Principal Demographics and Geography of Iowa

Iowa is a predominately rural state with approximately 3.2 million people according to the United States Census Bureau. Iowa has typically had a healthy economy with an unemployment rate of 2.7% (May 2022, Iowa Workforce Development), which is significantly below the national average. The unemployment rate during the COVID-19 pandemic rose to 8% (June 2020, Iowa Workforce Development). While agriculture and related industries are the main sources of commerce, advanced manufacturing, biosciences, insurance, and financial services also contribute to Iowa’s economy. Although the unemployment rate is low, 2020 data show the percentage of Iowans living below the federal poverty level was 10.2%, a slight decrease from 11.2% in 2019.

Ten of Iowa’s 99 counties have a population of 65,000 or more, 23 counties have between 20,000 and 64,999 residents, 64 counties have between 5,000-19,999 residents, and two counties have under 5,000 (State Data Center, 2021 population estimates). With the state’s predominantly rural population, a lack of transportation is one of Iowa’s most widespread and persistent concerns with regard to access to health services of all types.

In Iowa, the percent of women of reproductive age (WRA) has decreased by 2.1% from the year 2000 to 2020. By county, the percent decrease has been the greatest in rural counties while urban counties have seen an increase in the percent of WRA by as much as 55% (Dallas County). During this same time, Iowa has witnessed the closure of over 40 level one (community-based) obstetrical units. There may not be a direct correlation between the OB unit closures and the reduction and shift in the population of WRA. However, we continue monitor access to care by levels of rurality.

 

However, state maternal health indicators around health care access and quality have not declined, in spite of the number of closures of L&D units. For example, overall, prenatal care initiation has remained stable over the past 5 years. Staff does note that women living in micropolitan counties compared to those living in metropolitan and urban counties, initiate prenatal care later in their pregnancies. The women of color and those with Medicaid reimbursed births initiate prenatal care later compared to white women and those with private insurance coverage.  Accessing perinatal health care in rural areas is complicated by both patient factors and factors related to the delivery care system itself. Ensuring optimal maternal and neonatal outcomes for rural populations poses unique problems and challenges, including providing basic maternity services to these rural areas. A broad spectrum of provider models, including the use of Certified Nurse Midwives, freestanding birth centers, and the use of additional emotional supports such as doula services, will need to be considered as public health research increasingly supports these options to increase maternal health quality and access, particularly in rural areas and for women of color.

 

Statewide, 55 counties in Iowa have a Primary Care Health Professional Shortage Area (HPSA) and additional counties also have one or more Facility HPSAs. The total population living in designated HPSAs statewide as of June 2021 is 746,344, and only 51% of the need is being met. Medically Underserved Areas and Populations (MUAs/MUPs) are also important to consider, and these are designated by HRSA based on factors such as low-income populations or not enough primary providers. As of July 2021, Iowa statewide has 94 designations for MUAs/MUPs, which has not changed since 2018.

 

Overall, Iowa children are in good health. According to the US Census Bureau, 5.9% of Iowa’s total population were under the age of five in 2021. The 2020 Kids Count Profile from the Annie E. Casey Foundation, ranks Iowa 10th in the nation overall and 18th in the nation in terms of health for children. Three (3) percent of Iowa children under the age of 19 were uninsured in 2019, making Iowa the 7th lowest state. In 2019, 12% of families with related children under 18 years old were living below the poverty level. According to the 2018-2019 National Survey of Children’s Health, it is estimated that 143,000 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 83% White (Healthy Iowans June 2022 Report); however, racial and cultural diversity has increased over recent years. Between 2005 and 2021, the Hispanic population increased from 2.8% to 7% and, people of color increased from 7.3% to 17.3%. Additionally, 23% of Iowa’s younger people (ages 0-25) were people of color. Eliminating disparities in systems such as education, employment, health, income, and other social, economic, and environmental factors will improve overall health in Iowa and increase economic growth.

Iowa’s Population by Race and Ethnicity*, 20201

 

* Hispanic or Latino population is of any race. All others are non-Hispanic or Latino.

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%, and an improvement from the 2010 rate of 9%.

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. 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 FFY21, 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 FFY21, 23 local child health 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 obtain access to dental education and referral through Iowa’s I-SmileTM program. Child health 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 90 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 calendar year 2021, DCCH provided services and supports to over 7,300 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 1) access to care, 2) transition to adulthood, and 3) 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 Early ACCESS, which is part of Iowa’s Early Intervention program.

Workforce development, including increasing cultural diversity among 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 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 individuals 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 that CYSHCN are eligible for currently cover about 21,000 Iowans. For most of these waivers, a wait of 4 to 5 years is not uncommon. DCCH provides consultation, technical assistance, planning, and care coordination for approximately 520 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.

