This section puts into context the Title V Maternal and Child Health (MCH) program within the State's health care delivery environment. The overview provides an understanding of the State Health Agency's current priorities/initiatives and the Title V role.
Overview & Authority
The Kansas Department of Health and Environment (KDHE) is responsible for administration of programs carried out with allotments under Title V. The Bureau of Family Health (BFH), one of six Bureaus in the Division of Public Health, administers the Title V MCH Services Block Grant program. The mission of the Bureau is to “provide leadership to enhance the health of Kansas women and children through partnerships with families and communities.”
Kansas statutes do not mandate comprehensive services for MCH populations except for Children with Special Health Care Needs (CSHCN). Pursuant to K.S.A. 65-5a01, a "child with special health care needs” means “a person under 21 years of age who has a disease, defect or condition which may hinder normal physical growth and development." Statutes and regulations detail program requirements related to direct health services, in which services and supports are available to individuals birth to 21 with eligible medical conditions, and all ages with conditions diagnosed through the state's newborn screening program. Kansas provides direct services for state mandated eligibility criteria, care coordination for program defined eligibility criteria, and non-direct services through community partnerships to the broader CSHCN population, as defined by MCHB/HRSA.
KDHE convenes the Kansas Maternal and Child Health Council (KMCHC) and the Title V Family Advisory Council (FAC) to ensure ongoing stakeholder engagement, monitoring of Title V performance and outcomes, and provide opportunities to obtain input from subject matter experts to support innovation and early adoption of new strategies or initiatives on emerging needs, issues, or trends.
Kansas Demographics
Geography/Demography: Kansas, spanning 82,278 sq. miles, is divided into 105 counties with 628 cities.1 The U.S. Census Bureau estimates there are approximately 2,911,505 residents living in the state in 2018. Kansas has a unique geographic layout that ranges from urban to frontier counties. Within each of its regions there are few populous cities intermixed with multiple rural areas. For example, the South-Central region includes Wichita with a population of 389,255. Within that same region, also lies Pratt with a population of 6,630. This is a good example of Kansas’ diversity where rural communities are influenced by mid-sized cities, and mid-sized cities are influenced by rural communities. This diversity provides challenges to service delivery, but also an opportunity for sharing resources.2
Population Density & Peer Groups (Urban, Semi-Urban, Densely-Settled Rural, Rural, and Frontier): The population density of Kansas was 35.6 inhabitants per square mile in 2018, a 9.9% increase from 32.4 persons per square mile in 1999. For comparison, the population density of the U.S. increased from 73.1 to 92.6 persons per square mile from 1999 to 2018, a 26.7% increase. In 2018, 36 of the state’s 105 counties had population densities of less than 6.0 persons per square mile. The most sparsely populated counties were Greeley and Wallace, each with a density of 1.6 persons per square mile. The most densely populated county was Johnson, with 1,262.3 persons per square mile. Kansas counties are assigned to peer groups based on population density. During the 2014-2018 period, the population of the urban peer group increased by 2.4%, while the frontier, rural, densely-settled rural, and semi-urban peer groups decreased by 4.3%, 2.9%, 2.0%, and 2.1%, respectively.2
Population Growth/Change: The percent increase in the Kansas total population from 1999-2018 was 9.7%, including an 11.1% increase for Kansas males and an 8.3% increase for Kansas females. Kansas decreased in population from 2,913,123 residents in 2017 to 2,911,505 residents in 2018, a 0.1% decrease. Pottawatomie, Douglas, and Johnson counties had the largest relative increases in population from 2014 to 2018 with changes of 6.0%, 4.2%, and 4.1%, respectively. Morton, Geary, and Comanche counties had the largest relative decreases in population, with changes of 14.2%, 11.2%, and 10.5%, respectively.2 In 2018, there were an estimated 36,439 infants living in Kansas or about 1.3% of the total Kansas population (2,911,505). Women of reproductive age 15-44 accounted for 19.2% (560,121) of the Kansas population.2 In 2018, there were 837,605 children and adolescents aged 1-21 years living in Kansas, which represents 28.8% of the Kansas population.3 Among families with children under 18, 28.3% are single-parent families versus married-couple families (71.7%).4 According to the 2017-2018 National Survey of Children’s Health, 20.3% of Kansas children aged 0 to 17 (est. 144,559) were identified as having special health care needs (SHCN). The prevalence of children with special health care needs in boys and girls under 18 is about the same, 20.1% (est. 70,819) and 20.6% (est. 73,740), respectively.5
Age: The median age of Kansans in 2018 was 36.9 years, a 4.2% increase from the median age of 35.4 in 1999. The median ages of Kansas males and females in 2018 were 35.7 and 38.1, respectively. Shifts in the Kansas population distribution by age from 1999 to 2018 included a decrease in the 35-44 age group of 16.6% and 2.0% in residents 45-54 years of age. For the same period, Kansas experienced an increase among residents 55-64 years of age (69.5%) and residents 65-74 years of age (49.7%) reflected the aging of the baby boomers. Furthermore, there were 2.7%, 2.6%, 3.8%, 12.6%, and 11.2% increases in the 0-4, 5-14, 15-24, 25-34, and 75 and over age groups, respectively.2
In 2017-2018, the prevalence of children with special health care needs within the child population increase with age, from 17.1% of 0-5, 17.0% of 6-11, and 27.1% of 12-17.3 The higher prevalence of special health care needs among older children is likely attributable to conditions that are not diagnosed or do not develop until later in childhood.
