Demographics, Geography, Economy, and Urbanization

 

Mississippi encompasses nearly 47,000 square miles, making it the thirty-second largest state by total area in the nation. The state is geographically located in the southeastern portion of the United States and is named for the river that flows along its western border. Mississippi is bordered by Tennessee to the north; Alabama to the east; Louisiana and a narrow coast on the Gulf of Mexico to the south; and across the Mississippi River, by Louisiana and Arkansas to the west. Mississippi's physical features are lowland with the hilliest portion located in the northeast section of the state, where the foothills of the Appalachians cross the border, and Woodall Mountain rises to 806 feet. However, the mean elevation for the entire state is only 300 feet. From east central Mississippi heading south, the land contains large concentrations of piney woods, which give way to coastal plains towards the Gulf Coast.

 

Southwest Mississippi tends to be quite rural with significant timber stands. The Mississippi Delta, the northwest section of the state, is technically an alluvial plain, created over thousands of years by the deposition of silt over the area during repeated flooding of the Mississippi River. The Delta is exceedingly flat and contains some of the world's richest soil. Mississippi leads the nation in catfish production, and the Mississippi Delta is the birthplace of the Blues, which preceded the birth of Jazz, the only other original American art form.

 

The residents of Mississippi are dispersed throughout 82 counties and 298 incorporated municipalities. While three‐fourths of the state’s citizens reside in one of these incorporated places, most of these cities and towns are small. As of July 2022, Jackson, the state’s capital and largest city, had a population of 145,995 and the next largest city is Gulfport, with a population estimate of 72,236. The state is predominantly rural, where 65 (79.3%) of the 82 counties are considered rural areas. Mississippi has three standard metropolitan statistical areas (MSA): the Jackson Metropolitan Area (Hinds, Madison, and Rankin Counties); the Hattiesburg area (Forrest and Lamar Counties); and the Gulf Coast Region (Hancock, Harrison, and Jackson Counties). Desoto County, located in North Mississippi, is included in the Memphis, Tennessee MSA. All 82 counties in Mississippi are designated whole or in part as medically underserved areas, according to the Health Resources and Services Administration (HRSA).

 

Mississippi’s population is estimated to be 2,940,057. In comparison to the United States, Mississippi is less racially and ethnically diverse. However, the state has the largest Black / African American population in the United States. Mississippi has slightly higher rates of homeownership and a lack of health insurance coverage. Additionally, Mississippi has a slightly lower percentage of its population with a high school education or higher, a lower employment rate, and a higher rate of children living in poverty. The tables below depict comparison rates between Mississippi and the United States, based on the July 1, 2022 Census Bureau population estimates, for several of these factors.

 

Race	Mississippi (%)	United States (%)
White	58.8	75.5
Black	37.8	13.6
Two or more races	1.5	3.0
Asian	1.2	6.3
American Indian and Alaska Native	0.6	1.3
Native Hawaiian and Other Pacific Islander	0.1	0.3

 

Ethnicity	Mississippi (%)	United States (%)
Hispanic	3.6	19.1
Non-Hispanic	96.4	80.9

 

Socioeconomic Factors	Mississippi (%)	United States (%)
High school graduate or higher	85.6	88.9
Unemployment rate (July 2021)	3.8	3.5
Homeownership rate	68.9	64.6
Children in poverty (<18 yrs)	28.1	16.8
Persons in poverty (all ages)	19.4	11.6
Persons without health insurance (<65 yrs)	14.2	9.8

 

Health Status of Mississippi’s MCH Population

 

According to America’s Health Rankings, Mississippi ranked 49th in overall health in 2022. Historically, Mississippi has consistently ranked at the bottom for overall health. Similarly, there are several MCH population indicators that continue to have severe challenges, including infant mortality and food insecurity. However, Mississippi shows strength on a few MCH indicators that include a high enrollment level in early childhood education and a low percentage of housing with lead risk. Based on America’s Women and Children report, a sub-report of America’s Health Rankings, Mississippi ranked 40th overall in Women’s Health and 41st overall in Children’s Health.

