Geography

Missouri is comprised of 115 counties (114 counties and one independent city, St. Louis) covering an area of 69,704 square miles and ranks 21st in size among all states in the nation.1 The state is centrally located in the heartland of the United States and shares borders with Arkansas, Kansas, Kentucky, Illinois, Iowa, Nebraska, Oklahoma, and Tennessee. The two largest rivers in the state are the Mississippi, which marks the eastern border of the state, and the Missouri, which flows across the middle of the state. Two large metro areas, Kansas City and St. Louis are located on the western and eastern borders respectively, and are connected by the "I-70 Corridor."

 

Demography/Population Density

The 2018 U.S. Census population estimate for Missouri was 6,126,452 residents. From 2008 to 2018 the state's population increased by 3.4%, including a 3.7% increase for males and a 3.1% increase for females. Among over 6 million Missouri residents, 2.1 million, or 35%, live in rural areas. While the amount of growth varies among individual counties, population increases are occurring in both rural and urban areas. Overall, the population in rural areas increased by 0.3%, while urban areas increased by 5.1% during the past decade.2

 

Missouri's population reflects a dichotomy between its largest metropolitan statistical areas (MSAs) (St. Louis in the east and Kansas City in the west) and its more rural areas. There are large differences in population distribution across Missouri, with over half of the state’s population (55%) falling inside the MSAs of St. Louis (35%) and Kansas City (20%). Missouri has six other cities designated as MSAs by the Census Bureau, listed in order of size: Springfield, Columbia, Joplin, Jefferson City, St. Joseph and Cape Girardeau.

 

The population density of Missouri was estimated at 88.1 individuals per square mile in 2018. The City of St. Louis and 15 other counties were considered urban areas. The largest urban counties by population were St. Louis County (996,945) and Jackson County (700,307). The greatest population density was in St. Louis City with 4,891 people per square mile. The lowest population density was in Worth County with 7.7 people per square mile. The largest county in the state by area was Texas County, with an area of 1,179 square miles, and a population density of 21.7 persons per square mile. In total, 46 of Missouri’s counties had a population density below 25 persons per square mile.3

 

Age

In 2018, the average Missourian was just over 39 years old.4 Nearly 22% of the state’s population (1,376,830) was less than 18 years old, and 17% of the population (1,033,964) was age 65 or older. Missouri's estimated MCH population including women of childbearing age (15-44), infants, children, and adolescents (1-19) was 2,708,163. This accounted for more than two-fifths (44%) of the state’s entire population. This estimate represents 1,174,176 women of childbearing ages (15-44 years), 73,281 infants (under 1) and 1,460,706 children and adolescents (ages 1-19 years).There were 293,652 children between the ages of 0 and 17 that had special health care needs.5 In 2018, there were 73,281 Missouri resident live births, of which, 16.1% were African-American and 76.4% were White. Hispanic births in Missouri decreased by 2.6%, from 2008 to 2018 (4,525 and 4,407 respectively).6

 

Diversity/Language

Missouri residents are predominantly white (84.2%) with a significant African-American (12.6%) population and smaller Asian/Pacific Islander (2.5%) and American Indian (0.7%) resident populations. Over 74.3% of Missouri’s African-American population groups are located in the three largest counties (St. Louis City, St. Louis County, and Jackson County). Hispanics represent a small but growing segment of the population (4.3%), which is more broadly dispersed throughout the state. Population growth for Hispanics in Missouri was 33.6%, between 2008 and 2018 (an increase of 66,248 persons), compared to 18.3% for Hispanics nationally.7

 

In 2018, native-born United States citizens comprised 95.8% of the Missouri population. More than 4 million Missouri residents (66.4%) were born in the state of Missouri. Of the 258,390 residents that were not born in the United States, 41.4% came from Asia, 26.6% from Latin America, 18.3% came from Europe, 10.8% came from Africa, and 3.0% came from other world regions. Only 2.48% of Missouri residents lived in a different state or country the previous year, while 84.2% lived in the same house.8

 

According to the 2018 American Community Survey (ACS), 363,864 (6.3%) Missourians age five and above spoke a language other than English at home. Of that group, 132,639 persons (2.2% of the total Missouri population) spoke English less than 'very well'. An estimated 144,847 (2.4%) Missourians used Spanish as the primary language at home.9 The Missouri Department of Health and Senior Services translates program materials and health messages in a variety of languages, up to 17 different dialects, to reflect the growing diversity of the state population.

