State Overview

Geography

Nevada is the most mountainous state in the U.S. with over 150 named ranges and several mountain peaks exceeding 11,000 feet. The state has a unique topography, with vast distances separating frontier, rural, and urban communities. With a land mass of approximately 110,000 square miles, Nevada is the 7th largest state by land mass in the U.S. The State Demographer indicates Nevada has three urban counties (Carson City, Clark, and Washoe), three rural counties (Douglas, Lyon, and Storey), and eleven counties designated as frontier (Churchill, Elko, Esmeralda, Eureka, Humboldt, Lander, Lincoln, Mineral, Nye, Pershing, and White Pine). The three rural counties also meet “micropolitan” classification due to their proximity to the urban (metropolitan) counties (Carson City and Washoe). 

Figure 1. Map of Nevada with Counties

The distance between Washoe and Clark counties is 448 miles (approximately 7.5 hours by car); between Washoe and Elko counties is 290 miles (approximately 4.5 hours by car); and between Elko and Clark counties is 433 miles (approximately 7.5 hours by car). Residents in the rural and frontier counties are spread across 95,421 square miles or 86.9% of the state’s land mass. Population density ranges from 396 people per square mile in Carson City to 0.27 people per square mile in Esmeralda County. Approximately 90% of Nevada land is publicly owned and administered by federal, state, and Tribal entities, with the remaining 10% privately owned.

Figure 2. Map of Nevada with Cities

Population

In 2022, the Nevada State Demographer’s Office and the U.S. Census Bureau estimated Nevada’s population at 3,177,772 people. According to the U.S. Census Bureau, Nevada ranks eleventh in the country for numeric population growth from 2021 to 2022. Between 2010 and 2020, Nevada had the fifth-highest percentage growth in the nation (15%, U.S. Census Bureau). While Nevada’s population continues to grow, some rural and frontier counties lose population annually. The most densely populated area in the state is Clark County, home to nearly three-quarters (73.6% or 2,338,127 persons) of all Nevada residents (tax.nv.gov). The population in the rural and frontier counties ranges from approximately 1,000 (Esmeralda County) to 60,454 residents (Lyon County). In 2022, the child population (Nevadans under 18 years) made up 22.2% of the state’s population, equivalent to the proportion across the U.S.

The U.S. Census Bureau also indicates Nevada is an ethnically diverse state, with over 29% of the state’s population in 2022 documented as Hispanic Origin of Any Race. In comparison, Nevada’s population is 72.8% White alone, 10.6% Black alone, 9.1% Asian alone, 1.7% Native American or Alaskan alone, 0.9% Hawai’ian and Other Pacific Islander alone, and 4.9% two or more races. The Census Bureau website where data are obtained can be found here: https://www.census.gov/quickfacts/NV.

According to the most recent Kid’s Count Data Center (2021), approximately 32% of Nevada’s children are from non-U.S. national families or reside with at least one foreign-born parent, and of these children, 65% are from Latin America. These numbers have been holding steady over the last five years. Health concerns for Nevada’s diverse MCAH population include physical, reproductive, behavioral, mental, psychosocial, chronic disease concerns, health disparities, and care of CYSHCN. Language barriers, cultural differences, equitable access to insurance, structural inequities, and service availability can influence the use of clinics, hospitals, medical providers, and other health care and ancillary services. Nevada Title V MCH-funded partners provide bilingual referrals and resources to community events. Along with providing printed materials, staff link diverse populations to programs providing culturally informed services.

Public Health System/Organizational Structure

Governor Joe Lombardo is Nevada’s Governor, currently serving the first year of a four-year term. Nevada DHHS is the largest of the State’s departments and the Director is appointed by and reports directly to the Governor. The current DHHS Director is Richard Whitley, MS. DHHS is comprised of five divisions, with multiple stand-alone programs falling under the DHHS Director. Divisions include the Division of Public and Behavioral Health (DPBH), Aging and Disability Services Division (ADSD), Division of Child and Family Services (DCFS), Division of Health Care Financing and Policy (DHCFP/NV Medicaid), and the Division of Welfare and Supportive Services (DWSS).