Race/Ethnicity: According to the 2018 Census Bureau estimates, 75.7% of Kansans were non-Hispanic white and 5.7% were non-Hispanic black. Hispanics made up 12.1% of Kansas’ population.2 The race and ethnicity composition of women aged 15-44 (i.e., of childbearing age) was estimated at 71.6% non-Hispanic white, 6.1% non-Hispanic black, 0.9% non-Hispanic Native American or Alaska Native, 4.3% non-Hispanic Asian and Pacific Islander, 2.9% non-Hispanic multiple race, and 14.1% Hispanic (any race).2 The Kansas population, like that of the nation, is becoming more racially and ethnically diverse. About one-third (30.9%) of Kansas children and adolescents (1-21 years) belong to a racial or ethnic minority. Across the age groups, about one-third (31.4%) of young children (1-5 years) are part of a racial/ethnic minority versus about three in 10 (29.6%) young adults (20-21 years). About 16.6% of Kansans age 15-21 are Hispanic, compared to 18.5% of young children.3 In 2017-2018, the prevalence of special health care needs varied only a small amount by child’s race and ethnicity. Kansas Hispanic children (19.0%) had special health care needs, compared with 20.6% of non-Hispanic white children.5
Diversity/Languages: According to the 2018 American Community Survey, among people at least five years old living in Kansas, 11.8% spoke a language other than English at home. Of the same, Spanish was spoken by 7.9% and 4.6% reported that they did not speak English "very well." Notable is a change in Spanish speaking population in Kansas, which has been steadily increasing. The increase mirrors similar trends at the national level. An estimated 92.8% of the people living in Kansas were U.S. natives. About 59.5% of these residents were living in the state in which they were born. Approximately 7.2% of Kansas residents were foreign-born. Of the foreign-born population, 40.1% are naturalized U.S. citizens, and an estimated 71.3% entered the country before the year 2010. Foreign-born residents of Kansas come from different parts of the world with the majority from Latin America (52.4%), followed by Asia (33.3%), Europe and Africa (5.6%), Northern America (1.2%) and Oceania (0.9%).4
Education: In 2018, Kansas compares favorably with the U.S. average in terms of educational attainment with 91.0% of people 25 years and over with a high school education or higher compared with 88.3% for the U.S. About thirty-three percent (33.8%) of Kansans had a bachelor's degree or higher compared with 32.6% for the U.S.4 In Kansas, about 10.8% of children (1-17) received services under special education compared to 8.9% for the United States. For Kansas children with special health care needs 28.5% received special education or had an individualized education plan (IEP) compared to 31.0% for the United States.5
Income/Poverty: For 2018, the federal poverty level was $25,100 for a family of four.7 Research suggests that, on average, families need an income of about twice the federal poverty threshold to meet their most basic needs.8 In 2018, based on the Small Area Income and Poverty Estimates (SAIPE), a lower percentage of Kansans lived in households with incomes below the federal poverty level (11.9% vs. 13.1% for the U.S.) and a lower percentage of children under age 18 lived in households with incomes below the federal poverty level (14.8% vs. 18.0% for the U.S.). During the past 5 years (2014-2018), Kansas experienced a decrease in the poverty rate for children under age 18 but in 2017 and 2018 there were slight bumps from the previous years. A decrease was seen in the United States without the bumps from 2016 to 2018.9 In 2018, an estimated 102,616 Kansas children under 18 years of age were living in poverty. Five counties accounted for over half of all Kansas children (52,458 children; 51.1%) in poverty: Sedgwick (22,111), Wyandotte (11,949), Johnson (8,555), Shawnee (7,149), and Douglas (2,694). However, the rural southeastern portion of the state has many counties with high concentrations of children in poverty as well. In 2018, the percent of Kansas’ families living below the federal poverty level (8.0%) was lower than the U.S. (9.3%).10 Poverty was more common in Kansas families headed by single females with children in the household, regardless of race or ethnicity. In 2018, the Kansas percent of female headed households with related children under 18 years living below federal poverty level (33.6%) was slightly below the U.S. percent (35.1%).10 According to the 2017-2018 National Survey of Children’s Health, Kansas children living at or below poverty had an increased prevalence of special health care needs. Nearly one-half (48.5%) of children with special health care needs lived in families with incomes less than 200% of the federal poverty level.3