 

State’s Strengths and Challenges

 

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

 

Mississippians receive health care from a variety of sources that provide a continuum of care. The health care delivery system in Mississippi includes services for long-term care, care for the aged, and those with intellectual disabilities; mental health care, including psychiatric, chemical dependency, and long-term residential treatment facilities; perinatal care; acute care, including various types of diagnostic and therapeutic services; ambulatory care, including outpatient services and freestanding ambulatory surgical centers; comprehensive medical rehabilitation; home health services; and end stage renal disease facilities. Mississippi has 31 critical access hospitals, 50 rural hospitals with 49 beds or less, 208 Federally Qualified Community Health Centers, and 186 Rural Health Clinics.

 

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

 

Despite the health benefits to infants and mothers, Mississippi shows below average rates of breastfeeding. The Center for Disease Control and Prevention’s 2022 Breastfeeding Report Card reports that for infants born in 2019 in Mississippi, 69.4% started out receiving some breast milk (compared to 83.2% nationally), 35.7% were breastfeeding at 6 months (compared to 55.8% nationally), 22.2% were breastfeeding at 12 months (compared to 35.9% nationally), 31.1% were exclusively breastfeeding through 3 months (compared to 45.3% nationally), 15.6% were exclusively breastfeeding through 6 months (compared to 24.9% nationally), and 21.2% of breastfed infants received formula before 2 days of age (compared to 19.2% nationally).

 

Even so, Mississippi has had success in this area. Every two years, the CDC invites all hospitals to participate in a survey on their hospital maternity care practices that support healthy nutrition for infants, resulting in a Maternity Practices in Infant Nutrition and Care (mPINC) score, ranging from 0 to 100, with higher scores indicating better maternity care practices and policies. Mississippi’s mPINC score for 2022 is 82 (compared to 81 nationally). In addition, over 50% of live births occur at Baby-Friendly facilities (compared to 27% nationally).

 

According to 2022 America’s Health Rankings, the percentage of infants exclusively breastfed for six months increased 17%, from 11.1% to 13.0%; tobacco use during pregnancy decreased 13%, from 10.2% to 8.9%; of live births, teen births decreased 11% from 34.8 to 31.0 births per 1,000 females ages 15-19; meningococcal immunization among children ages 13-17 increased 37%, from 46.0% to 63.0%; Tdap immunization among children ages 13-17 increased 31%, from 70.8% to 92.4%; and physical inactivity among women ages 18-44 decreased 20% from 34.4% to 27.6%. These improvements show the progress of our state and Mississippi’s desire to improve its health rankings.

 

Mississippi has also shown steady improvement in education rankings moving from 50th in 2013 to 35th in 2021 according to the Quality Counts National Report. The state maintained its historic gains in 4th grade reading on the 2022 National Assessment of Educational Progress (NAEP), while nationally scores dropped in all four NAEP subjects and grades.  Based on information from the Mississippi Department of Education (MDE) statewide results from the 2021-22 Mississippi Academic Assessment Program (MAAP) show student achievement exceeding pre-pandemic levels in English Language Arts (ELA) and science and nearly tying in mathematics. Overall, the percentage of students scoring proficient or advanced reached an all-time high of 42.2% in ELA and 55.9% in science, and reached 47.3% in mathematics, just shy of the pre-pandemic rate of 47.4%.

 

As such, Mississippi is a leader among the few states that have shown improvements on one or more NAEP assessments over the past decade. Specifically

• Mississippi achieved significant gains in 4th grade reading and math since 2011.
• Along with Washington D.C., Mississippi is the only state or jurisdiction that improved over a 10-year period in two of the four core NAEP subjects.
• Mississippi is one of only two states with improved 4th grade math scores over a decade and one of only three states with gains in 4th grade reading.
• In 8th grade, Mississippi scores remained flat in reading and math over the past decade while the average scores nationally dropped in both subjects

 

While Mississippi has more improvements to make, substantial progress has been made through the state’s steady achievement in education.