Nevada’s three urban counties have their own health authority: Carson City Health and Human Services (CCHHS), Washoe County Health District (WCHD), and Southern Nevada Health District (Clark County, SNHD). The rural and frontier counties: Humboldt, Elko, Pershing, Lander, Eureka, White Pine, Churchill, Mineral, Esmeralda, Nye, and Lincoln counties do not have their own health authority; therefore, DPBH OPHIE and the DHHS Chief Medical Officer serve as the health authority for those counties. Additionally, rural and frontier counties have boards of health and/or a health officer and a Central Nevada Health District was approved by the State of Nevada Board of Health in December 2022 and will fully implement services starting July 1, 2023. Counties served by Central Nevada Health District will include Churchill, Eureka, Mineral, and Pershing. Nevada Community Health Services (CHS) has community health nursing clinics and behavioral health clinics in various rural and frontier counties to provide family planning services, related preventive health services, public health, and infectious disease services.

DHHS programs helping to promote Title V MCH priorities in Nevada include: Nevada 211, Office of Consumer Health Assistance, NGCDD, the Office of Health Information Technology, Individuals with Disabilities Education Act (IDEA) Part C Office, Nevada Early Intervention Services (NEIS), the Nevada Office of Minority Health and Equity (NOMHE), Tribal Liaisons (DHHS and DBPH partner with 27 Tribes across Nevada through a Tribal Consultation Process Agreement to strengthen ties and relationships with Tribal Governments), Nevada Primary Care Office (PCO) which addresses access to health care and identifies workforce shortage areas, Oral Health, CHS/CHNs, DPBH OPHIE, DHHS Office of Analytics, Substance Abuse Prevention and Treatment Agency (SAPTA), Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), DCFS, ADSD, Nevada Medicaid, Nevada’s Chronic Disease Prevention and Health Promotion (CDPHP) Section, Nevada Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Temporary Assistance for Needy Families located within DWSS, and the Nevada State Immunization Program (NSIP).

Nevada Revised Statutes (NRS) Chapter 442 details the Title V MCH public health authority of DPBH. The link to NRS Chapter 442 can be found here: http://www.leg.state.nv.us/NRS/NRS-442.html. The DPBH Administrator changed from Lisa Sherych to Cody Phinney in May 2023. The Community Services Branch of DPBH is led by Julia Peek, MHA, CPM. The Bureau of Child, Family and Community Wellness within the Community Services Branch was led by Bureau Chief Kyle Devine, MSW, and changed to Vickie Ives, MA, in May 2023. The Bureau includes WIC, NSIP, CDPHP, and MCAH. The position of Title V MCH and CYSHCN Director is held by Vickie Ives. Tami Conn, MPH, is the Section Manager for MCAH and will be the CYSHCN Director as of July 1, 2023. MCAH programs include Maternal, Infant, and Early Childhood Home Visiting (MIECHV); Personal Responsibility Education Program (PREP), RPE, Sexual Risk Avoidance Education Program (SRAE), ERASE Maternal Mortality, Nevada PRAMS, Early Hearing Detection and Intervention (EHDI), SSDI, and the Title V MCH Program.  As of October 30, 2022, Ghasi Phillips-Bell, ScD, MS, joined the Nevada MCH team as a CDC MCH Epidemiology Assignee to Nevada and has supported and strengthened Title V MCH and epidemiology efforts with a focus on congenital syphilis efforts.  A CDC Foundation appointee, Sarah Jane Smith, MPH, supported both MCH and NSIP in coordinated childhood vaccine catch up and COVID efforts for children and pregnant persons, including efforts on sensory friendly vaccine kits and education.

The MCAH Section also administers the Maternal Child Health Advisory Board (MCHAB), Diapering Resources Committee, Nevada Maternal Mortality Review Committee (MMRC), Alliance for Innovation on Maternal Health (AIM), and Account for Family Planning (AFP). The MCAH Section addresses health and social issues among the populations served by coordinating efforts with Nevada DHHS programs, LHAs, public and private partners, universities, MCH Coalitions, community coalitions, Family Resource Centers, Federally Qualified Health Centers (FQHCs), regional hospitals, and a variety of other traditional and non-traditional partners.

