care, Transition to Adulthood, and Family Support.  In addition to administering the MCH Title V program for CYSHCN, DCCH provides services and supports to Iowa CYSHCN and their families through a number of programs including the Pediatric Integrated Health Home program, the Community Circle of Care, the Iowa Regional Autism Assistance Program, the Iowa Pediatric Mental Health Care Collaborative, and Iowa’s Early Intervention program-- Early ACCESS.  

Workforce development, including increasing cultural diversity of the CYSHCN workforce, is a need within Iowa’s System of Care for CYSHCN. The capacity of the CYSHCN workforce is dependent on geographic location with shortages most acute in rural areas of the state. DCCH proudly supports family-centered services and advocates for family-professional partnerships at the local, state, and national levels. DCCH has continued to expand the use of telehealth to connect families with specialists and to train new family advocates through the Iowa Family Leadership Training Institute. 

Access to pediatric specialty care is a challenge for families in Iowa, especially for those with complex medical needs and those living in more rural areas of the state. Most pediatric specialty services are concentrated in only a few of Iowa’s 99 counties. Iowa ranked in the bottom 20% of states with number of general pediatricians ever certified, aged 70 and under per 100,000 of children (American Board of Pediatrics Workforce Data Book, 2017/2018). Iowa has a shortage of developmental specialists to assess, diagnose, and treat CYSHCN including those with Autism Spectrum Disorder and Serious Emotional Disorders. 

Iowa has seven Home and Community Based Services (HCBS) Waivers that provide funding for services and supports so that people who would otherwise require care in a medical institution can live in their own homes and communities. Five of these waivers apply to Iowa CYSHCN: The Health and Disability Waiver, the Intellectual Disability Waiver, the Brain Injury Waiver, the Physical Disability Waiver, and the Children’s Mental Health Waiver. Waivers for CYSHCN currently cover about 16,500 children. Nearly 6,000 children are on waitlists for waiver programs. DCCH also provides consultation, technical assistance, planning, and care coordination for approximately 600 individuals under the age of 21, with complex and special health care needs who are applying for the Health and Disability (HD) Waiver, are on the waiting list for the HD Waiver, or currently enrolled with the HD Waiver.

Medicaid In Iowa

In 2016, CMS announced that it approved the launch of IA Health Link (Iowa’s Medicaid Modernization initiative). The goals of Medicaid Modernization included improved quality and access, greater accountability for outcomes, and creating a more predictable and sustainable Medicaid budget. Medicaid agencies contract with managed care organizations (MCOs) to provide and pay for health care services. MCOs establish an organized network of providers and utilization guidelines to assure appropriate services are provided at the right time, in the right way, and in the right setting. This shifted the focus from volume to per member, per month capitated payments and patient outcomes.

The Iowa Department of Human Services currently contracts with the following two MCOs for Iowa’s Medicaid Modernization initiative to provide and pay for health care services to the vast majority of Medicaid members:

• Amerigroup Iowa, Inc.
• Iowa Total Care

IDPH has had a collaborative relationship with the Iowa Department of Human Services – Iowa Medicaid Enterprise (IME) – for more than 30 years.  Medicaid’s work with the Title V Maternal and Child & Adolescent Health program began with a systems change initiative to decrease barriers and assure that pregnant women and children have access to services to which they were entitled.  The relationship offered a comprehensive system of care that included outreach, informing of newly eligible families of EPSDT services, and care coordination services.  Although linkage with established medical and dental homes is a program priority, local Title V contract agencies are also able to bill Medicaid for direct care maternal and EPSDT services through specific provider packages established by Iowa Medicaid.  Title V agencies provide EPSDT gap-filling services under Iowa Medicaid’s Screening Center provider status, and Title V agencies provide Maternal Health gap-filling services under Medicaid’s Maternal Health Center provider status.

The working relationship between Iowa Medicaid and Bureau of Family Health programs is solidified each year through a contractual arrangement.  The current Omnibus Agreement is based upon a collaborative agreement with attachments that address administrative services; EPSDT/MH/OH/1st Five programs; Hawki Outreach; the 1-800 Healthy Families Line; and a Medicaid match project.

Bureau of Family Health program staff meet monthly with the IME Maternal Health Center & Screening Center Project Manager, IME Oral Health Project Manager, and IME Contract Manager. The meetings provide an opportunity for staff to pose questions and concerns, provide input, and receive guidance and updates from IME on Medicaid policy and current issues.  Ongoing challenges that local MCAH agency contractors have experienced since the transition to Medicaid Managed Care are presented and discussed.  IDPH staff share information on progress within Title V MCAH and other programs of mutual interest.