 

Despite these strengths and efforts, significant challenges still exist. Mississippi is still ranked last among all states for overall health system according to the Commonwealth Fund. Mississippi ranks 49th for access and affordability, 48th for prevention and treatment, 43rd for avoidable hospital use and costs, 30th for income disparity, and 50th for healthy lives.

 

Mississippians, including our children, are routinely ranked as the fattest in the country and we lead the nation in high blood pressure, diabetes, and adult inactivity. The Delta region, which is well known for its poverty and rural characteristics, is at even greater risk for health problems because of lack of accessibility and availability of medical care. An estimated 60% of Delta residents live below the poverty level. In 2021, as part of the Behavioral Risk Factor Surveillance System (BRFSS), 13.1% of Mississippians surveyed said they were unable to see a doctor at some point in the prior twelve months because of cost.

 

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

 

Akin to challenges for CYSHCN and other vulnerable populations, progress in improving maternal health outcomes is stunted due to inadequate access to obstetric and post-partum care. According to a report released by the March of Dimes in November 2022, more than half of Mississippi counties are considered maternity care deserts. A maternity care desert is one in which there are no hospitals providing obstetric care, no OB-GYNs, and no certified nurse midwives. It is important to note that since the report was released, additional hospitals that had provided obstetric care have closed, further widening the gap between those in need of help and the locations they can access it.

 

Understanding the composition of the state will help provide a measure to what is occurring within the health care needs of the population. The U.S. Census Quick facts as of July 1, 2022, reported Mississippi’s population as 2,940,057, with 51.4% female, 48.6% male. Compared to the nation, a substantially larger percent of the Mississippi population is Black (37.8% vs. 13.6%) and substantially small percentages of the state population are Latinix (3.6% vs. 19.1%) and white (58.8% vs. 75.5%). 

 

State Health Agency Roles, Responsibilities, and Priorities

 

Within MSDH, MCH/Title V is administered by the Division of Health Services. Health Services oversees the provision of services and programs in five Offices spanning the life course: a) Women’s / Maternal Health, including Breast and Cervical Cancer Program (BCCP), Healthy Moms/Healthy Babies (HM/HB) Perinatal Case Management, the Maternal and Infant Health Bureau, and Family Planning/Comprehensive Reproductive Health; (b) Child and Adolescent Health, including Genetics/Newborn Screening and Birth Defects (NBS), Early Hearing Detection and Intervention (EHDI), Early Periodic Screening, Diagnosis, and Treatment (EPSDT), Early Intervention (EI), Lead Poisoning Prevention and Healthy Homes (LPPHH), Maternal, Infant, and Early Childhood Home Visiting (MIECHV), Adolescent Health, and Children and Youth with Special Health Care Needs (CYSHCN) programs; (c) the Women, Infants and Children's Nutrition Program (WIC); (d) Oral Health; (e) Workforce Development; and (f) Financial Management and Operations.

 

The Health Services Division partners with the Office of Health Data and Research (OHDR) which assists the MCH Programs in data management, surveillance, data analysis, reporting, and program evaluation on MCH populations. The Health Services Division also partners with other Offices throughout the MSDH to support women, infants, children, and adolescents, such as the Office of Preventive Health (OPE), the Public Health Pharmacy, and the Office of Vital Records and Public Health Statistics.