The health of the economy plays a major role in the health status of the state’s MCH population as well as the delivery of MCH services. The economy in Kansas has been recovering since the economic downturn suffered during the most recent nationwide recession. The statewide gross domestic product (GDP), which measure the total economic output of a given area, has been rising steadily since 2010 including a 1.9% increase from 2017 to 2018. In Kansas, the GDP increased in 10 out of the 11 major industries, with declines in the agricultural GDP causing the natural resources and mining GDP to decline as well. The median annual wage in Kansas currently stands at $35,950 which, 69% of the national average. There was a 3.2% increase in personal income from 2017 to 2018 in all components except farm income, which decreased by 36.7%. The three top occupation titles in Kansas include “Office and Administrative Support” with an annual mean wage of $35,580, followed closely by “Food Preparation and Serving” with an annual mean wage of $21,740, and “sales and related occupations” with an annual mean wage of $39,430. While the unemployment rate was the lowest in the state’s history at 3.4%, prior to the COVID-19 pandemic, many of those jobs are low paying which makes it difficult for many individuals and families to meet their basic needs. Those households most disproportionately affected are female-headed households, blacks, Hispanics, people living with a disability, and unskilled recent immigrants. Moving the low-income population into the workforce is a protective factor for today’s families.12
The state of Kansas (as with many other states in the nation) has seen a dramatic economic impact from the COVID-19 pandemic. The May 2020 unemployment rate in Kansas rose to 10%, a dramatic increase from 3.1% one year prior in May of 2019. While this was lower than the national rate of 13.3% and a decrease from the April 2020 rates (11.9%), it is clear the virus has negatively affected employment and the economy. Seasonally adjusted job estimates indicate that as of May 2020 Kansas has gained back 17% of the jobs lost in March and April due to efforts to contain the spread of COVID 19. Kansas enacted many executive orders during the pandemic, including: temporarily prohibiting evictions and foreclosures; expanding telemedicine and addressing licensing requirements; conditional and temporary relief from certain motor vehicle carrier rules and regulations; requiring continuation of waste removal and recycling services; temporarily suspending driver’s license and vehicle registration expirations; allowing certain deferred tax deadlines and payments; and extending unemployment benefits to help ensure the protection of Kansas families.
Kansas Title V has worked closely with our local MCH agencies in order to use their funding in innovative ways to help support families in their communities during the pandemic, such as using MCH funds to purchase minutes for family cell phones so they could participate in telehealth activities and the purchase of “quarantine kits” for families in need (e.g., activities for families to enjoy together, coloring books, jump ropes, sidewalk chalk). Title V worked closely with the other KDHE bureaus and the Kansas Department of Emergency Management (KDEM) to make sure families have access to resources such as: the Emergency Food Assistance Program, the Supplemental Nutritional Assistance Program, Temporary Assistance for Needy Families, and Child Care Assistance. Additional resources for how to connect to crisis centers including mental health and substance use treatment facilities were developed.