IDPH and Iowa Department of Human Services (DHS) Alignment Project

IDPH and DHS are working to become one, single department. For nearly two years, the Departments have been working with Public Consulting Group (PCG) on ‘the Alignment Project.’ This project aims to:

• Align and integrate programs, practices and policies to improve delivery of services and most effectively leverage funding.
• Create an organizational structure that optimizes delivery of services, supports efficiency for staff, and integrates the departments’ programs and services with community and other available resources.
• Utilize gained efficiencies and better leverage resources to reinvest in our system and drive improved outcomes for Iowans.

There are extensive connections between Iowa’s public health and human services efforts to help all Iowans live safe, stable, and healthy lives. It’s become clear the departments can serve Iowans more effectively and efficiently through the following activities:

1. Implement an integrated organizational structure that brings like functions and services together
2. Establish shared direction and connection with the big picture through routinized cross-training, collaboration, and continuous improvement
3. Draw on existing tools, partnerships and other assets to present Iowans with a welcoming and efficient ‘front door’ to health and human services
4. Closed loops and facilitate warm handoffs to connect Iowans seamlessly to services and supports that are right for them
5. Improve the use of data to enable data integration, informed decision making, and seamless service to Iowans

Between the IDPH and the Iowa DHS, the connections are numerous, and, in many cases, the same families access similar services with no clear pathway to connect them that reaches across departments. The work these agencies can do to better wrap services around a family to ensure better outcomes, is significant in terms of impact.

Through aligning the departments, Iowa will be able to achieve several goals including opportunities to better leverage funding sources and the ability to identify potential for expanded funding sources; break down siloes to create a unified, integrated behavioral health system; and better access to services and easier navigation of the system for those served. Ultimately, better alignment across departments and programs will lead to improved outcomes for individuals, communities, and the state.

On March 24, 2022, the Departments released the final change package and functional organizational chart. This serves as the roadmap to bring together both agencies under a single leadership structure. This work is the culmination of nearly two years of meetings with IDPH and DHS staff, local public health, community partners, stakeholders, and the public to gather feedback on how to establish a unified health and human services agency to better support all Iowans. These conversations resulted in a prioritized set of recommendations on how the agencies can work together to align programs and services. These recommendations are outlined in the final change package published at https://hhsalignment.iowa.gov/. On July 1, 2022 state legislation officially established a unified Department of Health and Human Services. Below is the general timeline for the unification:

 

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.

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

A competitive RFP is currently under review to bring on at least one more MCO into Iowa's network.

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, 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 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.

Differences in interpretation and implementation of Medicaid policy and how policy is applied to paying for direct services by the MCOs in Iowa remains an ongoing challenge for Title V Contractors. IDPH meets monthly with IME staff and in FFY22 IDPH and Title V contractors began meeting with billing and utilization staff at the two MCOs facilitated by IME staff. While solutions have been slow, much greater progress has been made this year than ever before.

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.

 

signifycommunity has informed the IDPH they intend to not renew the contract with the current agreement ending in December of 2022. State Title V staff are working with Information Management within the department and Iowa’s Office of the Chief Information Office (OCIO) to explore the capacity for a replacement data system.

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 implementation is delayed due to the State Hygienic Laboratory switching to a new data system.

 

Sixteen 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 strongly encouraged to submit their demographic information electronically either through NANI or flat file import.

 

 

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. Title V program staff continue to participate in the department’s next steps now that accreditation has been achieved and reaccreditation is on the horizon. The department continues to further develop areas of strength and build on opportunities in order to further the quality culture, maintain accredited status and pursue reaccreditation.

Healthy People 2030 Champion

The Iowa Department of Public Health was designated as a Healthy People 2030 Champion by the US Department of Health and Human Service Office of Disease Prevention and Health Promotions. This designation recognizes IDPH’s commitment to achieve Healthy People’s overarching goals and objectives.

HHS programs may use the Healthy People 2030 Champion designation when writing grant applications or for other publications to show IDPH's close alignment to the Healthy People 2030 goals of health equity and well-being. 

To achieve this designation, IDPH met the following eligibility requirements:

• Have a demonstrated interest in, understanding of, and experience with disease prevention, health promotion, social determinants of health, health disparities, health equity, or well-being
• Have an organizational mission that's aligned with the Healthy People 2030 framework or objectives
• Sign a Partnership Agreement and Trademark License with ODPHP that includes details about how the organization supports the Healthy People 2030 vision

 

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 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.