 

Office and Program Organization and Descriptions

 

The Office of Women’s Health oversees the following programs and bureaus:

 

The Mississippi Breast and Cervical Cancer Program (BCCP) strives for early detection of breast and cervical cancer in those women at highest risk, including the uninsured, the medically underserved, minority, and women 40 and older. These women are more likely to have advanced disease when symptoms appear, reflecting differences in access to screening and care. The program provides education and promotes access to free screenings for breast and cervical cancer provided in partnership with screening providers in all Mississippi counties. BCCP has a broad network of approximately 120 contracted providers offering BCCP-supported services at over 290 sites throughout the state. These providers include federally qualified community health centers, health department clinics, private family physicians and other primary care providers, hospitals, ambulatory surgery centers, surgeons, radiologists, medical oncologists, and laboratories throughout the state. Using a fee-for-service reimbursement model, providers are reimbursed at the Medicare rate for allowable BCCP procedures. With federal (CDC) and matching funds, mammography screening is available through contracted providers to uninsured women between 50 and 64 years of age. Women under 49 years old and younger with positive breast symptoms are eligible for diagnostic screenings. Asymptomatic women 40-49 years old are eligible for screening mammograms only when special funding, such as that from NBCF is available. Timely follow-up and support is provided for all women with clinical findings through their enrolling providers. Timely referral to Medicaid for women diagnosed with cancer is provided directly through the BCCP clinical staff to expedite coverage for treatment.

 

The Healthy Moms/Healthy Babies of Mississippi program is a Medicaid-reimbursed targeted (perinatal) case management (TCM) program for high-risk pregnant women and their babies less than one year old. HM/HB partners with patients, communities, and medical providers to provide enhanced access to health care, nutritional and psychosocial support, home visits, and health education. The program aims to decrease preterm births, improve maternal health, decrease infant and maternal mortality, and support infant development. Key activities of targeted case management include: securing a medical home for mother and/or her infant, identifying family and community supports, providing referrals for enabling and supportive services such as Medicaid, food stamps (SNAP), WIC, family planning, mental health, transportation, housing, medical services, childcare, employment services, and breastfeeding assistance, providing postpartum home visits to assess the health and condition of mother and infant, and offering health education, such as preparing for the hospital, urgent maternal and post-partum warning signs, depression, anxiety, caring for baby, infant safety, and healthy infant development. The program receives referrals from health department clinics, other MCH-serving programs, birthing hospitals, OB-GYN practices, other health settings, and Medicaid coordinated care organizations (CCOs) and is available to residents of all 82 Mississippi counties.

 

The Maternal and Infant Health Bureau (MIHB), aims to reduce maternal and infant morbidity and mortality by understanding the causes of deaths through surveillance, review, and abstraction of records for infants, children, and women (pregnancy-related). MIHB further utilizes the information and recommendations gathered through review to engage health systems and communities to implement quality improvement initiatives and prevention strategies. MIHB utilizes strategies such as multidisciplinary review teams with guidance and technical assistance from the National Center for Fatality Review and Prevention (NCFRP) and the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM). Strategies included in the report for the Fetal and Infant Mortality Review (FIMR), Child Death Review (CDR), and Maternal Mortality Review Committee (MMRC) are aligned with processes developed and guided by the NCFRP and the MMRC.  Recommendations produced through these actions are carried out by MIHB community and health-setting based partners. MIHB further utilizes strategies such as quality improvement initiatives with guidance from the National Network of Perinatal Quality Collaboratives (NNPQC) and the Alliance for Innovation on Maternal Health (AIM). NNPQC is a partnership between the CDC and March of Dimes to support state perinatal quality collaboratives in making measurable improvements in statewide health care and health outcomes for mothers and babies. AIM is a national data-driven maternal safety and quality improvement initiative based on proven safety and quality implementation strategies that reduce preventable maternal mortality and severe morbidity.

 

MSDH continues to provide access to Family Planning/Comprehensive Reproductive Health through its county health department clinics to residents across the state. MSDH is a Medicaid Family Planning Waiver provider and receives reimbursement from the MS Division of Medicaid. The Medicaid FPW is accessible to female and male persons ages 13-44, with family income at or below 194% of the FPL, who are not currently pregnant and who have not had a vasectomy, tubal ligation, or hysterectomy. FPW assists beneficiaries who are not ready to have a child. Under the FPW, MSDH provides physical exams, which may include a medical history with a height weight, and blood pressure, Pap test, and clinical breast exam. Additionally, the clinics provides family planning counseling & education on all birth control methods, including abstinence and natural family planning, testing for pregnancy, HIV, and sexually-transmitted diseases, birth control supplies, contraceptive methods, and pre-conception counseling to help plan future pregnancies. Effective March 31, 2023, MSDH is no longer the Title X federal funding recipient. Patients who desire services that would be covered under Title X (i.e., free, confidential, minor, undocumented individuals, etc.) are referred to a Title X or other provider when MSDH cannot meet their needs.

