Demographics, Geography, Economy, and Urbanization

Mississippi encompasses nearly 47,000 square miles, making it the thirty-second largest state by total area in the nation. The state is geographically located in the southeastern portion of the United States and is named for the river that flows along its western border. Mississippi is bordered by Tennessee to the north; Alabama to the east; Louisiana and a narrow coast on the Gulf of Mexico to the south; and across the Mississippi River, by Louisiana and Arkansas to the west. Mississippi's physical features are lowland with the hilliest portion located in the northeast section of the state, where the foothills of the Appalachians cross the border, Woodall Mountain rises to 806 feet. However, the mean elevation for the entire state is only 300 feet. From east central Mississippi heading south, the land contains large concentrations of piney woods which give way to coastal plains towards the Gulf Coast. Southwest Mississippi tends to be quite rural with significant timber stands. The Mississippi Delta, the northwest section of the state, is technically an alluvial plain, created over thousands of years by the deposition of silt over the area during repeated flooding of the Mississippi River. The Delta is exceedingly flat and contains some of the world's richest soil. Mississippi leads the nation in catfish production and the Mississippi Delta is the birthplace of the Blues, which preceded the birth of Jazz, the only other original American art form.

The residents of Mississippi are dispersed throughout 82 counties and 298 incorporated municipalities. While three‐fourths of the state’s citizens reside in one of these incorporated places, most of these cities and towns are small. As of July 2018, Jackson, the state’s capital and largest city, has a population of 164,422, and the next largest city is Gulfport, with a population estimate of 71,705. The state is predominantly rural, where 65 (79.3%) of the 82 counties are considered rural areas. Mississippi has three standard metropolitan statistical areas (MSA): the Jackson Metropolitan Area (Hinds, Madison, and Rankin Counties) ; the Hattiesburg area (Forrest and Lamar Counties) ; and the Gulf Coast Region (Hancock, Harrison, and Jackson Counties). Desoto County, located in North Mississippi, is included in the Memphis, Tennessee MSA. All 82 counties in Mississippi are designated whole or in part as medically underserved areas, according to the Health Resources and Services Administration (HRSA).

Mississippi’s population is estimated to be 2,976,149. In comparison to the United States, Mississippi is less racially and ethnically diverse. Mississippi has slightly higher rates of homeownership and no health insurance coverage. Additionally, Mississippi sees slightly lower rates of socioeconomic factors (high school graduates, employment, and poverty). The tables below depict the comparison between Mississippi and the United States rates of several factors.

Health Status of Mississippi’s MCH Population

According to America’s Health Rankings, Mississippi ranked 50th in overall health in 2019. Historically, Mississippi has consistently ranked in the bottom of overall health. Similarly, the state ranks in the bottom for several MCH population indicators, including:

• Infant mortality (50th)
• Low birthweight (50th)
• Children in poverty (50th)

However, Mississippi ranks  well on a few MCH indicators that include:

• Excessive drinking (3rd)
• Pertussis case rate (4th)

Based on America’s Women and Children report, a sub-report of America’s Health Rankings, Mississippi ranked 48th overall in Women’s Health and 50th overall in Children’s Health.

State’s Strengths and Challenges

Access to comprehensive, quality health care services is important for the achievement of health equity and increasing the quality of a healthy life for everyone. Health care access impacts overall physical, social, and mental health status; prevention of disease and disability; detection and treatment of health conditions; quality of life; preventable death; and life expectancy.

Mississippians receive health care from a variety of sources that provide a continuum of care. The health care delivery system in Mississippi includes services for long-term care, care for the aged and those with intellectual disabilities; mental health care, including psychiatric, chemical dependency, and long-term residential treatment facilities; perinatal care; acute care, including various types of diagnostic and therapeutic services; ambulatory care, including outpatient services and freestanding ambulatory surgical centers; comprehensive medical rehabilitation; home health services; and end stage renal disease facilities. Mississippi has 32 critical access hospitals, 19 rural hospitals with 49 beds or less, 21 Federally Qualified Community Health Centers, and 160 Rural Health Clinics.

Efforts are being made to support and expand Mississippi’s MCH infrastructure and health care delivery system. Strengths include strong partnerships and collaboration with private sectors, other state agency and local departments; Increasing access to quality health care for mothers and children, especially for people with low incomes and/or limited availability of care; Health promotion efforts that seek to reduce maternal mortality, infant mortality, and teen pregnancy; and Family- centered, community-based systems of coordinated care for children with special healthcare needs.

According to America’s Health Rankings, in the past year, the percentage of infants exclusively breastfed for six months increased 17% from 11.1% to 13.0%, tobacco use during pregnancy decreased 13% from 10.2% to 8.9% of live births, teen births decreased 11% from 34.8 to 31.0 births per 1,000 females ages 15-19, meningococcal immunization among children ages 13- 17 increased 37% from 46.0% to 63.0%, Tdap immunization among children ages 13-17 increased 31% from

70.8% to 92.4%, and physical inactivity among women ages 18- 44 decreased 20% from 34.4% to 27.6%. These improvements show the progress of our state and Mississippi’s desire to improve its health rankings.