 

Addressing factors related to diversity that lead to adverse maternal-child health outcomes represents an ongoing challenge for public health in the state. Examining data from 2018, the infant mortality rate (age <1 year) for African American babies (11.9 per 1,000) was more than double that of white babies (5.2 per 1,000).10 Though minority populations tend to cluster near urban centers, granting better access to health services than many rural non-minorities, ability to secure care can remain a challenge.

 

Education

The 2018 ACS estimates of Missourians over the age of 25 who graduated from high school was 89.6%. This was higher than the national average of 88.0%. However, the percentage of Missourians that have a bachelor’s degree or higher 28.6% was slightly less than the U.S. average (34.8%).11

 

Economy

Missouri's metropolitan areas make up the largest portion of the state's economy. St. Louis County and Jackson County combined contribute nearly one third of the state's economy in terms of employment, personal income, and population. Regardless of population size, all regions of Missouri contribute to the state’s economic resources. Missouri's rural areas are especially important for tourism and agriculture in the state. In 2016 (most current data) agriculture, forestry, and related industries had an economic impact of $88.4 billion and generated 378,232 jobs.12 Missouri's median household income in 2018 was estimated at $54,478, which was $7,459, less than the national median household income of $61,937.13

 

Missouri’s unemployment rate increased from 3.9% in March 2020 to 7.9% in June 2020 (not seasonally adjusted).14 Due to COVID-19 many industries were forced to furlough and lay-off workers. Data from the Department of Labor and Industrial relations (DOLIR) showed the total number of initial unemployment claims in the month of June just under 75,000 compared to 104,000 initial claims reported during the last week of March 2020. Workforce development and economic growth have been major focuses of Missouri’s COVID-19 response. In July 2020, the Governor announced $125 million in CARES Act funding for workforce development and training.15

 

Poverty

According to the 2018 ACS estimates, 13.2% of Missourians had incomes at or below 100% of the federal poverty level (FPL) compared to 13.4% in 2017. Missouri’s child poverty rate was 18.3%, higher than the state overall rate; this means that more than 786,330 individuals were affected by poverty and 247,209 Missouri children lived in poverty.16

 

A key indicator of childhood poverty is children eligible for free/reduced lunch. For the 2018-2019 school year, Missouri had approximately 432,000 children eligible for free and reduced lunch or nearly 50% of children participating in the program.17 Food insecure families are at a higher risk for chronic diseases, diabetes, hypertension and weight gain.18 Missouri’s 2018 food insecurity rate was 13.3%, meaning 813,480 people in Missouri were food insecure. The national average rate of food insecurity was 11.5%. In 2018, food insecurity was highest in Pemiscot (21.6%) and Ripley (20.6%) counties.19 The overall child food insecurity rate was also 13.3%.20 According to the USDA 2016-2018 Economic Research Service report, the household prevalence for very low food security was 4.4%, which was greater than the national average of 4.3%.21

 

Homelessness

On a single night in 2019, there were roughly 567,715 people experiencing homelessness in the United States: for every 10,000 people in the country, 17 were experiencing homelessness. Approximately two-thirds (63%) were staying in emergency shelters or transitional housing programs, and about one-third (37%) were in unsheltered locations. In 2019, one-fifth of people experiencing homelessness were under 18 (18.9% or 107,069), 73% were over the age of 25, and 8% were between the ages of 18 and 24.

 

The 2019 Missouri rate of homelessness was 10 per 10,000 (6,179 persons) which was less than the national rate of 17 per 10,000. The 2019 Annual Homeless Assessment report indicates that between 2018 and 2019, individual homelessness in Missouri decreased by 296 individuals, or 2.2%.22

 

Environment

Lead mining and smelting has been an important part of Missouri's history since the early 1700’s. Missouri has been the dominant lead-producing state in the nation since 1907. Though there are many possible sources of lead exposure, the most common sources of lead poisoning in MO are lead dust, lead in soil, and peeling, chipping or cracking lead-based paint. The highest risk of lead exposure for children, however, comes from homes built before 1950, when most paint contained a high percentage of lead. Lead-based paint was banned from residential use nationwide in 1978. Therefore, any home built before 1978 may contain leaded paint. About 18.8% of existing housing stock in MO was built before 1950, and 56.1% was built before 1980.23