 

The Office of Child and Adolescent Health oversees the following programs and bureaus:

 

The Genetic Services Bureau houses the Mississippi Newborn Screening, Chronic Congenital Heart Defects (CCHD), and Early Hearing Detection and Intervention (EHDI) Programs and the Birth Defects Registry. MS Code §§ 41-21-201; 41-21-203 requires all newborns to be screened in accordance with the National Recommended Uniform Screening Panel (RUSP). The Genetics Services programs provide short-term follow-up for newborns identified through bloodspot and point of service, ensuring repeat screens are conducted when needed, families are referred to specialists for confirmatory testing, and families of children with identified conditions or risks are connected with long-term follow-up and care/service coordination. These programs partner with birthing hospitals, tertiary clinics, and pediatric facilities statewide as well as internal MSDH field services, CYSHCN, early intervention, and social services. The EHDI program also provides peer-to-peer family support for families of children with confirmed hearing loss as well as access to Deaf/Hard of Hearing role models. The Genetics Services programs ensure all newborns born in Mississippi receive timely newborn screening (i.e., 12-24 hours of birth for hearing screening and 24-48 hours of birth for bloodspot collection and CCHD screen). The NBS program partners with PerkinElmer, the state lab, which receives bloodspot cards, analyzes the samples, and provides results entered in the MSDH electronic health records database, EPIC. The Genetics Services programs also provide education for healthcare and intervention professionals on newborn screening and long-term care and treatment for children with conditions identified at birth. The Genetic Services programs aim to reduce infant mortality and morbidity of Mississippi Newborns with genetic conditions through early detection and treatment and ensure children are provided access to care for follow-up, diagnosis, intervention, and care coordination.

 

The MSDH clinic nurses are Medicaid recognized providers of Early Periodic Screening, Diagnosis, and Treatment (EPSDT) services in Mississippi as a gap filling service offered in areas with limited primary care providers. Children are provided well-child screenings according to the Bright Futures Periodicity Schedule.  All children whose screens indicate needs are referred to a general practitioner or specialty provider for diagnosis and/or treatment and to a local primary care provider or community health center for continuity of care (wellness and sick care) in a medical home, and long-term follow-up as needed and available. Many of the children who receive EPSDT screening are eligible for and are referred to internal MCH home visiting or service/care coordination programs.

 

The Mississippi First Steps Early Intervention Program (MSFSEIP) is the Individuals with Disabilities Act (IDEA) Part C program in Mississippi. The MSFSEIP is responsible for coordinating a statewide comprehensive interagency system of early intervention supports and services (EISS) for infants and toddlers under three years of age with a developmental delay or condition likely to lead to a developmental delay and their families. The MSFSEIP coordinates with healthcare providers, early childhood care and education providers, and families across the state to ensure infants and toddlers with identified disabilities and/or developmental delays are identified, evaluated, and receive timely, comprehensive, and family-centered services. The MSFSEIP is composed of a state office, three regional offices, and nine local early intervention programs (LEIPs). All offices participate in public awareness campaigns and outreach to conduct Child Find activities, including promotion of developmental screening, monitoring by primary care and childcare providers, and conducting of developmental screening for infants and toddlers referred from Child Protective Services. The MSFSEIP State Office provides training, guidance, and oversight to the regional offices and LEIPs. The regional offices recruit and form agreements with local providers of early intervention services, such as physical, occupational, and speech therapists, to participate in the EI system. Each LEIP has a Program Coordinator and multiple Service Coordinators who are assigned to provide ongoing support, from intake through transition to school- and/or community-based services, and referrals to participating service providers who educate and support families in understanding their children’s special needs and helping them help their children grow, develop, and learn.