Kansas Tribes: KDHE has been working over the last several years to develop a working relationship with the four Kansas tribes (Iowa Tribe of Kansas and Nebraska, Prairie Band Potawatomi Nation, Sac & Fox Tribe, and Kickapoo Tribe) (1.0% of the Kansas population). As a result of improved communication and established trust with KDHE, the Kansas Tribal Health Summit took place for several years. Initially KDHE planned the summit directly with the Tribal Council (related to conducting a community needs assessment and identifying priorities). Even though KDHE has not played a lead role in the recent past (Tribes are taking more of a leadership role in planning), the agency and staff have remained involved in planning as requested. The 2019 Summit (https://www.pbpindiantribe.com/event/kansas-tribal-health-summit/) was held August 19-20. On August 19th tribal employees, members, and partners were invited to learn from experts and discuss the 7 Circles of Indigenous Wellness. Representative Sharice Davids provided a special address during lunch. August 20th involved learning about opportunities to improve access to healthy, traditional foods. A partnership meeting was scheduled for November 5, 2019, with the Tribal Council and KDHE Bureau Directors, including the Title V/Bureau of Family Health Director; however, the meeting was canceled due to a conflict with agency leadership. It has not been rescheduled.
KDHE and Title V work to remain engaged with the Tribes through other work beyond the annual Summit. The Kansas Maternal Mortality Review Committee has tribal representation as well as the PRAMS Steering Committee and Early Childhood Recommendations Panel (similar to other states’ Early Childhood Advisory Council [ECAC]). Kansas does not receive funding through the federal Office of Minority Health; however, KDHE recently created the new Health Equity Manager position within the agency to address the growing needs in the state and filled the position in July. The individual hired for this position had previously completed an internship with Kansas MCH/Title V focusing on health equity. In addition to addressing disparities that result in inequities across all populations, the efforts and initiatives will focus on the Native-American population as appropriate, considering the small population and lack of information available through Vital Statistics.
Kansas Medicaid & Health Insurance Coverage
Kansas Medicaid, known as KanCare, provides health coverage for traditional Medicaid and the Children’s Health Insurance Program (CHIP). For most eligible groups, including children, pregnant women, low-income adults, people with disabilities and people with both Medicare and Medicaid dual eligibility, services are provided through a managed care model. Enrollees choose, or are assigned to, one of three managed care organizations (MCOs), who receive monthly payments from the state. MCOs are incentivized to ensure enrollees receive services that help reduce costs over time by improving their health and quality of life.16
Contracts with the MCOs require them to provide essential services through Medicaid, including prenatal care, well-child visits, preventive services, hospital care, medication, in home care, community-based services and nursing facility care. The MCOs also must ensure services are available statewide and at Medicaid-required levels. They may provide additional services not traditionally covered by Medicaid to help prevent hospital admissions or institutionalization. Additionally, Kansas has adopted seven Home and Community-Based Services (HCBS) waivers to provide flexibility around additional services not covered by Medicaid or CHIP.16 See below table for list of those waiver programs.
Medicaid Expansion: Medicaid expansion is a current topic of much discussion in Kansas. Kansas is only 1 of 14 states that has not expanded Medicaid coverage to all adults up to 138 percent of the FPL. Several legislative initiatives have occured recent years, most recently in 2020, however these bills have continue to be unsuccessful during regular legislative sessions.
Health Insurance Coverage: Data from the Small Area Health Insurance Estimates (SAHIE) show that the percentage of Kansas children under 19 years old without health insurance decreased from 5.6% in 2014 to 5.0% in 2018, a 10.7% decrease. After a low of 4.5% in 2016, there was a slight increase in the uninsured population under age 19 in 2017 (5.2%), then a slight decrease in 2018 (5.0%).11 The U.S. percentage also decreased from 6.3% in 2014 to 5.2% in 2018. In 2018, more than half (52.0%) of all uninsured Kansas children under age 19 lived in the four largest population centers: Sedgwick County (Wichita), Johnson and Wyandotte counties (Kansas City metropolitan area), Shawnee County (Topeka), and Douglas County (Lawrence). However, the southwestern part of the state, a largely Hispanic populated area where presumably many are not KanCare (Medicaid or CHIP) eligible, has many counties with high concentrations of uninsured children under age 19. The southeastern portion of the state (Kansas Ozarks), on the other hand, has a cluster of counties with high concentrations of children in poverty, as stated above, but the children are less likely to be uninsured than those in the southwestern part of the state. According to the 2017-2018 National Survey of Children’s Health, in Kansas, 97.7% of CSHCN were reported to have some type of insurance at the time of the survey: 49.4% had private coverage, 39.9% had public coverage, 8.4% had both, and 2.3% had no insurance.5 Based on the 2018 average monthly eligibility for Medicaid and CHIP, Blacks made up 12.7% and 21.2% of eligible individuals but had rates of 39.6 per 100 people and 24.3 per 100 people, respectively. This puts the rate of Medicaid and CHIP enrollment for Blacks at 3.7 and 2.3 times higher than Whites (66.3% of enrollees) with a rate of 10.8 per 100 eligible people.17,18
