The state’s demographics, geography, and economy

According to the most recent census data, Louisiana has a population of about 4.6 million people. 62.5% of the population identify as white, 33% percent identify as Black, 5.8% identify as Hispanic / Latino, 1.9% identify as Asian, 1.9% identify as two or more races, and 0.8% identify as American Indian/Alaskan Natives. Nearly four out of every five residents were born in-state.1 

Covering an area of 43,193 square miles along the Gulf of Mexico, Louisiana is the 33rd largest state in the country.2 The total area of Louisiana includes approximately 4,600 square miles of inland waters. Distinct geographic, cultural and economic regions of the state include the Northwestern Red River Valley region, the Northeast Mississippi Delta region, the Western Acadiana region, Eastern Acadiana / Lower Mississippi region, and the Greater New Orleans region.  Each of the regions have distinct histories, cultural characteristics, and economic contexts. 

Image One: Five Regions of the State of Louisiana3 

Of Louisiana’s 64 parishes (counties), 37 are considered rural. The largest urban centers include New Orleans, Baton Rouge, Lafayette, and Shreveport. 

Historically, Louisiana’s economy has been heavily dependent on agricultural and fisheries production. The state's principal agricultural products include seafood, cotton, soybeans, cattle, sugarcane, poultry and eggs, dairy products, and rice. Louisiana’s oil and gas industries constitute another significant segment of the economy. Louisiana's 15 oil refineries account for nearly one-sixth of the nation's refining capacity and can process about 2.9 million barrels of crude oil per day.4 Due to the abundance of oil and gas, Louisiana is home to more than 300 process manufacturing facilities supporting production of petroleum products and chemical manufacturing. The state's petrochemical plants are concentrated along the Mississippi River between Baton Rouge and New Orleans, a region referred to as Louisiana’s industrial corridor. 

Tourism, especially to the Greater New Orleans area, is another significant driver of the state’s economic production. In 2024, Louisiana attracted 44.5 million domestic and international visitors, who spent 18.5 million dollars.   Louisiana’s tourism and hospitality sector is the fourth largest employment sector in the state.5  

The state’s unique strengths and challenges that impact the health status of its MCH population, including CSHCN

Underlying challenges contributing to the persistently poor health outcomes of MCH populations in Louisiana include persistent poverty, climate hazards, industrial pollution, low literacy and numeracy skills, lack of access to specialized health services including mental health services, historical and present day racial and economic segregation and discrimination, and the state’s high incarceration rate.

Household poverty prevents many Louisianans from reaching their full health potential. The overall poverty rate in Louisiana was 19.4% in 2023, the second highest in the nation.6 24.6% of children in Louisiana are living in poverty, which is the third highest in the nation. At $58,229, the State’s median household income is the third lowest in the nation.7 Women are more likely to live in poverty than men (20.5% vs. 16.5%), and Black (29.4%), Hispanic (20.3%), and indigenous (18.8%) households are more likely to live in poverty than Asian (12.3%) or non-Hispanic white (12.9%) households.8

Severe weather events cause economic shocks that contribute to financial instability. Severe weather events in the past decade include severe flooding; tornados and flooding due to multiple hurricanes. Severe weather events are projected to increase in both frequency and severity due to climate change.  The number of tornadoes in recent decades has been steadily increasing. From 2000-2009, there was an average of 48 tornadoes per year. In 2010-2019, the frequency of tornadoes increased to over 58 tornadoes per year across the state.9 In 2023, historically low levels of rainfall combined with historically high temperatures contributed to large scale wildfires in multiple regions of the state and saltwater intrusion into the Mississippi river.  The intrusion of saltwater into Louisiana’s coastal communities and into the Mississippi river has the potential to threaten agricultural production and sources of drinking water for much of the greater New Orleans, Eastern Acadia, and Western Acadiana regions of the state. 