Iowa Health and Wellness Plan

The Iowa Health and Wellness Plan, Iowa’s version of Medicaid expansion, was enacted through bi-partisan legislation to provide comprehensive health care coverage to low income adults. The plan offers coverage to adults age 19-64 with an income up to 133 percent of the Federal Poverty Level (approximately $15,521 per year for an individual and approximately $20,921 per year for a family of two or higher depending on family size). The plan began on January 1, 2014, and currently serves approximately 150,000 Iowans. The Iowa Health and Wellness Plan includes dental services under the Dental Wellness Plan (DWP). Effective July 1, 2017, adult Medicaid members age 19 and older were combined into a single, improved Dental Wellness Program administered by Delta Dental of Iowa and MCNA Dental.

Data Integration

The BFH and Oral Health Center continue to integrate program data including care coordination, referral management, risk assessment, practice management, billing, and client and population level reporting. The data systems consolidated/integrated to the new system, signifycommunity (formerly TAVConnect), are the Child and Adolescent Reporting System (CAReS), Women’s Health Information System (WHIS) and Ahler’s family planning data system.

The CAReS data system included the CAH, 1st Five, Early ACCESS and Oral Health programs, and was replaced by signifycommunity on April 3, 2017. The WHIS database that stores the Maternal Health program data was integrated with signifycommunity on June 1, 2017. Ahler’s, was integrated on April 1, 2018. A billing solution, Softatics, was integrated into the system for a more streamlined billing protocol. Currently, signifycommunity and IDPH are importing data from external data interfaces like lead lab results, WIC, MIECHV/HOPES and Immunizations through data feeds and other sharing mechanisms.

IDPH implemented a system to document screening, further testing, and follow-up/referrals for newborn screening programs. The system name is Iowa Newborn Screening Information System (INSIS). IDPH contracts with Optimization Zorn (OZ Systems​, Inc.​) for its web-based surveillance software system, eScreener Plus (eSP™). The data system was built to integrate three newborn screening databases (Early Hearing Detection and Intervention [EHDI], Dried Bloodspot [DBS] and Critical Congenital Heart Disease [CCHD]) into one system. INSIS ​hearing screening and CCHD modules went live in June 2016. The blood spot screening module is scheduled to go live in 2022; implementation is delayed due to the State Hygienic Laboratory switching to a new data system.

Twenty Iowa birthing hospitals are using an admission/discharge/transfer (ADT) interface from OZ called NANI (Newborn Admission Notification Interface) to automatically import ADT information from the hospital electronic medical record system into INSIS. This interface has improved the accuracy and timeliness of data entry of demographic and basic newborn information. All Iowa birthing hospitals are now required to submit their demographic information electronically either through NANI or flat file import.

As an entity of the University of Iowa Health Care System, DCCH integrates data through the Epic electronic health record (EHR). This allows families and health care providers to access information and allows for timely communication. DCCH has been involved in adapting the EHR to accommodate Title V priorities. For example buttons and pull down menus have been created that allow practitioners to review and document family goals, the transition to adulthood checklist, and care plan templates. Through the EHR, DCCH is able to extract data for measuring progress toward block grant strategies. Families are able to access their child’s health information through MyChart software that is part of the Epic EHR. An additional feature of this integrated data system is that community-based primary care providers/medical home have web-based access to their patients’ records through the Epic application CareLink. CareLink provides complete access to clinical data, care plans, and medical and community referrals.

Public Health Accreditation Board

The Iowa Department of Public Health achieved accreditation from the Public Health Accreditation Board (PHAB) in November 2018.  This award marked an important milestone in the department’s journey towards adopting a culture of quality.  Benefits of the accreditation process included: learning that occurred through the use of cross-department teams, increased focus on the importance of reviewing and updating documents, an opportunity to hone in on both opportunities and gaps, and having quality improvement, health equity, performance management, workforce development and other topics embedded in the work of the department.  MCAH program staff were active participants in the site visit process by providing their expertise in site visit interviews.  Program staff have also participated in the department’s next steps now that accreditation has been achieved.  The department plans to continue to further develop areas of strength and build on opportunities in order to further the quality culture, maintain accredited status and pursue reaccreditation.

Strengths and Challenges Impacting the MCH Population

Challenges

Rural

The rural nature of Iowa presents unique challenges for clients to access services throughout the state. Local Title V MCAH agencies work to ensure needed health services are provided in the rural counties. This is accomplished through building partnerships with health providers and community resources. Likewise, DCCH provides services for families of CYSHCN in many rural areas.  In 2019, the Iowa Legislature eliminated the Rural Health and Primary Care Advisory Committee. BFH staff is currently exploring other ways to ensure involvement of rural populations in the development and implementation of Title V activities in all 99 counties.