 

The MO Childhood Lead Poisoning Prevention Program (CLPPP) within the Division of Community and Public Health (DCPH) was established in 1993. The program's mission is to assure the children of MO a safe and healthy environment through primary prevention, detection, surveillance, and case management for lead exposures. There is no “safe” level of lead in the body. Inhalation or ingestion of even very small amounts of lead causes neurotoxic health effects, and can affect nearly every other body system. Very high blood lead levels may cause death. Passed in 2001, RSMo 710 required DHSS to promulgate rules and regulations to establish a statewide lead screening plan. The rules and regulations define criteria for establishing blood lead testing and reporting requirements and for medical and environmental case management follow-up and treatment procedures.

 

Over the last 10 years, the annual percent of Missouri's children younger than six years old tested for lead exposure decreased slightly, ranging from a high of 20.4% in 2010 to a low of 17.7% in 2019. The number of children tested, however, has decreased more dramatically, from a high of 95,562 in 2010 down to 78,758 in 2019. This decrease closely follows the state’s declining birth rate. Of the number of children tested, the percentage found to have blood lead levels of 10 μg/dL or greater has declined steadily from 0.97% (930) in 2010 to 0.54% (543) in 2019. This decrease mirrors a nationwide decrease in children's blood lead levels. Similarly, the trend for children who tested with blood lead levels greater than or equal to 5 μg/dL, the 2012 “reference value” recommended by the CDC, has decreased from 6.65% (6,181) in 2010 to 2.76% (2,174) in 2019.24

 

Transportation

In 2019, Missouri had the seventh largest highway system in the nation.25 The transportation infrastructure has three key measures: railroad mileage, waterway mileage, and airports. The Missouri highway system is comprised of nearly 34,000 miles of highways and more than 10,000 bridges. Additionally, the county road system adds 97,000 miles and nearly 14,000 additional bridges. The extent of this infrastructure gives Missouri residents and businesses efficient accessibility to major markets for distribution needs and telecommunication. However, in both urban and rural areas access to public transportation can be cumbersome.

 

There was a 1.3% decrease in vehicle fatalities from 2008 to 2018 with 969 fatalities in 2008 and 956 reported vehicle fatalities in 2018.26 Missouri’s rural traffic fatality rate was nearly three times higher than the fatality rate on all other roads in the state. It is estimated that roadway features are likely a contributing factor in approximately one-third of all fatal and serious traffic crashes. Between 2010 and 2018, 7,896 people were killed in traffic crashes in Missouri, an average of 877.3 fatalities per year.27 Missouri’s overall traffic fatality rate of 1.20 fatalities per 100 million vehicle miles of travel in 2018 was slightly higher than the national average of 1.13.28

 

The MO Department of Transportation works with safety advocates across the state with a goal of 700 or fewer fatalities. In 2018, rural deaths made up 56% of motor vehicle deaths.29 The safety belt usage rate in Missouri (87%) was below the national average of 90%.30 Missouri does not have a primary seatbelt law and in 2019 only eight states ranked lower in safety belt use.31 Drivers, front seat passengers, and children under the age of 16 are required to buckle up.

 

Health Infrastructure

There are five predominant schools that train new physicians in Missouri. The Kansas City University of Medicine and Biosciences and the University of Missouri – Kansas City operate in the northwest portion of the state. The University of Missouri in Columbia operates centrally. Saint Louis University and Washington University in St. Louis operate in the eastern portion of the state.