The MCAH Section includes the Title V MCH Program led by MCH Manager Kagan Griffin, MPH, RD. Title V MCH Program fiscal staff include two partially funded Management Analyst II positions and a part time Accounting Assistant III. Administrative staff includes an Administrative Assistant III. The SSDI Manager is Taliman Afroz, PhD. This position leads MCAH and PRAMS data efforts. Nevada Title V MCH Program staff and topic units include:

• The CYSHCN Program Coordinator, Cassius Adams, MS, administers and promotes the MHP, serves family and self-advocates for CYSHCN, provides supports for CYSHCN, provides and coordinates health education for CYSHCN and their families, administers the Critical Congenital Heart Disease (CCHD) Registry, and provides trainings for families and health professionals. Partners working with the CYSHCN Coordinator include the University of Nevada, Children’s Cabinet Nevada Pyramid Model, Family Navigation Network through NCED, partners providing transition activities for older CYSHCN, and NGCDD.
• The Title V MCH Epidemiologist, vacant, is responsible for MCH data needs for annual reporting and the five-year needs assessment. Additionally, the MCH Epidemiologist analyzes data and writes reports for federal, state, and local use, including for the Nevada PRAMS and other MCAH programs. Funding for this position is provided through the Title V MCH Block Grant (0.7 FTE) and CDC PRAMS (0.3 FTE).
• The RPE Coordinator, Samm Warfel, collaborates with statewide partners to prevent sexual violence and intimate partner violence among youth and young adults ages 12 to 24 years. Funding for the RPE Coordinator position and related prevention activities is provided through the Title V MCH Block Grant (0.25 FTE), Preventive Health and Health Services Block Grant (PHHSBG) set-aside, and CDC (0.75 FTE).
• The Adolescent Health and Wellness Program (AHWP) Coordinator, Eileen Hough, MPH, collaborates with community partners on improving access to health insurance, increasing utilization of adolescent well visits and general health and wellness services, including trauma informed yoga, increasing daily physical activity by adolescents, and administering school-based health center Medicaid certification and related technical assistance.
• The Maternal and Infant Health Program Coordinator, Anastasia Cadwallader, MBA, collaborates with diverse community partners on a variety of perinatal and interconception care initiatives, including substance use prevention, breastfeeding promotion, injury prevention, perinatal mood and anxiety disorders, safe sleep, and FIMR. 
• The Administrative Assistant III, Desiree Wenzel, is responsible for administrative duties related to the Maternal and Child Health Advisory Board, purchase orders, travel coordination, and other tasks in support of the MCAH Section.

Nevada’s Title V MCH activities occur at the local, regional, and statewide levels and MCH cooperates with programs and sections within DPBH supporting women of childbearing age, infants, children, CYSHCN, adolescents, and their families. Examples of Title V MCH-funded partners administering programs congruent with the priorities indicated in the five-year plan include:

• Children’s Cabinet Nevada Pyramid Model provides technical assistance and facilitates parent involvement in social emotional Pyramid Model activities.
• Family Navigation Network, Nevada’s Family to Family partner, serves CYSHCN and supports families and health professionals who work on their behalf providing advocacy, education, training, and other supports including a toll-free hotline.
• Washoe County FIMR evaluates elements impacting health in pregnancy and perinatal outcomes, as well as fetal and infant birth outcomes to reduce fetal and infant mortality.
• Money Management/Nevada 211 provides information and referral via https://www.nevada211.org, a toll-free phone number, text support, as well as hosting the Title V MCH toll-free line, supporting the MHP resource sections, and educating on the priority status of pregnant persons at SAPTA-funded treatment centers.
• Immunize Nevada supports training and workforce development, including the coordination of the statewide Nevada Health Conference with trainings to build topical MCH knowledge; they also conduct a variety of other trainings and public media campaigns which support MCH population health and immunization needs.
• Nevada Broadcasters Association provides airtime and support for the Sober Moms Healthy Babies (SMHB), PRAMS, and Safe Sleep campaigns. DP Video supports adolescent wellness, transition to adult care, youth mental health and resilience, tobacco quit line, and MHP social media campaigns.
• KPS3 updated the Nevada Breastfeeds website.
• Nevada’s PRAMS partner is UNR, Center for Surveys, Evaluation and Statistics in the School of Community Health Sciences.
• The Statewide MCH Coalition supports website maintenance, disseminates communications, advocates for MCH populations across public and private health entities in Nevada, conducts or refers to maternal mental health trainings, and supports planning with statewide partners for meeting the community needs of diverse populations.
• UNR NCED provides training on leadership, advocacy, transition education, and the medical home model for parents of CYSHCN.
• Urban Lotus provided trauma-informed yoga to youth who are experiencing health/SDOH disparities. This organization closed its doors in December 2022, and a new partnership with Yoga Haven was established to continue this work.
• The Regional Emergency Medical Services Authority (REMSA) operates as the lead agency for the Cribs 4 Kids (C4K) program in Nevada and provides educational resources to parents and caregivers on the importance of practicing safe sleep behaviors with infants to prevent mortality. A Tribal pilot in concert with interested Tribal Nations, C4K, Indian Health Services staff, The Nevada Institute for Children's Research and Policy (NICRP), and MCH is funded via the Title V MCH Program to prevent mortality and injury.