Kansas Strengths and Challenges
KDHE recognizes that while there are needs across the state, there are also unique needs in different areas of the state. Access to care has been recognized as a challenge for the maternal and child health population living in both urban and rural geographic areas, but for different reasons. For example, women in rural areas face barriers accessing transportation and getting to providers who may be unavailable in their area. Whereas, women in more densely populated areas, have a wider availability of services yet may not have time off work or the insurance needed to receive services. The CSHCN population often experiences reduced access due to the lack of pediatric specialists in the state, in addition to the other barriers mentioned. In fact, according to the 2016-2017 National Survey of Children’s Health, in Kansas, 31.5% of CSHCN families reported that they had trouble getting specialist care versus 18.4% of non-CSHCN families.5
Estimates derived from national prevalence and 2017 US Census data suggest at least 157,151 or 21.9% of Kansas children have experienced a mental disorder, and around 34,888 or 4.9% of Kansas children meet the criteria for severe impairment. Over 65% of Kansas youth with major depression do not receive mental health treatment, and only 26.5% of Kansas youth with severe depression receive consistent treatment. Largely rural, Kansas faces severe shortages of medical providers across the state, particularly mental health professionals. Ninety-nine of the 105 counties in Kansas are designated as mental health professional shortage areas, or mental health HPSAs. This shortage leaves more than 70% of Kansas children with unmet mental health needs.13
Due to the shortage of providers, ensuring adequate access to mental health services for Kansas youth will require an innovative approach that increases capacity across a range of medical settings and offers new avenues for care. Kansas is home to more than 700,000 children, all of whom should have access to integrated healthcare. Such integration would require primary care providers, including pediatricians, family practice physicians and non-physician primary care providers (PCPs), have the ability to screen, diagnose, and treat children and adolescents with uncomplicated mental illness, such as anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD). A reformed model of care would also require the establishment of an expert pediatric mental health care team to provide training, consultation, and support services to PCPs.
Overall, KDHE has recognized that programs and providers are an important part of the landscape and the unique needs of the Kansas MCH population are being addressed throughout the state. The Bureau has been and will continue to be committed to working with local partners to address those unique needs, and to build on the successes at the local and regional levels in improving maternal and child health.
Health Equity and Social Determinants of Health (SDoH)/Disparities: When looking at outcomes such as infant mortality, preterm birth and smoking during pregnancy rates, we see consistent trends based on race/ethnicity (particularly non-Hispanic black and non-Hispanic white) and socioeconomic factors (particularly Medicaid vs. non-Medicaid) in Kansas, such as:
- Race/Ethnicity
- Insurance Type
- Education Level
- Federal Poverty Level
- Special Health Care Needs
It would not be prudent to look at these variables in isolation, as one often affects another. For example, people with lower education levels are more likely to live in poverty. According to the 2017-2018 National Survey of Children’s Health (NSCH), households with lower income are more likely to adults in the household with a high school diploma, GED, or less. Whereas those with higher education levels also have higher household incomes.
According to the 2017-2018 National Survey of Children’s Health (NSCH), families of CSHCN utilize public insurance only at a much higher rate than those without special health care needs. The uninsured rate is lower among CSHCN families; however, they are more likely to utilize public and private insurance combined, than private insurance alone.
The annual KIDS Count Data Book uses 16 indicators to rank each state across four domains - economic well-being, education, health, and family and community - that represent what children need the most to thrive. According to the 2019 KIDS COUNT Data Book, Kansas ranked 15th for overall child well-being, 6th in economic well-being, 18th in education, 24th in health, and 23rd in the family and community.14
Health coverage is also a critical factor associated with differing health and birth outcomes. Mothers on Medicaid have a greater risk of worse health outcomes than mothers not on Medicaid.
Kansas Birth Statistics, by Insurance Status, and Year19
While the examples above focus largely on single issues, when SDoH factors overlap the risk of negative outcomes can grow. Kansas must work to address SDoH across multiple fronts to most effectively create change in the State.