 

Over 4,000 Osteopathic Physicians, and over 23,500 Medical Physicians and Surgeons are licensed in Missouri. There are 906 certified OBGYNs in Missouri. Of these, 22 specialize in OB/GYN surgery. There are 2,026 physicians in Missouri that are certified in pediatrics and another 606 specialized pediatricians (e.g. pediatric pulmonology, pediatric emergency medicine, pediatric cardiology, etc.).32

 

As of June 2020, there were 161 licensed hospital facilities in the state of Missouri spread across 71 counties. Of these facilities, 18 are specifically licensed as psychiatric hospitals. The majority of hospitals (98) are located in urban counties. There are 30 trauma (12 I-R, 9 II-R, and 9 III-R) facilities and 65 stroke (11 I-R, 27 II-R, 26 III-R, and 3 IV-R) facilities in Missouri.33 Over 21,300 beds are available in Missouri hospitals, including 853 dedicated pediatric beds and 881 NICU beds.34 In addition, there are four VA Medical Centers and one VA Health Care System in the state of Missouri. This does not include 29 community based outpatient clinics and five veterans centers.35

 

A Rural Health Clinic (RHC) must be located in a non-urban area and in a federally designated or certified shortage area. With 356 RHCs, Missouri has more than any other state. A Federally Qualified Health Center (FQHC) is a community-based and patient driven care center designed to help people with limited access to care. There are 29 FQHC’s in Missouri.36

 

Health Indicators

Missouri was ranked the 39th healthiest state in 2019, according to the America's Health Rankings 2019 Annual Report published by the United Health Foundation. Some of the indicators for which Missouri had the best rankings were high school graduation (12), disparity in health status (25), air pollution (28), and primary care physicians (15). Some of the worst rankings for Missouri were smoking (41), obesity (42), violent crime (43), dentists (40), frequent mental distress (39), and cancer deaths (39). Regarding birth outcome indicators, the state of Missouri was ranked 31st for low birth weight and 33rd regarding infant mortality.37

 

Health Insurance Coverage

Overall, the percentage of uninsured Missourians has decreased from 10.5% in 2013 to 9.6% in 2018. In 2018, an estimated 4.7% of children (under 18) and 13.7% of women (ages 18-44) were without health insurance in Missouri. The percentage of children under 18 without health insurance in Missouri (5.6%) was slightly higher than the national rate (5.3%).38

 

The MO HealthNet for kids (Medicaid) program provides health insurance coverage for children under age 19 whose monthly family Modified Adjusted Gross Income does not exceed 196% of Federal Poverty Level (FPL) for children under age one, and 148% of FPL for children ages 1-18.39 Approximately 627,204 low-income Missouri children were enrolled in FFY2018.40 Overall, Medicaid covered 45.0% of Missouri's children and paid for about 38.8% of all births in the state for 2018. Children represent the largest demographic group served by MO HealthNet, with 57% of all Medicaid enrollees being age 18 or younger.41 In SFY2019, MO HealthNet spent $1.14 billion on nursing home services (12.3% of MO HealthNet expenditures).42

 

Using the State Children’s Health Insurance Program (SCHIP) funds, Missouri expanded its existing Medicaid program for low-income children in 1998. This SCHIP expansion extended health coverage to low-income children with family income up to 300% of FPL.43 The SCHIP program provides the same health services as those covered under Medicaid, except that children covered by SCHIP are not eligible for non-emergency medical transportation. Based on an income scale, some individuals covered under Missouri's SCHIP program must pay premiums. Premiums paid per family per month range from $15 to $573.44 In CY2018, up to 88,034 children had coverage under the CHIP and Medicaid programs in Missouri.45

 

The MO HealthNet for pregnant women program offers Medicaid coverage to pregnant women whose family incomes are up to 201% FPL. This program includes coverage up to 60-days postpartum even with subsequent increases in family income. In June 2018, this program provided insurance benefits to approximately 25,115 women (roughly 3% of MO HealthNet recipients).46

 

Statewide-Managed Care

The MO HealthNet managed care system (formerly known as MC+) started in 1995 when Missouri DSS first contracted with managed care plans in an effort to improve the accessibility and quality of health care services for Missouri’s Medicaid populations, while improving predictability of the costs associated with providing care. Missouri initially used managed care plans to deliver Medicaid benefits to children, families, and pregnant women across a specific geographic corridor of 54 counties that spanned the center of the state and included the cities of St. Louis, Columbia, Jefferson City, and Kansas City.