Program management and fiscal staff meet weekly to discuss and coordinate all Title V MCH activities across Nevada, while program personnel meet weekly to discuss the status of funded program activities and associated outcomes. Program and fiscal goals, potential barriers, training needs, and technical assistance are all topics for discussion and action. New activities are considered as funding allows. Program staff work with community partners to determine the scope of work and budget needed for community-level activities annually. This includes monthly check-in calls and annual site visits to monitor subawardee program deliverables and fiscal processes.

Culturally and Linguistically Appropriate Services (CLAS) Standards

Title V MCH-funded programs provide outreach and culturally informed services and ensure funded products are ADA-compliant. Cultural humility Tribal trainings are a valuable component and are offered to case managers, nurses, and other professionals. Licensed personnel provide CLAS trainings and CHWs, Home Visitors, and various support staff access CLAS and related trainings.

Nevada’s Title V MCH Program works with partners in remote areas to increase the number of sufficiently trained staff in rural/frontier Nevada. Program staff, including funded partners, work with diverse communities across Nevada, including other partners who have greater understanding of the communities in which they live. Partners offer language and translation assistance, either through local community organizations or over the phone. Several partners have personnel with language skills who can provide language assistance and translation. Bilingual information and media are provided to serve Spanish language speakers, and Title V MCH is working to disseminate information in Tagalog and Chinese as well. Nevada State Purchasing provides additional assistance with the capacity to work with diverse entities who provide translation assistance and can aid with translation of documents. Family Navigation Network provides interpretation and translation services. Information and materials disseminated by these partners are required to be culturally appropriate. Internal translation support is provided by bilingual MCAH and CFCW staff.

MCAH staff and partners received training related to equity, disparity reduction, and diversity and participated in webinars and trainings related to health equity, diversity, CLAS, intergenerational trauma, racism and MCH, implicit bias, reproductive justice, minority health and wellness, Tribal partnerships, SDOH, ACEs, stigma, race and disparity, and health literacy. The SDOH IM-CoIIN 2.0 included surveys related to implicit biases and readiness for change in support of enhancing capacity to address biases and disparities. Nevada’s Title V MCH Program works with community members to expand the MCH presence across populations to address gaps and expand service scope to engage all state MCH communities. The Title V MCH Program collects accurate statewide and regionalized demographic information and shares information and trends across all funded community partners and is participating in the Language Access Plan.

Healthcare

The Patient Protection and Affordable Care Act (ACA) and Medicaid expansion continue to have a positive effect in Nevada. The percent of children ages 18 years and below without health insurance fell from 17% in 2012 to 8% in 2019 but increased to 9% in 2021. Nevada will continue to monitor insurance enrollment data for MCH populations and review related Nevada PRAMS data, as well as monitor Medicaid unwinding impacts.

Nevada Medicaid is administered by DHCFP with enrollment administered by DWSS for Medicaid and Nevada Check-Up, Nevada’s Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Program. Both Fee for Service (FFS) and Managed Care Organizations (MCOs) operate in Nevada. Rural areas are served by FFS providers and the urban areas of Clark and Washoe counties are served by contracted MCO providers.

As of December 2022, an estimated 870,550 individuals were enrolled in Medicaid and Nevada Check-Up. This total increased from September 2020, when an estimated 722,616 individuals were enrolled. Furthermore, in September 2013 only 332,560 individuals were enrolled. Open enrollment for the ACA began in October 2013. These numbers demonstrate continued growth in enrollment and a net increase of 162% in Nevada’s Medicaid-covered population over the past nine years. (https://www.medicaid.gov/medicaid/by-state/stateprofile.html?state=nevada).