An initiative in Iowa to incentivize providers to practice in underserved areas is the Primary Care Recruitment and Retention Endeavor (PRIMECARRE) which was authorized by the Iowa Legislature in 1994 to strengthen the primary health care infrastructure in Iowa. PRIMECARRE allocations currently support the Iowa Loan Repayment Program, with matching federal and state funds. This initiative offers two-year grants to primary care medical, dental, and mental health practitioners for use in repayment of educational loans. This program requires a two-year practice commitment in a public or non-profit site located in a health professional shortage area (HPSA). While Title V is not directly working on PRIMECARRE, Title V staff communicate regularly with PRIMECARRE staff to address shortages in primary care, OB and dental providers that impact the MCH program.

Medicaid

The transition to Medicaid Managed Care remains one of the biggest challenges for Iowa’s Title V local MCAH agencies.  Nearly all of Iowa’s Medicaid population (all but approximately 5%) were shifted to managed care.  Although significant groundwork was laid with each MCO well in advance of startup through meetings addressing Iowa’s Title V structure and its strong relationship with Iowa Medicaid, difficulties remained.  These include the following:

• Shifting MCO enrollment for individuals has caused difficulties when serving clients.  Initially in April 2016, there were three MCOs established – AmeriHealth Caritas, Amerigroup, and UnitedHealthcare.  As of November 30, 2017, AmeriHealth Caritas withdrew from Iowa.  This resulted in these clients shifting either to Iowa Medicaid (fee-for-service) or UnitedHealthcare.  Several months later, once Amerigroup was able to handle greater capacity, some of the clients were shifted to Amerigroup.  In March 2019, it was announced that UnitedHealthcare would be leaving the state on June 30, 2019; and on July 1, 2019, a new MCO (Centene’s Iowa Total Care) began coverage of services.  As a result, effective July 1, 2019 Iowa had two Medicaid MCOs in the state -- Amerigroup and Iowa Total Care.  This series of changes in MCO providers has caused significant challenges for both Medicaid members and providers.  Title V agencies work to stay abreast of the changes and assist clients in understanding the shifts in MCO assignment.
• Numerous challenges related to payment of certain services allowed under Maternal Health Center and Screening Center provider types have occurred, including inconsistencies in payment and denials of payment.  Policies established for payment may vary from one MCO to another.  Reasons provided for non-payment may include ‘lack of medical necessity,’ declaring some services are an ‘add on code’ requiring another primary procedure, third party liability, stating services are ‘not covered,’ and limitations on the number of services -- all that did not formerly exist.  Bureau of Family Health staff continue to work with Iowa Medicaid staff to try to resolve difficulties as they arise.
• Fiscal challenges have created a burden in working with the MCOs.  Submitting claims among multiple MCO providers who have differing processes is not a small undertaking.  Handling claim resubmissions, denials, and appeals has taken significantly greater staff time and therefore cost.  In addition, tracking payments and recoupments to assure fiscal accountability is not always straight-forward.  In some cases, payments are made and subsequently recouped at a later date and at times from a completely different provider type.

Other adjustments to service provision by Iowa’s Title V local contract agencies resulted from initiation of managed care.  The following include permanent changes that have altered Title V service provision:

• Medical care coordination is included in the MCO’s contract with DHS.  As a result, local Title V MCAH contract agencies are no longer able to bill for medical care coordination services provided for MCO enrolled clients.  This has had a significant impact on the continuity of care that Title V contract agencies are able to provide for their population.  Title V MCAH agencies are able to bill IME for medical care coordination provided for the Medicaid fee-for-service population (approximately 5% of the Medicaid population) and for all dental care coordination.
• Transportation services provided by local Title V MCAH agencies were significantly impacted by the advent of Medicaid MCOs.  Historically, Title V agencies were able to arrange and bill specific types of transportation services for Medicaid clients through their Maternal Health Center and Screening Center provider types.  This enabled local staff to assist clients to gain access to Medicaid covered services/appointments.  This ability is now limited to only the Medicaid fee-for-service population, as each Medicaid MCO has a transportation broker for handling rides for the MCO enrolled population.  Agencies have experienced many reports from clients regarding difficulties and the lack of flexibility among the transportation brokers.

The above challenges have resulted in continued financial challenges for MCAH agencies, which typically consist of small private non-profit or county public health agencies.  Many have reduced staff and continue to face tough decisions as to the ability to continue services at their former levels.  One Title V MH provider made the decision to no longer contract for the Title V program due to such issues October 1, 2019. The counties covered by this MH were accepted by a contiguous MCAH agency.