 

The Mississippi LPPHHP was established as a result of the federal law (42 U.S.C. at 1936a) requiring states to screen children enrolled in Medicaid for elevated blood lead levels (EBLLs) as a part of prevention services provided through the Early and Periodic Screening, Diagnosis and Treatment Program (ESPDT). The statewide program provides practical prevention measures through care coordination, education, policy intervention, and risk reduction activities for children and their families. Families of children with a confirmed venous blood lead level (BLL) greater than or equal to 3.5 micrograms per deciliter (µg/dL) receive care coordination services (i.e., telephone counseling, home visit; environmental assessments, lead poisoning prevention, healthy homes assessments, and Sudden Infant Death Syndrome** education; nutritional counseling and referrals) which are designed to identify lead and other environmental home health hazards, and provide recommendations for decreasing hazards. Additionally, as required by the MSDH’s Reportable Diseases and Conditions policies and procedures; all laboratories and medical facilities throughout the state are required to report all blood lead levels to MSDH. This data is analyzed to determine the status of lead poisoning and healthy homes issues in the state, and to identify high-risk areas to target education, outreach, and policy interventions.

 

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is the newest program to be implemented within the MCH system. In May 2023, MSDH was awarded the MIECHV grant. The program is currently under development. Once implemented, the program will provide evidence-based home visiting services to families and children at risk for poor maternal and child health outcomes. Services will include up to weekly personal visits, monthly community educational and networking meetings, regular health and developmental screening, and referrals for additional services and resources as needed.

 

The Adolescent Health program promotes the health of adolescents by strengthening the state-level public health capacity and infrastructure for their access to preventive care, mental health resources, and other developmentally appropriate services. Recognizing how crucial this developmental period is, given the physical, emotional, and intellectual changes as well as changes in social roles, relationships, and expectations, the program focuses on the elimination of health disparities and inequities that affect young people and advances leadership practices for MCH at the national, state and local levels for adolescence (ages 10-17) and young adulthood (ages 18-21).

 

The Children and Youth with Special Healthcare Needs (CYSHCN) program provides family-centered care coordination services for children and youth with special health care needs from birth to 21 years of age. CYSHCN are defined as "those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services of a type or amount beyond that required by children generally. Care Coordination is provided through a statewide, comprehensive, coordinated, multi-disciplinary, system of care by the health department system and primary care practices for children and youth with special health care needs, their families, and caregivers.  Personal contact with the family as soon as possible after diagnosis provides an opportunity to counsel, provide literature, answer questions, initiate referral, establish local medical home and coordinate tertiary center, specialty clinic and/or physician appointments as needed. This service is available to state residents who were born with a special health care need or developed a chronic illness (not due to accident or injury).

 

The Office of WIC oversees the administration of WIC Special Supplemental Nutrition Program and Breastfeeding Promotion and Support Program:

 

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public health program funded and guided by the United States Department of Agriculture (USDA) Food and Nutrition Services (FNS) to safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to healthcare. WIC serves pregnant women, breastfeeding women, postpartum non-breastfeeding women, infants, and children less than five years of age who live in Mississippi and meet income requirements.

 

WIC provides nutritious foods via a network of retail vendors using an electronic benefit card, referred to as an eWIC card. This includes full-service grocery stores that provide WIC-approved food items and pharmacies that provide special medical formula and WIC-eligible nutritional supplements. MSDH WIC currently authorizes 273 retail vendors across 78 counties, including 104 grocery stores, 157 grocery stores with a pharmacy on site, and 12 free-standing pharmacies. The WIC Shipping and Receiving Unit orders and ships special medical formula and WIC-eligible nutritional supplements to clinics for participants who have access issues. The WIC Breastfeeding Promotion and Support Program focuses on the personal, local, regional, and state advantages of breastfeeding. WIC staff provide breastfeeding information and support to all pregnant and breastfeeding women receiving services from the Mississippi WIC Program to enhance the breastfeeding experience. The MSDH WIC Program serves as an adjunct to good health care by providing peer support, breastfeeding management, information, and assistance throughout the prenatal and postpartum period.