On the contrary, Mississippi has repeatedly ranked last in education nationally, but in the past five years Mississippi has achieved unprecedented academic success and student achievement. Mississippi’s rankings for the National Assessment of Educational Progress (NAEP) Gains from 2017-2019 were:

• No. 1 in 4th grade mathematics
• No. 1 in 4th grade reading
• No. 3 in 8th grade mathematics
• No. 4 in 8th grade reading
• Only state with significant gains in three of four tested subjects

  While it is clear that Mississippi has more improvement to make, it is clear that substantial progress has been made through the state’s steady achievement in education. Mississippi’s education narrative is changing for the better with greater support, bold initiatives, and the desire to achieve great things.

Despite these strengths and efforts, significant challenges still exist. Mississippi is still ranked last among all states for overall health system according to the Commonwealth Fund. Mississippi ranks 45th for access and affordability, 46th for prevention and treatment, 50th for avoidable hospital use and costs, 34th for disparity, and 50th for healthy lives.

Mississippians, including our children, are routinely ranked as the fattest in the country and we lead the nation in high blood pressure, diabetes, and adult inactivity. The Delta region which is well known for its poverty and rural characteristics in the country, is at even greater risk for health problems because of lack of accessibility and availability of medical care. An estimated 60% of residents live below the poverty level here. In 2018, as part of the Behavioral Risk Factor Surveillance System (BRFSS), 20.3% of Mississippians surveyed said they were unable to see a doctor at some point in the prior twelve months because of cost.

Besides poverty, Mississippi’s healthcare system mal-distribution of providers contributes to the poor overall health. High quality health care services depend not only on an adequate supply of fully qualified health care professionals, but also require appropriate distribution of these providers for adequate access. The HRSA Data Warehouse current listing of Health Professional Shortage Areas (HPSAs) for Mississippi includes 109 primary care (75 of which are single county designations), 110 dental (77 of which are single county designations), and 42 mental health (29 facility and 13 catchment areas).

The state’s challenges particularly impact the state’s most vulnerable residents, including CYSHCN’s and their families, Medicaid recipients, the working poor, undocumented immigrants, and rural residents. Mississippi has a high percentage of CYSHCN, a high percentage of CYSHCN living in poverty, and more severe health care provider shortages than most states. In addition to those challenges are Medicaid changes to MCOs, closure of the Title V Children’s Special Health Services clinic, and the decision not to expand Medicaid within the state of Mississippi. Also, Mississippi still faces challenges as a result of health care reform with the rising cost of health care. In the absence of any intervention, the burden of high health care costs will worsen, as health care spending per capita in Mississippi is projected to nearly double between 2010 and 2020.

State Health Agency Roles, Responsibilities, and Priorities

MCH initiatives are housed with the Mississippi State Department of Health (MSDH). MSDH’s mission is to protect and advance the health, well-being and safety of everyone in Mississippi. The major operations of MSDH include disease surveillance, environmental protection, disease injury and prevention, standards of care, immunizations, keeping Mississippians safe inn emergencies, providing information, comprehensive reproductive health, women, infants and children, licenses and records, and social services.

Within MSDH, MCH/Title V is administered by the Division of Health Services. Health Services oversees provision of the Women, Infants and Children's Nutrition Program (WIC); Child and Adolescent Health, including the genetic disease screening program; Women’s Health; Oral Health; the Office of Tobacco Control; and the MSDH Pharmacy. Health Serviced partners with the Office of Health Data and Research (OHDR). OHDR provides scientific integrity and quality assurance in management, surveillance, data analysis, reporting, and program evaluation related to MCH, chronic disease, and tobacco control. Title V aligns with the MSDH mission to provide services and programs that promote and improve the health and well-being of the Mississippi’s mothers, children, including children with special needs, and their families.

Public health efforts in Mississippi are ongoing. The MCH program priorities relate to the state’s MCH population, with MSDH being committed to improving the health and well-being of the MCH population across the life-course.

State Systems of Care for Underserved and Vulnerable Populations

A careful study of the past several decades shows that Mississippi has consistently created components of a functional system of care, even with limited resources. Mississippi has worked hard to build a system of care that engages the public through heightened organization and improved alignment of policies, practices, goals, financing, and accountability. The intent is to provide the services and supports needed to meet the needs of underserved and vulnerable populations, including CYSHCN.

Mississippi’s system of care model involves collaboration across agencies, community-based organizations, Federally Qualified Health Centers (FQHC’s) and various other entities. This approach provides a functional framework for making use of resources to optimize care. Planning, implementation and evaluation are deliberately designed to include relationships with other systems. The systems of care in Mississippi include but are not limited to:

• Mental Health System Alcohol/Drug Treatment System Education System
• Child Protection System Juvenile Justice System
• Vocational Rehabilitation Systems Health System

As of January 2020, Mississippi has 32 Critical Access Hospitals designated to preserve access to local primary and emergency health services. These hospitals are in rural counties with a high prevalence of populations that demonstrate higher rates of obesity, diabetes, preventable hospitalizations, cardiovascular deaths and cancer deaths as compared to state and national benchmarks. Additionally, these hospitals are in rural counties with fewer physicians and with a higher proportion of patients who live in poverty and are Medicaid recipients.