Poverty is both cause and consequence of negative health outcomes. For families including children and youth with special healthcare needs (CYSHCN), poverty poses unique challenges including balancing employment and income generation with caretaking roles. Regardless of insurance coverage, families that include CYSHCN face significant out-of-pocket expenses related to accessing health services. While these out of pocket expenses contribute to economic insecurity, the effects of economic insecurity (including lack of sufficient nutrition, increased exposure to environmental risks/hazards, and decreased access to health information and services) contribute to increased prevalence of special healthcare needs. The bidirectional causal link creates a vicious downward spiral perpetuating both high poverty rates and high prevalence rates of special healthcare needs.

While Louisiana’s oil and gas industry has been a significant contributor to the state’s economy, the air and water pollution created by petrochemical production sites present a significant hazard to workers and surrounding communities.  Families living in Louisiana’s industrial corridor, including communities along the Mississippi river between Baton Rouge and New Orleans, are at higher risk of multiple health conditions associated with exposure to hazardous air and water toxics.

According to the Program for the International Assessment of Adult Competencies (PIAAC), 27% of adults in Louisiana have a literacy rate below Level 1 (the lowest level) and 42% of the state had numeracy skills at or below Level 1.  Level 1 literacy rates were lowest in the Northwest Mississippi Delta region.  In East Carroll Parish, which borders both Mississippi and Arkansas, over 50% of the population had a literacy skills of Level 1 or below and 77% had numeracy skills of Level 1 or below.10

Mental health care access remains a challenge for many in Louisiana. 1 in 5 adults in Louisiana experience mental illness.11 181,000 adults in Louisiana reported needing treatment but not receiving it in 2018-2019. Furthermore, 74,000 Louisiana adolescents experience a major depressive episode each year.11 As of December 2023, Louisiana has 175 Mental Health Care Professional Shortage Areas as designated by the HRSA’s Bureau of Health Workforce. More than 3.6 million Louisianans live in areas without enough mental health services.12

Louisiana’s history of colonization, slavery, and legalized discrimination affected portions of Louisiana’s population over multiple centuries. While laws and policies have changed over time, some continue to have a significant impact, resulting in persistent disparities between rural/urban households, households with different levels of income, households of different race/ethnicity categories, and households including children and youth with special healthcare needs.

Louisiana has one of the highest incarceration rates in the world. According to the Prison Policy Initiative, 1953 people per 100,000 are detained in prisons, jails, immigration detention, and juvenile justice facilities, compared to 565 nationally.13 This rate is impacted by sentencing laws for non-violent offenses, insufficient funding of jails and prisons, privatization of facilities, and a lack of investment in services and supports.  

Key strengths and assets available to support improved health for Louisiana’s MCH populations include expansion of Medicaid, a long-standing commitment to children’s health and wellbeing, and continued investments in early childhood care and education programs. In 2022, Louisiana was among the first states in the country to expand Medicaid postpartum coverage to 12 months.  

Historically, Louisiana had one of the highest uninsured rates in the nation. In July of 2016, Medicaid was expanded to all adults under 138% of the federal poverty line (FPL) (children were not part of this expansion population because children in that income range are already eligible for public insurance coverage). With that change in health policy, Louisiana experienced one of the largest reductions in the uninsured rate for any state. With the expansion of Medicaid, more than 516,000 adult men and women have gained health care coverage under public insurance. Medicaid is now responsible for approximately 1.5 million child and adult participants in Louisiana.14 Furthermore, Medicaid expansion has had a significantly positive impact on Louisiana’s economy: within the first year of Medicaid expansion, more than 19,000 new jobs were created and $178 million in new state and local revenues were generated.15 Economic gains are expected to continue, with the state projected to save $1 billion by 2028 due to Medicaid expansion.16

In April of 2022, Louisiana became the first state to expand Medicaid coverage from 60 days to 12-months postpartum. Over 60% of births in Louisiana are covered by Medicaid.17 Effective January 1, 2024, Louisiana Revised Statute 22:1059.2 requires private health plans regulated in Louisiana to include coverage for doula care. Doulas offering services that are to be covered by insurance must be registered with the Louisiana Doula Registry Board.  