Nevada continues to promote the utilization of EPSDT screenings among Medicaid-eligible children younger than 21 years. Healthy Kids, the Nevada EPSDT Program, reimburses providers for well-child visits for all children enrolled in Nevada Medicaid and Nevada Check-Up. Outreach to providers and families to encourage EPSDT screenings is a continuing effort for the DHCFP and Title V MCH Program. Continued collaboration between DHCFP and Title V MCH includes education and outreach to promote available preventive benefits and EPSDT screenings, particularly as they relate to maternal, child, and infant health, SBHC certification and toolkit distribution, and initiatives to increase well-visits for young adults.

Nevada’s Title V MCH Program is instrumental in advancing the Healthy Kids Program by funding parent education materials which encourage Bright Futures recommended preventive health services for infants, children, and adolescents and provide information on enrollment in Nevada Medicaid or Nevada Check-Up. The Title V MCH Program has also developed a growth chart based on Bright Futures recommended preventive pediatric health care visits. The growth chart includes important milestones and immunization schedules, as outlined by Bright Futures guidelines. Title V MCH partners receive these materials to disseminate to their clients. In addition, a one-page version of the growth chart is included in the Protect and Immunize Nevada’s Kids “PINK” packets; across the state, hospitals distribute these materials to all new parents after the birth of a child. The Title V MCH Program provides data related to MCH quality measures to DHCFP annually.

Nevadans who are uninsured continue to have difficulty accessing healthcare providers; however, Nevada Health Link (www.nevadahealthlink.com), the online insurance marketplace operated by the state agency, the Silver State Health Insurance Exchange (SSHIX) facilitates and connects eligible Nevadans without insurance to Affordable Care Act Qualified Health Plans and subsidy assistance to help off-set monthly premiums and out-of-pocket costs. In addition, Access to Healthcare Network (AHN) offers a medical discount program for members who pay a membership fee to access the discounted provider network and case management services. Participating network providers agree to receive reduced payments to serve AHN members. People in Nevada unable to pay for their health care needs can access limited financial assistance. The Mexican Consulate in Las Vegas provides information relating to health insurance for non-U.S. nationals. FQHCs in Nevada provide sliding scale fees for health care services to all prospective patients, irrespective of citizenship status.

No-cost health care is provided in Northern Nevada through the University of Nevada, Reno, School of Medicine (UNRSOM) Student Outreach Clinic operated by medical students. The clinic is operated in cooperation with the Family Medicine Center and UNSOM and made possible by faculty and community physicians who donate their time. Services include general and acute medical care, gynecological exams, immunizations, and discounted laboratory services. Currently, the Student Outreach Clinic operates four separate clinics: General and Pediatric; Geriatric and Dermatology; Rural Outreach; and Women's.

Volunteers in Medicine of Southern Nevada provides no-cost medical care in southern Nevada. The Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV) clinical practice provides Southern Nevadans with access to a full range of academic medicine faculty physicians delivering clinical patient-focused and collaborative services. The UNLV clinics are open to the public. Further, Rural Access Network events provide oral health, immunizations, and other needed medical services at no cost to people who are medically underserved in Nevada. Title V MCH Program staff support efforts related to CHS/CHNs and routinely share information with the Nevada Hospital Association (NHA), Nevada Rural Hospital Partnership (NRHP), the Nevada Primary Care Association (NVPCA), and the Nevada Rural Health Network.

Employment

According to the Bureau of Labor Statistics, Nevada ranked 32nd in the nation for unemployment in February 2020, with an unemployment rate of 3.6% compared to the national average of 3.5%. Data can be found on the Bureau of Labor Statistics website here: https://www.bls.gov/web/laus/laumstrk.htm). The COVID-19 pandemic and subsequent response resulted in a dramatic increase in unemployment for Nevada. The average unemployment rate for Nevada in 2020 was 12.8% compared to the national average of 8.1%. Nevada ranked 51st in the nation for unemployment during 2020. Nevada’s unemployment rate recovered from the highest point of 29.5% in April 2020 to 13.0% in September 2020. As of February 2023, Nevada still has the highest unemployment rate in the nation, with 5.5% unemployment.

Nevada’s traditional industries include tourism, gaming, and hospitality; logistics and operations; mining; and agriculture. Other industries including manufacturing, information technology, aerospace and defense, energy, and health care have all historically experienced growth and helped stimulate the economy according to the Nevada Governor’s Office of Economic Development (GOED).