 

Missouri expanded Medicaid managed care in 2017 to include all 114 counties and the city of St. Louis for that same population (children, families, and pregnant women). The State of Missouri contracts with three MO HealthNet Managed Care health plans to provide health care services to enrollees. These include: Home State Health Plan, Missouri Care (WellCare), and United Healthcare. Prior to the statewide expansion, Missouri also contracted with Aetna Better Health of Missouri which covered an estimated 55 percent of people enrolled in the MO HealthNet managed care system.47

 

All MO HealthNet recipients must enroll in a managed care health plan if they fit into one of the following eligibility categories:

• Parents/caretakers, children, pregnant women, and refugees;
• Other MO HealthNet children who are in the care and custody of the state and receive adoption subsidy assistance; and
• CHIP children.

 

In SFY 2018, there were 97,582 low-income custodial parents and 620,294 low-income children covered by MO HealthNet.48 The goal of the MO HealthNet Managed Care program is to improve health care quality and access to needed services, as well as increase the efficiency of health care delivery for covered low-income custodial parents, pregnant women, and children while controlling the program’s cost. The MO HealthNet Managed Care program operates statewide through contracts between the MO Department of Social Services’ MO HealthNet Division (MHD) and three Managed Care health plans. Each Managed Care health plan has a network of doctors, hospitals and other providers across the state of MO that coordinate care to help individuals and families stay healthy.

 

Missourians who are aged, blind or disabled, including those Missourians with developmental disabilities served through the Missouri Department of Mental Health, will not be included in the MO HealthNet Managed Care program. They will continue to receive services through the traditional MO HealthNet Fee-for-Service (FFS) program. Certain participants (including a child with special health care needs) may also opt out of the managed care program and choose the FFS program.

 

Medicaid Expansion

In August 2020, Missouri voters approved an amendment to the Missouri Constitution to adopt Medicaid Expansion for persons 19 to 64 years old with an income level at or below 133% of the federal poverty level, as set forth in the Affordable Care Act. Currently, Medicaid eligibility is set forth in state statute, but this amendment adds Medicaid Expansion to Missouri’s constitution (effective July 1, 2021). This amendment prohibits placing greater or additional burdens on eligibility or enrollment standards, methodologies or practices on persons covered under Medicaid Expansion than on any other population eligible for Medicaid. The amendment requires state agencies to take all actions necessary to maximize federal financial participation in funding medical assistance under Medicaid Expansion. Federal law requires states to fund a portion of the program in order to receive federal funding (state match). This amendment does not provide new state funding or specify existing funding sources for the required state match.

 

DHSS Priorities

In Missouri, the Title V Maternal and Child Health program is located within DHSS. Randall W. Williams, MD, FACOG, is the director of DHSS and is responsible for the management of the department and the administration of its programs and services. He is an obstetrician and gynecologist who previously served as both the Deputy Secretary for Health and State Health Director in the Department of Health and Human Services in North Carolina. Dr. Williams was selected by peers and presently serves on the Board of Directors for the Association of State and Territorial Health Officials (ASTHO).

 

Since 2016, DHSS has been accredited through the Public Health Accreditation Board. The mission of DHSS is ‘To be the leader in promoting, protecting and partnering for health’ in order to achieve the vision of ‘Healthy Missourians for life.’ DHSS executes the following foundational responsibilities:

• Providing public health services and supports to all citizens.
• Ensuring regulation of facilities and service providers that deliver care to Missourians.
• Performing oversight of programs and protections for elderly and vulnerable residents.

 

Premiere DHSS Initiatives

Enhancing and Innovating Health Services for Missouri’s Women and Mothers

DHSS is implementing 2019 legislation enhancing Missouri’s Pregnancy Associated Mortality Review (PAMR) Board to inject clinical best practices and data-driven solutions to improve maternal health and mortality rates. Grants have been awarded to Missouri as part of the Alliance for Innovation on Maternal Health (AIM) quality improvement initiative to implement proven outcome based national models that improve maternal safety.

 

The Department has also been awarded the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) grant to identify, review, characterize, and identify prevention opportunities within maternal deaths. DHSS is the first state health department in the nation to launch a Count the Kicks program to enhance education and awareness among expectant mothers of possible safety or health concerns of their unborn child.

 

Reconnecting Care in Rural Missouri

Beginning with the Governor’s Rural Health Summit in 2018, DHSS has been working to realign resources to address the state’s rural health issues. DHSS is working collaboratively with other public and not-for-profit entities to address Missouri’s rural care provider shortage to attract and retain additional health professionals in underserved areas. The Department is coordinating a robust response to Hepatitis A outbreaks in rural Missouri, while also administering grants to address the opioid crisis in rural communities.