 

The Office of Oral Health works across agency departments to implement programs to prevent oral diseases. The Office is responsible for assessment, policy and program development, and assurance in the prevention and control of oral diseases. Programs address oral health access and use of services for children and adolescents, adults, families and communities through public health clinics, schools, and licensed medical and dental health providers. Among its many activities, the fluoride program supports communities to adopt community water fluoridation. Additionally, the dental sealants program, Mississippi Seals, provides preventive dental services in schools throughout the state. Oral health screenings, dental sealants, and fluoride varnish applications are provided on-site in schools in collaboration with dental professionals in the community. As a workforce development and capacity building approach, the program offers opportunities for students to shadow and intern with the office to expose them to public health dentistry and statewide oral health disparities. As funding permits, the program also provides Dental Admission Test (DAT) preparations and assistance with applying to dental school. While the program does not offer direct services at county health departments, it employs Regional Oral Health Consultants (ROHCs) who are state licensed dental hygienists who assist with grass roots implementation of all programs and trainings. The ROHCs strive to improve the oral health of all Mississippians by assisting county health departments to deliver age-appropriate oral health anticipatory guidance and preventive oral health services in each public health district. ROHCs and other team members promote information sharing between health professionals and community stakeholders to educate the public about the importance of good oral health and to reduce the burden of oral disease. The ROHCs also represent the agency, MCH, and the oral health program at schools, health fairs, and other public-facing settings where education and outreach are most needed. The Office of Oral Health is committed to creating a culture of health in Mississippi that includes oral health through oral health promotion, oral disease prevention, oral health surveillance and dental care coordination over one’s lifespan.

 

The MCH Workforce Development Office was established to support workforce development, training, and capacity building to meet the needs of the MSDH Health Service and MCH programs. There are three components within this office: professional development for existing public health personnel; building a pipeline from preservice programs to public health; and providing social service support to Title V and Health Service programs via an integrated public health social work team. The Office is currently responsible for assessing, coordinating, and providing Health Services personnel foundational knowledge surrounding public health, Title V, and MCH and is in development to expand its reach to assess, coordinate, and provide training to other MSDH Offices and external partners throughout the state. The office develops agreements between MSDH and in-state and out-of-state Institutes from Higher Learning to offer internships within MCH programs aligned with student interests.

 

The Office of Financial Management and Operations oversees all MCH budget expenditures and supports programs in developing budgets and tracking expenditures. Computer generated cumulative expenditures, transaction listings and spending/receipt plans are available in electronic format for all MCH programs.

 

Title V aligns with the MSDH mission by focusing its primary mission to programs that promote and improve the health and well-being of Mississippi’s mothers, infants, adolescents, and children, including children with special needs, and their families. The identified MCH program priorities relate to the state’s MCH population, with MSDH being committed to improving the health and well-being of the MCH population across the life-course.

 

State Systems of Care for Underserved and Vulnerable Populations

 

Mississippi has worked hard to build a system of care that engages the public through heightened organization and improved alignment of policies, practices, goals, financing, and accountability. The intent is to provide the services and support needed to meet the needs of underserved and vulnerable populations, including CYSHCN.

 

Mississippi’s system of care model involves collaboration across agencies, community-based organizations, FQHCs, and various other entities. This approach provides a functional framework for making use of resources to optimize care. Planning, implementation, and evaluation are deliberately designed to include relationships with other systems.

 

The systems of care in Mississippi include but are not limited to:

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

 

Mississippi has 31 Critical Access Hospitals designated to preserve access to local primary and emergency health services. These hospitals are in rural counties with a high prevalence of populations that demonstrate higher rates of obesity, diabetes, preventable hospitalizations, cardiovascular deaths, and cancer deaths as compared to state and national benchmarks. Additionally, they are staffed with fewer physicians and have a higher proportion of patients who live in poverty and are enrolled in Medicaid.