Health Equity

The Child and Adolescent Health Equity Advisory Committee (HEAC) began as a way to focus health equity in Iowa’s 2020 Title V Needs Assessment. Since that time it has been used to guide programmatic health equity work, such as the Child and Adolescent Health Request for Proposals. However, there has been a struggle with continued engagement among this group. The HEAC has lost members throughout the year, and often only two or three members attend meetings, out of a possible 24. Staff are still looking to gather feedback from those that have left to learn more about why they left and how the group’s activities can be more engaging, as the HEAC has been invaluable to date.

While it has been a challenge, staff have been trying to find opportunities to make the HEAC more of a fixture in guiding the state’s Title V work. Title V would like to begin by shifting the power to the committee, have them guide the direction of the work, and ensure the members have a larger voice in programmatic decision making at the state level. This would allow staff and other programs within BFH to better engage and partner with the HEAC. Staff are currently looking for ways to structure the advisory committee so the group is truly able to give their insights and knowledge to guide Title V and other MCH-related programs. The HEAC has the beginnings of the framework necessary to achieve this but need to bolster state staff members’ skills and knowledge to be able to successfully implement it. In 2022, Iowa (both MCH and CYSHCN staff) joined the Accelerating Equity Learning Community through the MCH Workforce Development Center. This opportunity has helped focus our efforts, and identify opportunities for growth. Participants in the cohort will be looking to shift the culture of health equity within the Title V program by shifting power to the HEAC, and focusing on building health equity skills among Title V staff, not just knowledge. This will also ideally lead to increased support for Title V contractors as they work on their own health equity and community engagement efforts; in a way that does not put undue burden on the committee. Another goal is to shift from knowledge to skills based health equity training to help increase the confidence of Title V staff to assess and offer support to contractors wherever they are in their health equity and community engagement journey.

DCCH is focusing on building capacity for leading systems-level health equity initiatives. Strategic planning for these efforts are led by an internal Health Equity Committee. DCCH’s participation in the Accelerating Equity Learning Community has focused on increasing skills that lead to systems-level health equity change. DCCH is committed to providing care that is culturally and linguistically appropriate, and building capacity to thoughtfully engage diverse families across the state. DCCH is also working to learn new ways to measure and evaluate the impact of the health equity initiatives.

Strengths

Health Insurance Coverage

In 2021, America’s Health Rankings reported that 94.3% of children, 19 years and under, in Iowa had some form of medical insurance. It is estimated that 96.2% of all uninsured and 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 87.1% from America’s Health Rankings. 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 Health 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 Iowa’s 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, a 0.5 FTE position for a Registered Nurse 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 Iowa Maternal Quality Care Collaborative (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

In 2019, the Iowa Maternal Quality Care Collaborative (IMQCC) was developed through the HRSA Maternal Health Innovation grant awarded to IDPH. The IMQCC’s first quality improvement project was to implement the Association of Women's Health Obstetrical and Neonatal Nurse's (AWHONN) POST-BIRTH Warning Signs program statewide. Data from the Maternal Mortality Review Committee report showed that 56% of Iowa pregnancy associated death occurred postpartum. The AWHONN program utilized strategies to empower postpartum parents to recognize and act on warning signs of potential life threatening postpartum emergencies. The education component focuses on the prevention of complications and death that can occur during pregnancy and postpartum. Iowa would like health care providers to communicate with patients about warning signs and use tools to help patients and families identify early warning signs to ensure women 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 with postpartum women in Iowa’s Birthing Hospitals and by provide education through 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 started October 1, 2021. This grant supports the work of the Maternal Mortality Review Committee and staffing responsibilities of IDPH.

I-Smile™

In 2006, child health contractors received funding to begin administering the I-Smile™ program in Iowa communities. Each contractor is required to maintain a dental hygienist as their I-Smile™ coordinator and is responsible for developing their own community-based strategies. These 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 have shown annual improvements for Medicaid-enrolled children (ages 0-12) receiving through this program care. In 2021:

●   Nearly 30% more children received gap-filling preventive care from a dental hygienist or nurse through I-Smile™ in a public health setting than in 2005 (10,418 in 2021; 7,863 in 2005).

●    50% more Medicaid-enrolled children in Iowa were seen by a dentist than in 2005.

●   56% of children ages 3-12 years saw a dentist, nearing the rate (63%) of privately insured children.

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 University of Iowa DCCH developed a five-year strategic plan in 2017, which was updated in 2021. Funding through the Title V program serves as foundational support for all activities that take place within DCCH. The 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 at the local, state, and national levels.

 

• 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 DCCH’s Child Health Specialty Clinics (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/iac/chapter/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