 

Assessing and Impacting Vaping among Missouri’s Youth

DHSS has taken the lead among various state departments for establishing the “Clear the Air” campaign to persuade those under 18 from initiating or continuing use of electronic cigarettes or vaping technology devices. This marketing initiative resulted in 5.1 million social media impressions; 85,142 video views; and 27,271 visits to the Clear the Air landing page. Missouri has received national attention for deaths associated with E-Cigarette or Electronic Vaping Use Associated Lung Injury (EVALI). The Department continues to partner with the Centers for Disease Control and Prevention and the Food and Drug Administration to determine specific causes with the national EVALI outbreak, and is examining the legal impacts associated with the ban on tobacco and vaping products from being purchased by those under 21 years of age that was passed by Congress and signed into law by President Trump.

 

Improving the Quality of Provider Care for Missouri Children

DHSS has been working to improve processes associated with providing child care. The

Department has implemented legislation to provide a 30-day waiver for homeless and foster children to provide verification of immunizations to childcare providers. More than 32,000 background screenings have been completed for those providing childcare to ensure compliance with new federal law. DHSS processed 508,365 background screenings and 88,485 registrations in state fiscal year 2019 through the Family Care Safety Registry.

 

Strategic Management Priorities

The State of Missouri Cabinet team developed a management change agenda to improve how Missouri government operates. All 16 Cabinet Departments developed strategic management priorities, and a simple “placemat” summarizes these priorities. These priorities include a set of change initiatives DHSS is pursuing to improve performance and outcomes for the citizens of Missouri. The aspiration set by DHSS is to protect health and keep people of Missouri safe. Four themes identified to reach this aspiration are to reduce opioid misuse, improve the health and safety of Missourians most in need, enhance access to care, and foster a sustainable, high-performing department. There are specific priority initiatives to address each theme that are usually completed in one year or less. Initiatives to be completed by January 2021 include the PAMR Board reviewing 100% of 2018 maternal deaths, creating and disseminating an infographic regarding perinatal OUD to providers in Missouri, and finalizing contracts with LPHAs who have agreed to join the Safe Cribs for Missouri program with a goal of increasing participation from 65 to 80 counties.

 

Missouri’s Title V program is involved with many of the DHSS initiatives and priorities. Title V efforts to provide positive health outcomes for the MCH population aligns with the DHSS goal to improve the health of all Missourians. Title V program strategies for the national and state performance measures identified in the Title V block grant also assist in achieving DHSS objectives. For example, Missouri selected the measure to reduce sleep-related infant deaths and focus on ensuring that all babies are sleeping in a safe environment. The Title V MCH Director and relevant Title V staff participate in and/or lead the PAMR Board meetings and discussion to reduce maternal mortality. The Title V program team also works with Local Public Health Agencies, the majority of which are located in rural communities, to ensure access to healthcare services for women and children.

 

Revised Statutes of Missouri (RSMo) Relevant to Title V

Title XII Public Health and Welfare, Chapters 191, 192, and 201 include laws in place to benefit the MCH population. A few specific examples are listed below.

• §191.323 (1985) gives DHSS the power and duty to prevent and treat genetic disease and birth defects and §191.331 (2007) allows infants to be tested for metabolic and genetic diseases. This chapter also addresses prenatal and postnatal care and education for women and children, breastfeeding, and prenatal screening counseling.
• §192.002 (2001) and §192.005 (2018) established DHSS to supervise and manage all public health functions and programs. The department shall be governed by the provisions of the Omnibus State Reorganization Act of 1974, Appendix B, RSMo, unless otherwise provided in sections 192.005 to 192.014.
• §192.025 DHSS is designated as the official agency of the state to receive federal funds for health purposes.
• §192.067 authorizes DHSS to receive information from patient medical records for the purpose of abstracting data (i.e. PAMR).
• §192.070 (2001) states that DHSS shall issue educational literature on the care of the baby and the hygiene of the child including, but not limited to, the importance of routine dental care for children; study the causes of infant mortality and the application of measures for the prevention and suppression of the diseases of infancy and childhood; and inspect the sanitary and hygienic conditions in public school buildings and grounds.
• §192.601 (2013) requires a toll-free telephone number established for the use of parents to access information about health care providers and practitioners who provide health care services under the Title V Maternal and Child Health Services Block Grant, the medical assistance programs, and other relevant health care providers, as required by 42 U.S.C. 705(a)(5)(E).
• §201.010 (2010) gives DHSS the authority to administer children’s special health care needs service, a program of service to children who have a physical disability or special health care need and to supervise the administration of the services that are included in this program. The purpose of this service is to develop, extend, and improve services for locating such children, especially in rural areas, and for providing medical, surgical, corrective and other services and care and facilities for diagnosis, hospitalization, and aftercare (§201.030).