For 2021 U.S. Census Bureau data indicate there were approximately 57,000 children who had at least one parent unemployed, an increase from 23,000 in 2019. There were 92,212 children ages 6 to 12 years old with at least one parent not in the labor force during the year.

Housing

Market forces continue to decrease the availability of affordable rental housing, increasing rates of rent burden for lower income households. According to the National Low-Income Housing Coalition, the 2022 Fair Market Rent in Nevada for a two-bedroom apartment was $1,232. For a household to afford this level of rent without paying more than 30% of their income on housing, the household must earn at least $4,108 monthly or $49,294 annually. The estimated hourly mean renter wage in Nevada is $20.66, at which workers could realistically afford a monthly rent charge of only $1,074. Data related to housing were obtained here: Out of Reach | National Low Income Housing Coalition (nlihc.org).

According to data from County Health Rankings and Roadmaps, 19% of households experience severe housing problems, including at least one of the following: overcrowding, high housing costs, or lack of kitchen or plumbing facilities.

Income

Economic distress indicators such as poverty rate, housing vacancy rate, and percent of adults not working are compared across communities to create the Distressed Communities Index (DCI). According to the Economic Innovation Group 2022 DCI, 12.8% of Nevadans reside in distressed zip codes. Compared to 2018, when four Nevada counties were considered “prosperous” (Douglas, Eureka, Storey, and Washoe), only two met this tier in 2022 (Douglas and Washoe). One county, Esmeralda, is considered distressed, and four counties are considered at higher risk (Lander, Lincoln, Pershing, and White Pine). 2022 DCI Interactive Map - Economic Innovation Group (eig.org).

Nevada is anticipating a budget surplus for state fiscal years 2023 through 2025 due to increases in state tax revenue. The Nevada Legislative Fiscal Report from the Fiscal Analysis Division of the Legislative Counsel Bureau reported that for state fiscal year 2021 actual General Fund revenue after tax credits increased by 9.7%. On an inflation-adjusted per capita basis, this amount is 6.8%, with an inflation rate of 2.3%. In state fiscal year 2022, actual General Fund revenue after tax credits increased by 21.6%, but on an inflation-adjusted per capita basis, it increased 11.3% with an inflation rate averaging 7.2%.

The median annual household income for all households in Nevada decreased from $70,906 in 2019 to $61,164 in 2020, but increased to $64,340 in 2021, according to the American Community Survey. Between 2018-19, the U.S. median annual household income increased from $63,179 to $68,703, and then decreased to $68,101 in 2020. In 2021, it increased to $70,784, the highest amount on record. According to County Health Rankings and Roadmaps, “Income inequality helps measure gaps in household earnings.” Income inequality is measured as the ratio of household income at the 80th percentile to income at the 20th percentile. In Nevada, the ratio is 4.67 overall and ranges from 3.8 (Lincoln County) to 5.5 (Esmeralda County) The two largest counties, Clark County and Washoe County, have a ratio of 4.3 and 4.2, respectively.

Nevada’s urban areas struggle with an unusually high cost of living relative to low wages and insecure work associated with service industry tourism economies. The poverty level in rural and urban areas is comparable; however, accessing medical and health care services is severely limited in rural and frontier counties due to geographic access barriers, as well as difficulties in recruiting and retaining providers. This translates into low rates of routine preventive health services being delivered to these regions, such as recommended EPSDT screening and childhood immunizations, and decreased access to preconception health services, including the screening and management of chronic conditions, counseling to achieve a healthy weight, and smoking cessation.

Overall, Nevada’s relatively strong economy has not offset other measures of state performance that rank poorly compared to other states, as evidenced by Nevada’s rankings in the 2021 Camelot Index. The Camelot Index ranks states on six quality of life measures: economy, health, crime, education, society, and state government. Nevada ranks 29th for economy, which considers poverty rates, incomes, and tax bases. Nevada experienced a double-digit loss in ranking from 2020, dropping 10 spots. Nevada ranks 26th for prudent state government fiscal measures, the same as in 2020. The state is in the bottom half for all other measures. Nevada ranks 38th for health of the state’s population; this measure encompasses age-adjusted death rates, infant mortality rates, and health insurance coverage rates. When comparing crime rates across states, Nevada ranks 40th, and for measures of a healthy society, such as home ownership rates and food security, Nevada ranks 45th. Finally, when comparing measures for education such as high school graduation rate, standardized testing scores, and pupil to teacher ratio, Nevada ranks 46th in the nation. Notably, Nevada is the bottom-ranked state for pupil-teacher ratio. These rankings are useful to know to help inform where Nevada can leverage its strengths to improve these and related measures in the future.