Another strength in Louisiana is the long-standing commitment to facilitating healthcare coverage for children. Louisiana has achieved and sustained high rates of coverage for children. Between 2009 and 2016, the percentage of uninsured children decreased from 7% to 3%, and this decrease has been sustained for several years.14

Louisiana's early care and education system has also undergone significant change in an effort to better serve the state's families. Child care licensing was unified with other early education programs under the Louisiana Department of Education in 2015 in order to create a cohesive early childhood system and improve school readiness. This system has continued to stabilize and mature, though access to childcare subsidies remains more limited than a decade ago.  According to the State of Babies Yearbook 2023, Louisiana lags behind the national averages for nearly every measure associated with positive early learning experiences.18

Other assets in the state include its strong communities of faith, academic and social institutions, and culture of community gathering and festivity.  According to a March 2024 Household Pulse Survey, Louisiana has the highest rate of regular participation in religious services of any state in the country.19 Louisiana is home to thirteen universities, including six Historically Black Colleges and Universities (HBCUs). In 2024, Xavier University of Louisiana, a leading undergraduate institution in preparing Black students to successfully complete medical school, announced an expansion of their partnership with Ochsner Health, the Gulf South’s leading academic medical center in training physicians, to launch the Xavier Ochsner College of Medicine.  The Xavier Ochsner College of Medicine is the only Historically Black College and University (HBCU) medical school in the Gulf South.

The defined roles, responsibilities, and targeted interests of the state health agency and how they influence the delivery of Title V services

The Louisiana Department of Health includes the Office of the Secretary; Office of Aging and Adult Services; Office of Behavioral Health; Office for Citizens with Developmental Disabilities; Bureau of Health Services Financing (Medicaid); Office of Public Health; Office of Women’s Health and Community Health; five 24-hour healthcare facilities; Legal, Audit, and Regulatory Compliance; nine Human Services Districts and Authorities (HSDAs); Louisiana Emergency Response Network; and the Developmental Disabilities Council.

The Office of the Secretary (OS) is comprised of LDH’s Executive Management Team as well as the teams that handle centralized LDH functions, including internal and external communications; legislative and governmental relations; policy and QI; human resources; training and staff development; legal, audit, and regulatory compliance; finance; and budget.

The Office of Aging and Adult Services (OAAS) develops, provides, and enhances services that offer meaningful choices for people in need of care in long-term care facilities and in-home and residential settings through home- and community-based services.

The Office of Behavioral Health (OBH) manages and delivers the services and supports necessary to improve the quality of life for residents living with mental health challenges and substance-related and addictive disorders. This program office monitors and serves as subject matter consultant for the children’s Coordinated System of Care program and the Medicaid Healthy Louisiana managed care plans, which manage behavioral health services. OBH also delivers direct care through hospitalization and has oversight of behavioral health community-based treatment programs through the HSDAs. Services are provided for Medicaid and non-Medicaid eligible populations.

The Office for Citizens with Developmental Disabilities (OCDD) serves as the single point of entry into the developmental disabilities services system, overseeing public and private residential services and other services for those living with developmental disabilities. This program office works to ensure individuals living with developmental disabilities and their families have access to a seamless services system that is responsive to both individual needs and desires. In addition, OCDD promotes partnerships and relationships that empower people living with developmental disabilities’ to more fully participate in family and community social and economic life.

Medicaid provides government-subsidized medical benefits to qualifying low-income individuals and families. Although the federal government establishes the general rules for Medicaid, specific requirements are established by each state. In Louisiana, more than 1.8 million residents receive healthcare coverage through Medicaid.

The Office of Public Health (OPH) is responsible for protecting and promoting the health and wellness of all individuals and communities in Louisiana. OPH accomplishes this through educational initiatives, promoting healthy lifestyles, preventing disease and injury, enforcing regulations that protect the environment, sharing vital information, and assuring preventive services to uninsured and underserved individuals and families. This office also monitors the food Louisiana’s residents and visitors eat; keeps our water safe to drink; fights chronic and communicable disease; ensures we are ready for hurricanes, disasters, and other threats; manages, analyzes, and disseminates public health data; ensures access to vital records like birth certificates; and improves health outcomes with an emphasis on preventive health services.