 

Code of State Regulations (CSR)

• 19 CSR 20-60.010 establishes criteria and procedures for reporting standardized assessments and levels of maternal and neonatal care designations for birthing facilities.

 

Major Legislative Initiatives

Provided below is a list of bills and provisions passed during the 100th General Assembly, 2nd Regular Session (2020) and signed by the Governor that impact Missouri families:

 

HB 1682 Establishes the "Postpartum Depression Care Act.”

Directs hospitals and ambulatory surgical centers providing labor and delivery services to provide patients and their families with information about postpartum depression. Subject to appropriation and federal approval, Medicaid coverage of postpartum depression treatment will be provided for up to one year to women who begin treatment within 60 days of giving birth.

 

Provisions Which Interact With Children

• Designations for health awareness
  • May: Mental Health
  • July: Minority Mental Health
  • September: Deaf / Infant & Maternal Mortality
• Requires CPR trainings to include proper use of AED (automated external defibrillator)
• Prohibits use of vapor products in an indoor area of schools or on a school bus
• Prohibits marijuana-infused products that could appeal to children (shaped like humans, animals, fruit)

 

HB 1963 – Motorcycle Helmet Law

Permits those age 26 and older to operate motorcycles without wearing helmets if they have insurance coverage for treatment of injuries caused by an accident.

 

HB 1414 – Protection of Children

Foster Children

• Requires Children's Division within the Department of Social Services to complete a standard risk assessment within 72 hours of a report of abuse or neglect as part of its structured decision-making protocols for responding to abuse and neglect.
• Modifies Foster Parents’ Bill of Rights

Homeless Youth

• Authorizes Medicaid coverage of homeless youth, subject to federal approval of a Medicaid plan amendment.
• Allows a homeless child or youth to obtain a free copy of their birth record
• Applies state law governing the ability of minors to consent to medical care on their own behalf to mental health treatment. Establishes additional ways to validate that an unaccompanied minor is able to independently consent to and contract for services.
• Creates liability protections for health care providers and others who follow state law in providing services directly to a minor without parental consent.

Child Care Providers

• Provides for certain immunities for employees of child assessment centers: Under this act, an employee of a child assessment center shall be immune from civil liability arising from the employee's participation in the investigation process and services by the center, unless such employee acted in bad faith.
• Removes requirement for 2-year license renewal
• Updates/streamlines list of crimes for those ineligible for providing child care
• Clarifies procedures and designated department to oversee the background check process

 

COVID-19

On March 13, 2020, Governor Parson signed Executive Order 20-02 declaring a State of Emergency due to COVID-19. Executive order 20-12 further extended four previous Executive Orders assisting with Missouri’s COVID-19 response through December 30, 2020. Other measures taken to address the pandemic are listed below.

 

Pandemic-related assistance

• Expanded eligibility for child care subsidy for parents
• Pandemic SNAP Assistance
• Pandemic-EBT for Free/Reduced Lunch Children
• 12-month Continuous Eligibility for MO HealthNet
• Family Support Division waived work requirements for TANF recipients
• Congregate Food Settings from USDA Waived
• Several WIC-related waivers

 

Pandemic-related economic impact

• Increase of children enrolled in MO HealthNet
• Increase of Food Stamp families
• Increase in Food Stamp Individuals
• Children in foster care numbers stagnant
• Decrease in the children receiving subsidized child care
• Increased unemployment rate
• State revenue numbers down

 

For references, please refer to the references in the supporting document attachments.