Policy/Legislature

The 80th Nevada Legislative Session passed Assembly Bill (AB) 169 which established a Maternal Mortality Review Committee and protections for the Committee. MCAH staff support the MMRC programmatically and administratively. The MMRC began meeting in 2020 and from 2020 to September 2021, had no funding. In 2019, MCAH staff applied for the The Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) grant through CDC. The application was approved but not funded. In July 2021, Nevada was notified the application was funded and MMRC funding began September 2021. AB 287 granted MMRC access to Nevada Central Cancer Registry data for case abstraction and AB 119 of the 81st Legislative Session strengthened language on identifying disparities in maternal mortality and severe maternal morbidity

Nevada’s Title V MCH Program shared legislative information relating to MCH populations with partners statewide. Changes to the Nevada Check-Up and Medicaid programs which broaden allowable billing codes or reimbursement and creation of a Diapering Committee and Family Planning account which created opportunities to improve reproductive health statewide.

Nevada Revised Statutes (NRS) Chapter 442 codifies statutes related to Title V MCH. NRS 442.133 provides the membership and terms of the MCHAB. The MCHAB is comprised of nine members appointed to two-year terms by the State Board of Health, with two legislators appointed by the Legislative Counsel. MCHAB is staffed by the Title V MCH Program Manager and an Administrative Assistant III. MCHAB advises the DBPH Administrator on objectives related to primary care, infant mortality, preventing fetal alcohol syndrome and substance use by pregnant persons, and increasing immunizations. The MCHAB meets at least quarterly.

The MCH/CYSHCN Director serves on the AMCHP Board. Chapter changes under review by Medicaid relevant to MCH populations are shared widely with MCH partners and coalitions, and DHCFP has worked with the Title V MCH Program on provider draft chapter changes related to preterm birth, education on billing codes for SBIRT and LARCs, and meet quarterly to collaborate.

The MCAH Section and Title V MCH Program worked in close partnership with DCFS and SAPTA to support efforts to align and implement federal and state legislative changes to the Infant Plan of Safe Care and are active in Infant Plan of Care efforts as a key partner. Title V MCH Program staff function as core members of the Nevada Perinatal Health Initiative team on substance use in pregnancy and NAS reduction efforts.

COVID-19

As the response to the outbreak of the respiratory illness caused by the 2019 novel coronavirus (COVID-19) shifted from a public health emergency to maintenance, Title V MCH continued to post MCH-specific COVID-19 resources on the program website, engage in COVID-in-pregnancy surveillance monitoring discussions with CDC as part of an OPHIE-led team, and share COVID-19 resources and technical bulletins to partners.

Title V MCH staff continued to facilitate a COVID-19 and MCH data presentation with the DHHS Office of Analytics during MCHAB meetings. MCAH staff have also discussed NOMHE-planned equity and COVID-19 toolkit distribution opportunities and shared materials from NOMHE and other quality organizations about racism and public health, health equity, health disparities and racism, and racism and pregnancy outcomes.

Nevada PRAMS applied for and received supplemental funding to include 11 survey questions related to maternal experiences and attitudes related to COVID-19. Data collection began October 2020 and concluded September 2021. This data, once available from CDC, will be utilized to guide Title V efforts related to COVID-19 and future pandemic response for maternal and infant populations.

MCH staff worked with UNR’s F2F partner, LHAs, and the CDC Foundation MCH-Immunizations Assignee to share information on childhood COVID-19 vaccine promotion, catch-up vaccinations, vaccination in pregnancy, ADA compliant educational webinars, and creating a sensory friendly toolkit program being distributed statewide. Numerous immunizations focused educational efforts were made possible due to partnership with MCH and MCAH programs.