Race and ethnicity are also a significant marker of mothers and children. Non-Hispanic Blacks, especially, show greater risk for worse health and pregnancy related outcomes. For example, Non-Hispanic Black Kansans have a lower prenatal care rates and higher rates of low birthweight babies, and infant mortality.15
State Health Agency Priorities & Initiatives - Title V Roles & Responsibilities
Kansas is a state that values young children and families. Over the past decade, significant investments have been made in building a collaborative environment and in supporting at-risk communities to improve child and family health and well-being. The Kansas Department of Health and Environment, Bureau of Family Health has been a leader in these efforts. The Bureau/Title V Program plays a key role with the following:
Infant Mortality Reduction: Kansas Title V is a lead partner in convening and facilitating efforts to reduce infant mortality and eliminate disparities in maternal and infant health. Over the past several years, the Title V program has invested in comprehensive approaches prenatal care and education, tobacco/smoking cessation (before, during, after pregnancy), and pre/early term birth. From concept to reality, the state has worked to integrate initiatives into existing systems to provide the mechanism to achieve current success and future expansion of successful programs. There were 231 infant deaths in 2018 in Kansas, an increase of 6.5% from 217 infant deaths in 2017. The infant mortality rate slightly increased from 6.0 infant deaths per 1,000 live births in 2017 to 6.4 in 2018. This does not meet the Healthy People 2020 target of 6.0 for infant deaths. The infant death rate for non-Hispanic white mothers in 2018 was 4.8, an increase of 2.1% from 4.7 in 2017. The rate for non-Hispanic black mothers in 2018 was 10.0, a decrease of 15.3% from 11.8 in 2017. The rate for Hispanic mothers in 2018 was 9.0, an increase of 25.0% from 7.0 in 2017. Infant death rates for non-Hispanic black mothers have consistently remained higher than those of non-Hispanic white and Hispanic mothers for the past twenty years (1999-2018). Rates for Hispanic mothers have sometime been higher and sometimes lower than those for non-Hispanic white mothers.2
Maternal Mortality Review: Within the population of women of reproductive age, maternal mortality (death of a woman during pregnancy or up to one year after pregnancy) is an indicator that is monitored by KDHE pursuant to K.S.A. 65-177. Kansas maternal mortality data are closely aligned with national trends, as in there are clear patterns that can be identified within the data. The following Kansas women are at greater risk of maternal death and therefore remain target populations for prevention efforts: advanced maternal age (35 years or older); Non-Hispanic black women; and women who have lower levels of education, are unmarried (separated, divorced, widowed, or never married), and live in rural areas.
Health Equity & Disparities: To address disparities, Title V has taken the following action steps to improve health equity and eliminate disparities:
- Using data to determine where to pilot/target programming, based on disparities (e.g., Smoking Cessation pilot sites chosen from the counties with the highest smoking rates)
- Collecting quantitative and qualitative data through focus groups to determine impactful activities to address disparities in health outcomes within black communities.
- Increasing access to prenatal education and service access in communities with demonstrated disparities (Kansas Perinatal Community Collaboratives/Becoming a Mom®)
-
Providing culturally appropriate prenatal education (bi-lingual curriculum and instructors)
- Currently accommodate for the Hispanic population (curriculum in Spanish and program forms also translated)
- Providing culturally appropriate breastfeeding support and resources in communities with demonstrated disparities (Chocolate Milk Cafes, Black Breastfeeding Coalition of Wyandotte County, increase breastfeeding educators and peer counselors of color)
- Assessing the need for health coverage, transportation, housing, food, education, etc. (holistic care coordination)
- Implementing nontraditional community-level outreach (minority and at-risk)
-
Assuring gap-filling services for those without insurance/access
- Expediting Medicaid eligibility for prenatal care coverage
- Assuring Medicaid reimbursement for perinatal mood and anxiety disorder screening in multiple settings, including the pediatric setting
-
Screening for social determinants through local MCH programs
- Development of a prescreening tool that aligns across MCH programs that includes screening for SDOH, mental health, substance use, IPV, Tobacco use, pregnancy intention
- Working with the agency-appointed staff person to coordinate/advance minority health and health equity strategies (utilizing the CoIIN SDoH network framework and resources)
- Development of a health equity learning collaborative that allows local communities to uncover root causes of a health equity issue in their community
- Raising awareness of health disparities with public education campaigns in partnership with the Kansas African American Affairs Commission
- Expanding the Community Baby Shower model focused on safe sleep to integrate smoking cessation and breastfeeding education and referral to services on site; partnering with managed care organizations (MCOs) to align efforts
- Implementing a centralized, web-based data sharing system (DAISEY) that allows for monitoring outcomes and quality improvement along MCH programs; assessing ongoing if local programs are serving those most in need, in line with the Title V purpose
- Implementing a centralized, web-based data tracking system (Community Check Box) that allows monitoring of activities and initiatives focused on health equity and ethnic and racial minorities
- Supporting development among the MCH workforce through provision of health equity and SDoH trainings to the Family Advisory and Maternal and Child Health Councils
- Supporting development among the MCH workforce through the provision of health equity, SDoH, and unconscious bias training to state and local agency MCH staff
State Systems Development Initiative (SSDI): The SSDI project provides data capacity and support to the Title V program and specifically aims to: 1) build and expand MCH data capacity, allowing for informed decision making and resource allocation to support effective, efficient and quality programming; 2) advance the development and utilization of linked information systems between key MCH datasets, including minimum/Core dataset for the Kansas Title V MCH program; and 3) support surveillance systems development to address data needs related to emerging MCH issues, for example, establishing maternal mortality review committee and conducting ongoing surveillance of pregnancy-related deaths.