Strengths

Health Insurance Coverage

In 2019 it was reported that 97.1% of children, 19 years and under, in Iowa had some form of medical insurance. It is estimated that 96.2% of all uninsured eligible children participate in Medicaid or Hawki. Since 2010, children eligible for Hawki and Medicaid have been able to obtain immediate, temporary Medicaid coverage through the Presumptive Eligibility for Children program. All Title V agencies are able to assist families in applying for Medicaid and presumptive eligibility. Iowa’s Hawki program also has a dental-only option to increase access to oral health services for families that have medical coverage but lack dental coverage.

Iowa women with medical insurance was reported to be 94.4%. Iowa is currently one of the most inclusive states in the US in terms of Medicaid income eligibility for pregnant women. Iowa women that make 375% of the Federal Poverty Limit (FPL) or below are eligible for Medicaid assistance during pregnancy and for 60 days postpartum. All Title V funded local Maternal Agencies assist clients in applying for presumptive eligibility, helping women obtain Medicaid coverage early in pregnancy regardless of legal status.

Maternal Mortality Enhancement

Iowa is working towards significant improvements to the maternal mortality review process. Beginning in 2020, Iowa began to develop a multidisciplinary Maternal Mortality Review Committee (MMRC); previously Iowa’s MMRC only included physicians. IDPH will identify pregnancy-associated deaths within one year of the death and abstract available data to support multidisciplinary review of each death. The comprehensive de-identified information about all deaths related to pregnancy will be entered into a standard data system [Maternal Mortality Review Information Application (MMRIA)]. Annual reviews of the maternal deaths will be done and summaries of the committee decisions will also be entered into MMRIA within 2 years of the maternal death. Previously our MMRC only reviewed maternal deaths once every three years. All de-identified data entered into MMRIA will be shared with the Center for Disease Control (CDC). Quality assurance processes, in partnership with CDC, will be used for improving data quality, completeness, and timeliness. IDPH and the CDC will analyze data and share findings with a broad range of stakeholders to inform policy and prevention strategies to reduce maternal deaths. To accomplish this work, 0.5 FTE for an RN to do data abstraction and oversee the review of maternal deaths was created. Job responsibilities also include oversight of Iowa's Regionalized System of Perinatal Care. 

In 2019, Iowa’s MMRC found that 18% of Iowa maternal deaths were the result of motor vehicle accidents in the last three years; 71% of the women were not wearing a seatbelt and frequently were ejected from the vehicle. Deaths to these young women occurred during pregnancy and the postpartum period. Iowa’s Title V program, in partnership with the newly formed IMQCC, the Governor’s Traffic Safety Bureau, the Iowa Department of Transportation- Zero Fatalities, and Safe Kids Iowa at Blank Children’s Hospital, is developing a social media campaign on seatbelt use during pregnancy. For more information on safe seat belt use during pregnancy go to the following link: https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/pregnant-seat-belt-use.pdf

The Iowa Maternal Quality Care Collaborative (IMQCC) was developed through the HRSA Maternal Health Innovation grant that was received by IDPH in 2019.  The IMQCC’s first quality improvement project was to implement statewide the Association of Women's Health Obstetrical and Neonatal Nurse's (AWHONN) POST-BIRTH Warning Signs program. This was based on data from our Maternal Mortality Review Committee report that showed 56% of Iowa pregnancy associated death occurred postpartum.  The strategies in the program focuses on a standard approach to empower postpartum parents to recognize and act on warning signs of potential life threatening postpartum emergencies. The goal of the education is to prevent pregnancy complications and death that can occur during pregnancy and postpartum. Iowa would like healthcare providers to communicate with patients about warning signs, and use tools to help patients and families identify warning signs early to ensure women can receive timely treatment.  It is important for women and their families to communicate their pregnancy history any time care is received in the year after their pregnancy has ended and to know when and who to call for help. Iowa will use AWHONN’s POST- BIRTH warning signs to postpartum women in Iowa’s Birthing Hospitals and by education provided by Title V Maternal Health nurses in local communities. For more information on AWHONN’s POST-BIRTH warning signs go to https://awhonn.org/education/hospital-products/post-birth-warning-signs-education-program/

Iowa has received a grant from the CDC titled Preventing Iowa Maternal Deaths: Maternal Mortality Review Committee. This is a three (3) year award which starts October 1, 2021. This grant will support the work of the Maternal Mortality Review Committee and staffing responsibilities of IDPH.