Title V MCH worked with DPBH’s Immunization Section to fund OptimuMedicine, a mobile COVID-19 vaccine and testing vendor to promote vaccine uptake amount Nevadans. Vaccination sites were located statewide, including in rural counties, with a total of 55 sites administering primary COVID-19 vaccines, boosters, and flu vaccines from June to September 2022. A total of 16,298 COVID-19 vaccines and 2,750 flu vaccines were administered, with 3,027 of those administered to children 17 and younger.

State Title V Emerging Issues

Congenital Syphilis

In 2018, Nevada was the top ranked state for primary and secondary syphilis rates and ranked second for congenital syphilis (CS) rates. In 2019, Nevada remained the top ranked state for primary and secondary syphilis rates, while falling to fourth for CS rates. These rankings remained the same for 2020. More information on congenital syphilis in Nevada can be found in the State Title V Program Purpose and Design section.

Teen Suicide

Teen suicide is an emerging issue in Nevada. Data from NVSS shows the adolescent suicide rate for those ages 15-19 years per 100,000 adolescents in Nevada was 15.1 for the reporting period of 2019-21. Nevada’s 2019-21 teen suicide rate is higher than the U.S. rate of 10.6 suicides per 100,000 adolescents during the same reporting period. When stratifying adolescent suicide rates for those ages 15-19 years by urban/rural residence, the 2017-21 rate in Nevada was 25.1 in non-metro (rural) areas compared to 16.8 and 14.6 in small/medium and large metro areas, respectively. More information on teen suicide in Nevada can be found in the State Title V Program Purpose and Design section.

Substance Use During Pregnancy and Substance Exposed Infants

Close monitoring of substance use during pregnancy and substance exposed infants will continue to be a priority for DPBH and Nevada’s Title V MCH Program. According to data from NVSS, the percent of women who smoked during pregnancy was 3.3% in 2021; a decrease from 5.4% in 2010, or a change of 39%. MCAH will continue to work on state efforts regarding CARA and the Infant Plan of Safe Care including education, training, OMNI/Perinatal Health Initiative work group participation, and increasing awareness, and more information can be found in the State Title V Program Purpose and Design section.

Maternal Mortality Review Committee and Alliance for Innovation on Maternal Health Efforts

As described in the Policy/Legislature section, Governor Steve Sisolak signed Assembly Bill (AB) 169 of the 80th Nevada Legislative Session into law in June 2019, establishing the Nevada MMRC. AB169 was codified in NRS 442.751 through 442.774, inclusive, and reflected the work of a wide variety of supporters and advocates. The MMRC is required to: 1) review incidents of maternal mortality and severe maternal morbidity (SMM) in Nevada; 2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; 3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada.

Nevada’s MMRC convened its first meeting in February 2020 and met four times that year. The MMRC will continue to meet at least twice annually to review all incidences of maternal mortality and SMM in Nevada. The Title V MCH Program will support MMRC-related travel to meetings and ancillary costs for members; and, in considering possible opportunities for implementing MMRC recommendations in MCH programmatic efforts for prevention, increased awareness of the existence and recommendations of the MMRC among the public, clinicians, and policy makers, and supporting dissemination of required reports and data-driven MMRC recommendations (e.g., evidence-based practices, screenings, and patient and provider education).

Reporting produced by the MMRC support staff is included in Nevada’s Title V MCH Block Grant reporting. Health equity in birth outcomes and maternal domain population health maximization will be key areas of topical intersect in priorities of the MMRC, MCAH Section, SSDI Program, AIM, ERASE MM, and Title V MCH Program. SSDI funds help support MMRC administrative support staff.

The Title V MCH Program is in discussions with the NRHP to launch Advanced Life Support in Obstetrics (ALSO), American College of Obstetricians and Gynecologists (ACOG) efforts to reduce rural maternal mortality by working with critical access hospitals. Nevada is an AIM State, which helps staff support activities reducing preventable maternal mortality and SMM, beginning with the hypertension patient safety bundle with the Nevada AIM which launched June 24, 2021.

Early Childhood Continuum

Strengthening the early childhood education continuum to include public health is an emerging issue the Nevada Title V MCH Program will help address and staff partner with ECCS and Children’s Advocacy Alliance leads statewide in joint efforts. The Title V MCH Program will continue and expand efforts to achieve the goal of NPM 6: To increase the percent of children, ages 9 to 35 months, who received a developmental screening using a parent completed screening tool. More information on efforts to enhance the early childhood education continuum can be found in the State Title V Program Purpose and Design section.