Family and Consumer Partnership: The creation of Supporting You Kansas, a peer-to-peer support network, in 2018 greatly compliments the direction the new Strengths-based Family Supports priority under the 2021-2025 Title V State Action Plan. This provides opportunity to focus on family and consumer partnerships, leadership, peer supports, and the integration of the National Standards of Quality for Family Strengthening and Support. Additionally, Title V CSHCN has been working towards a shift in service delivery with maintaining state mandated program focus on direct health services and adding capacity through care coordination and other population health, systems of care, and policy initiatives.
Financial Assistance for CSHCN: Kansas Law mandates financial supports for health care services for CSHCN pursuant to K.S.A. 65-5a01, based on medical and financial eligibility, provided through the Kansas Special Health Care Need Program (KS-SHCN) and core Title V program. KS-SHCN provides this assistance through nine (9) direct assistance programs, referred to as DAPs. The chart below outlines the services available and eligibility for the DAP.
Each of the following DAPs have eligibility criteria and annual maximum assistance amounts. All families who meet medical and financial eligibility for the program can receive support through up to two DAPs each year. More information can be found in the CSHCN Section.
Kansas’ Systems of Care for Underserved and Vulnerable Populations
A primary focus of the Kansas Title V program is to provide ongoing leadership to advancing and improving systems of care for underserved and vulnerable MCH populations. To support this effort, KDHE contracts with local public health departments (independent entities) and Federally Qualified Health Centers (FQHCs) across the state to ensure provision of MCH services within a coordinated, family-centered system.
Aid to Local Funding/Statewide MCH Network: When funds are allocated to external programs, the Bureau maintains contracts for the use of funds to outline the nature of the work in support of MCH priorities. Services are delivered in compliance with Title V legislation and in accordance with the KS MCH Manual: https://www.kdheks.gov/c-f/downloads/SFY2021_MCH_Manual_&_Appendix.pdf. The manual provides background on the Title V MCH Block Grant legislation/authority, KS MCH program principles, and service guidance and offers a vast appendix of resources related to practice and national performance measures.
The process with local agencies begins with the development of Grant Application Guidance and Reporting Materials annually in December. Materials are available by mid-January to local agencies applying for Title V funding. The review process informs funding recommendations and involves external reviewers applying guidance and a scoring matrix, a funding formula based on poverty and population by county/target area, and willingness/ability to comply with grant requirements. Detailed client and service data is required to be collected, aggregate progress reports and affidavits of expenditures are required quarterly, and site visits are conducted to verify compliance with funding requirements and progress. More information about the MCH Aid to Local Program is available online through the Kansas Grant Management System (KGMS) site: https://khap2.kdhe.state.ks.us/KGMS/Default.aspx.
Title V contracts with nearly 70 local agencies to provide MCH services across the population domains and the majority of local services funded by the Block Grant are delivered by local health departments and safety net clinics (independent entities). These agencies are positioned to provide core public health services in addition to MCH, so the delivery system has the advantages of convenience and comprehensive care. The services delivered by local agencies are designed to address ongoing needs and those identified by the most recent needs assessment. In May of 2020 an interactive map of MCH service delivery sites was created to allow community organizations, providers and the public to easily identify and connect to services in their area: The interactive map displaying reach can be found here: https://www.kdheks.gov/bfh/index.html. Aid to Local contract documents and the list of 2019 MCH grantees are attached as Supporting Documents.