I-Smile

The I-Smile program began in December 2006 when child health contractors began to receive funding to administer the program in their communities. Each contractor is required to maintain a dental hygienist as I-Smile coordinator, responsible for strategies that include: developing local partnerships to increase awareness about oral health; working with dental offices to encourage acceptance of referrals of underserved families needing dental care; promoting oral health through participation in community events and presentations at meetings; training medical providers how to apply fluoride and do oral screenings to build the safety net; and assuring care coordination and gap-filling preventive services (e.g., fluoride applications) are provided for at-risk families.

Each year, Medicaid paid claims are reviewed to measure program impact. Using 2005 data, the year before I-Smile began, as the baseline, data has shown annual improvements for Medicaid-enrolled children (ages 0-12) receiving care. In 2019:

• Nearly four times as many children received gap-filling preventive care from a dental hygienist or nurse through I-Smile in a public health setting than in 2005 (30,924 in 2019; 7,863 in 2005).
•  73% more Medicaid-enrolled children in Iowa were seen by a dentist than in 2005.
• 60% of children ages 3-12 years saw a dentist, nearing the rate (63%) of privately insured children.
• When adjusting for inflation, the average annual cost to Medicaid per child was just $21.49 more than in 2005, yet nearly twice as many children saw a dentist and four times as many received preventive services from I-Smile in a public health setting (e.g., school).

Iowa Department of Public Health’s Current Goals/Strategic Plan and Title V’s Role

In 2017, IDPH released a new strategic plan. The plan is focused on the following goals:

●        Strengthen the department’s role as Iowa’s chief health strategist.

○        Title V provides leadership on many programs at the state and local level. This grant is intended to develop and implement strategies at all levels to improve the health and well-being of Iowa’s children, mothers, and families.

●        Strengthen the department’s capability and capacity to improve population health through partnerships, communications, workforce development and quality improvement.

○        Title V relies heavily on partnerships at the state and local levels to collaborate to impact the eight National Performance Measures and the five State Performance Measures.

○        The Title V Block Grant is looking at the MCH workforce and how to strengthen the skill sets of the employees at the state and local level.

○        Quality Improvement is a cornerstone of the Title V Block Grant. There is a team at the state level that monitors the activities of the grant and looks for ways to make the activities more efficient and quality focused.

●       Implement a collaborative, department-wide approach to addressing Iowa’s top health issues.

○        Title V went through a transformation at the federal level to align with the essential Public Health Services. With these changes staff at the local level has been deliberately involving different programs within the department who have not been actively involved in the past. Iowa Title V selected the NPM focusing on breastfeeding initiation and duration.  This directly aligns with obesity, nutrition and physical activity which is the top selected health issue through strategic planning.

Division of Child and Community Health Strategic Plan and Title V’s role

The DCCH program at the University of Iowa implemented a revised strategic plan in 2017, and this was updated in 2021. Funding through the Title V program serves as foundational support for all activities that take place within DCCH. The DCCH strategic plan includes the following goals:

• Care Coordination and Clinical Services
  • Title V funding supports the regional center structure and allows resources to be combined so services can be provided through a community-based approach, even in the most rural areas of the state.

• Family Professional Partnerships
  • Title V funding is combined with other state and federal funding sources to build a robust system of family-centered care and shared decision making at all levels.

• Advocacy and Policy
  • Strengthened by the designation as Iowa’s Title V program for CYSHCN, DCCH provides a leadership role in pediatric advocacy and policy efforts and the local, state, and national levels to better support children and youth with special health care needs.

• Health Equity
  • The promotion of health equity and honoring diversity among Iowa children and youth with special health care needs and their families is a primary goal in DCCH’s strategic plan. Leadership support is funded through the Title V CYSHCN program.

Other State Statutes and Regulations that Impact Title V Programs:

Iowa Administrative Code Chapter 641.76 Summary

The Maternal, Child, and Adolescent Health (MCAH) programs are operated by the IDPH as the designated state agency pursuant to an agreement with the federal government. The majority of the funding available is from the Maternal and Child Health Block Grant, administered by the United States Department of Health and Human Services. The purpose of the program is to promote the health of mothers and children by providing preventive, well child care services to low-income children and prenatal and postpartum care for low-income women.

Chapter 641.76 explains how Maternal and Child Health programs will be administered in the state, the relationship between IDPH and CHSC, what services can be provided, who is eligible to provide the services, the eligibility requirements of the clients and the purpose of the MCAH Advisory Council. For more information on Iowa Administrative Code Chapter 76 follow this link: https://www.legis.iowa.gov/docs/ACO/chapter/06-10-2015.641.76.pdf

Other sections of Iowa Code that impact Title V:

To review previous code references follow this link: http://search.legis.state.ia.us/nxt/gateway.dll/ic?f=templates&fn=default.htm