Eighty counties are federally designated as either whole or partial-county Health Professional Shortage Areas (HPSAs) for Primary Care (based on either the low-income population or geography). 79 counties are designated as federal Dental HPSAs and all, but four counties are designated as federal Mental Health HPSAs. All of the state’s 82 counties are designated as either whole or partial-county Medically Underserved Areas (MUA). There are 42 birthing hospitals in Mississippi.

In the state of Mississippi there are a total 124 hospitals, with 58 designated Government hospitals and 36 private hospitals. The total number of beds available in Mississippi is 14986, with 81 hospitals having Helipad facilities.

Mississippi has a total of 606,646 t Medicare enrollees with an enrollment to population ration of 20% compared to the national enrollment population ratio of 18%. In Mississippi the average length of hospital stay is 5 days compared to national average hospital stay of 4.55 days. There is only one children’s specialty hospital in the state located on the campus of University of Mississippi Medical Center.

Primary Care Physicians/Dentists/Psychiatrists Distribution

Source: PC Health HRSA Shortage Designation Management System (SDMS) Source: 2020 MS State Health Plan

Source: Mental Health HRSA Shortage Designation Management System (SDMS)

With the passage of the ACA, MS has had the opportu43ity to make substantial changes in the availability of health insurance coverage to its citizens. MS’s present uninsured rate is forecasted to be near 12%. In 2017, the Center for Mississippi Health Policy commissioned researchers at the Social Science Research Center (SSRC) at Mississippi State University to survey non-elderly Mississippi adults to assess their knowledge, attitudes, and behaviors related to health insurance and the Affordable Care Act (ACA). Key findings of this research included:

• Approximately 16 percent of survey respondents reported not being currently covered by health insurance, a drop from 23 percent in 2013.
• In a departure from previous surveys, more Mississippi adults expressed a positive opinion of the ACA than a negative one, with 47 percent supporting the law, 38 percent opposing the law, and 15 percent stating they were unsure.
• As in the previous surveys, respondents showed support for many of the components of the ACA, with the notable exception of the individual mandate penalty which has been repealed as of the end of 2018.
• While 40 percent forecasted in 2013 that they expected to be worse off as a result of the ACA, only 29 percent in 2017 said they were worse off due to the Act. Almost half (47%) said they were unaffected by the law.
• Most (62%) of those surveyed who did not have insurance had been uninsured for a year or more, and 43 percent had been uninsured for two or more years.

While the percentage of Mississippi adults who report being uninsured has dropped since 2013, cost is still the greatest barrier to obtaining health insurance coverage. The price of basic health insurance coverage with reasonable cost-sharing far exceeds the amount people are willing to pay without substantial subsidies. For those Mississippians with low-incomes, unaffordable private coverage and lack of access to premium assisted coverage through an employer, the Marketplace, Medicaid, or other source leave some with no other alternative than to remain uninsured.

In order to increase access to care, CYSHCN monitors and works closely with patients identified as not having medical health coverage. The program maintains a partnership with the states' Navigator office. Parents referred are expected to keep their appointments and to submit their letter of eligibility to the program in the processing of their application for services as verification of efforts to obtain affordable healthcare insurance.

State Statutes and Other Regulations Impacting MCH/Title V

The Mississippi Legislature passed House Bill 494 in March 2017 authorizing the Mississippi State Department of Heath to establish the Maternal Mortality Review Committee to review maternal deaths and establish strategies to prevent maternal deaths. The Mississippi Maternal Mortality Review Panel is a multidisciplinary committee whose geographically diverse members represent various specialties, facilities and systems that interact with and impact maternal health. The panel consists of approximately 8-10 members who commit to serve a 2-year term. Maternal Mortality Review Panel will review and make decisions about each case based upon the case narrative and abstracted data. The purpose of the review is to determine the causes of maternal mortality in Mississippi and identify public health and clinical interventions to improve health systems of care. Maternal mortality includes deaths occurring during pregnancy and up to one year after pregnancy. Information is gathered from death certificates, birth certificates, medical records, autopsy reports, and other pertinent resources. Records are abstracted by a trained abstractor and de- identified case narratives are reviewed by the committee of experts from diverse disciplines.

Genetic Screening is vital to the state’s MCH population. Legislation passed Senate Bill 2746 as an act to create Hudson's Law, to require health care providers to provide educational information to new or expectant parents who receive a positive test for chromosomal disorder regarding their child; to require the Department of Health to make information available regarding chromosomal disorder; and for related purposes. Similarly, additional information regarding legislation for Newborn Screening and Early Hearing Detection and Intervention can be found in the links below:

https://msdh.ms.gov/msdhsite/_static/resources/346.pdf

https://law.justia.com/codes/mississippi/2017/title-41/chapter-90/