Navigating Kansas Medicaid and the Insurance System: Local MCH agencies assist clients in navigating Kansas Medicaid and the public/private insurance system. Many local agencies facilitate on-site enrollment of MCH clients and screen for insurance status and coverage at each encounter. If the individual or family does not have insurance, Medicaid eligibility is reviewed, and a referral is made if appropriate. Staff assist in completing the application and submitting it to Medicaid when need. For those who do not qualify for Medicaid, private Marketplace health insurance information is provided along with contact information to a Navigation Specialist.
Systems of Care for CSHCN: The Kansas Title V and KS-SHCN vision spans far beyond the mandate for the supports listed above. Rather, Kansas aims to assess and address needs of all children and youth with special health care needs and their families. KS-SHCN continues to expand the focus of the program to address the needs of families through collaboration, systems integration, and increased statewide capacity. Utilizing quality improvement and evaluation, the program strives for sustainable and systemic changes for the CSHCN population. The completion of the Kansas State Plan for CSHCN in 2018 provides opportunity to further engage with partners in ways to improve the system of care and collaborate more effectively and efficiently.
References
- Kansas - Wikipedia. https://en.wikipedia.org/wiki/Kansas
- Oakley D, Crawford G, Savage C. Kansas Annual Summary of Vital Statistics, 2018. Topeka, KS: Kansas Department of Health and Environment, 2019. https://www.kdheks.gov/phi/as/2018/2018_Annual_Summary.pdf
- U.S. Census Bureau. Bridged-race population estimates, July 1, 2018.
- U.S. Census Bureau. 2018 American Community Survey 1-Year Estimates. Table DP02. Selected Social Characteristics in the United States. https://data.census.gov/cedsci/table?d=ACS%201-Year%20Estimates%20Data%20Profiles&tid=ACSDP1Y2018.DP02&vintage=2018
- National Survey of Children's Health (NSCH). Combined 2016-2017 NSCH. Combined 2017-2018 NSCH. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website. www.childhealthdata.org
- U.S. Census Bureau. 2018 American Community Survey 1-Year Estimates. Table S1602. Limited English-Speaking Households. https://data.census.gov/cedsci/table?q=S1602&g=0400000US20&tid=ACSST1Y2018.S1602&vintage=2018
- U.S. Census Bureau. Poverty Thresholds. https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html
- Columbia University, National Center for Children in Poverty. Kansas Demographics of Low-Income Children. http://www.nccp.org/profiles/KS_profile_6.html
- U.S. Census Bureau, Small Area Income & Poverty Estimates (SAIPE), 2018. https://www.census.gov/data-tools/demo/saipe/saipe.html.
- U.S. Census Bureau. 2018 American Community Survey 1-Year Estimates. Table S1702. Poverty Status in the Past 12 Months of Families. https://data.census.gov/cedsci/table?q=S1702&g=0400000US20&tid=ACSST1Y2018.S1702&vintage=2018
- U.S. Census Bureau, Small Area Health Insurance Estimates (SAHIE), 2018. https://www.census.gov/data-tools/demo/sahie/#/
- Bureau of Labor Statistics, Occupational Employment Statistics, Occupational Employment Statistics Query System: https://data.bls.gov/oes/#/home
- Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSAs), as of September 30, 2019. https://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
- Annie E. Casey Foundation. 2019 KIDS COUNT Data Book. https://www.aecf.org/m/resourcedoc/aecf-2019kidscountdatabook-2019.pdf
- Annie E. Casey Foundation. KIDS COUNT Data Center. https://datacenter.kidscount.org/
- Kansas Health Institute, Kansas Medicaid Primer 2019. Publication number KHI/19-01. www.khi.org/assets/uploads/news/14859/2019_medicaid_primer_r_web.pdf
- KDHE Division of Health Care Finance, 2018
- U.S. Census Bureau. 2018 American Community Survey 1-Year Estimates. Table DP05. ACS Demographic and Housing Estimates https://data.census.gov/cedsci/table?q=dp05&g=0400000US20&tid=ACSDP1Y2018.DP05
- KDHE, Bureau of Family Health, Kansas Department of Health and Environment Bureau of Family Health. Title V Outcome Measures and Performance Measures, 2019.
To Top
Narrative Search