The Office of Women’s Health and Community Health (OWHCH), created in 2022, serves as a clearinghouse, coordinating agency, and resource center for women’s health data and strategies, services, programs, and initiatives that address women’s health-related concerns. The OWHCH focuses on health needs throughout a woman’s life, including chronic or acute conditions that significantly affect women, access to healthcare for women, and women’s health disparities. OWHCH is also charged with developing and implementing agency-wide plans to reduce health disparities and support the implementation of community engagement practices and standards across LDH.

LDH also operates five 24-hour healthcare facilities. These facilities include the Central Louisiana State Hospital, Central Louisiana Supports and Services Center, Eastern Louisiana Mental Health System, Pinecrest Supports and Services Center, and the Villa Feliciana Medical Complex. Together, these facilities provide behavioral health, developmental disability, and long-term care services for over 1,400 Louisiana residents.

Legal, Audit, and Regulatory Compliance (LARC) includes the Bureau of Legal Services, Internal Audit, Program Integrity, and Health Standards sections of LDH. The Bureau of Legal Services is the legal arm of the Department and is responsible for handling all legal matters including procurement and the provision of legal advice around state and federal regulations applicable to all Department offices. The Internal Audit Section is responsible for conducting internal audits of various Department programs to ensure efficient operations and appropriate controls geared at maintaining programmatic integrity. The Internal Audit section additionally acts as the liaison for the Department with the Legislative Auditor, and other audit entities, regarding external audits of the Department’s programs. The Program Integrity section is responsible for ensuring programmatic and fiscal integrity of the Department’s Medicaid program, along with other Medicaid-funded programming provided by other departments. Program Integrity is responsible for monitoring Medicaid-funded programs for provider and/or recipient fraud, waste, or abuse. Finally, the Health Standards Section is responsible for the licensing and certification of various healthcare facilities in Louisiana, which includes ensuring that facilities are maintaining compliance with applicable standards, statutes, rules, regulations, and policies. This is accomplished through periodic surveys and inspections, including complaint investigations of providers that are subject to licensure and/or certification by the Department.

Human Services Districts and Authorities (HSDAs), also known as local governing entities (LGEs), are established by Louisiana state law to direct the operation and management of community-based programs and services relative to mental health, intellectual / developmental disabilities and challenges, and substance-related and addictive disorders. HSDAs were established by Louisiana state law beginning in 1989 with the last entity authorized in 2013.

The Louisiana Emergency Response Network (LERN) is responsible for developing and maintaining a statewide system of care coordination for patients suddenly stricken by serious traumatic injury or time-sensitive illness (such as heart attack and stroke). It is a system also designated to serve as a vital healthcare resource in the face of large-scale emergencies and natural disasters.

The Developmental Disability Council’s mission is to increase independence, self-determination, productivity, integration, and participation for Louisianans with developmental disabilities and challenges by engaging in advocacy, capacity building, and systems change.

In 2025, legislation was adopted to streamline the mandate of the Department of Children and Family Services (DCFS). DCFS will continue to oversee child protective services, human trafficking prevention, adoption services, and prevention of child abuse and neglect.  Programs including the Family Independence Temporary Assistance (FITAP) Program and Temporary Assistance to Needy Families (TANF) Program will be transitioned to Louisiana Works, formerly the Louisiana Workforce Commission. The Supplemental Nutrition Assistance Program (SNAP) will also be transitioned from DCFS to the Department of Health.  

State-specific statutes and regulations 

Statutes and regulations relevant to maternal and infant health

Statutes and regulations relevant to child and adolescent health

Statutes and regulations relevant to children and youth with special healthcare needs (CYSHCN) health

Statutes and regulations relevant to the MCH block grant authority and its impact on LA’s MCH and CYSHCN systems of care