 

Mississippi also has 128 hospitals of which there are ninety-five acute care, four psychiatric, one rehabilitation, one OBGYN and ten long- term acute care facilities. Seven counties in our state do not have a hospital: Amite, Benton, Carroll, Humphreys, Issaquena, Itawamba, and Tunica. A shortage of emergency personnel, including medical technicians and equipment is resulting in increased wait times for responses to rural and medical emergencies.

 

Compared to 2015, we have four comprehensive behavioral health state programs, six intellectual developmental disability regional programs, 2 specialized programs for adolescents and 13 regional centers with county governing authorities.

 

Increased health promotion and prevention efforts, workforce staffing models, telehealth technology inclusion, data bridges to link EMS and trauma care and reform to healthcare coverage and reimbursement are needed provisions to build a healthier Mississippi.

 

Mississippi’s Health Professional Shortage Areas

 

Besides poverty, Mississippi’s inadequate and uneven distribution of providers contributes to the overall poor health of its residents. High quality health care services depend not only on an adequate supply of fully qualified health care professionals, but also an appropriate distribution of these providers for adequate access.

 

Eighty counties are federally designated as either whole or partial-county Health Professional Shortage Areas (HPSAs) for primary care (based on either the low-income population or geography). Seventy-nine counties are designated as dental HPSAs, and all but four counties are designated as mental health HPSAs. All of Mississippi’s 82 counties are designated as either whole or partial-county Medically Underserved Areas (MUAs).

 

In the state of Mississippi there are a total 128 hospitals, with 58 designated government hospitals and 36 private hospitals. There are 42 birthing hospitals in Mississippi. The total number of beds available in Mississippi is 14,986, with 81 hospitals having Helipad facilities.

 

In 2022, Mississippi had a total of 796,778 Medicaid enrollees providing coverage to 27.7% of the state’s population. The state’s average length of hospital stay is on par with the national average hospital stay of 5 days. There is only one children’s specialty hospital in the state, located on the campus of the University of Mississippi Medical Center

 

Distribution of Primary Care Physicians, Dentists, and Psychiatrists in MS
Health Profession Category	% Serving Rural	% Serving Urban (MSAs)
Primary Care Physicians	46% 837 physicians serve 61 rural counties 4 rural counties have no primary care physicians	65% 994 physicians serve 17 urban counties all urban counties have primary care physicians
Dentists	6% 68 dentists serve 59 rural counties 6 rural county has no dentist	94% 997 dentists serve 17 urban counties all urban counties have dentists
Mental Health (Psychiatric Only)	34% 42 psychiatrists serve 59 rural counties 6 rural counties have no psychiatric mental health providers	66% 83 psychiatrists serve 17 urban counties all urban counties have psychiatric mental health providers

 

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

 

To increase access to care, CYSHCN monitors and works closely with patients identified as not having medical health coverage. The program maintains a partnership with the state’s Navigator office. Parents referred are expected to keep their appointments and to submit their letter of eligibility to the program in the processing of their application for services as verification of efforts to obtain affordable healthcare insurance. Similarly, the BCCP Program assists patients by providing direct payments for breast and cervical cancer screening and diagnostic services and provides a direct link for expedited eligibility and Medicaid coverage when a BCCP participant has diagnosed with breast or cervical cancer. Other programs that assist patients to access coverage include the Family Planning/Comprehensive Reproductive Health Program which promotes application to and uptake of Medicaid Family Planning Waiver, and the HM/HB Program which follows women through their pregnancies and up to 60 days postpartum and infants up to 1 year old to assure they understand the Medicaid coverage rules and renewal requirements.

 

State Statutes and Other Regulations Impacting MCH/Title V

 

Newborn Screening Panel

In March 2022, the Mississippi Legislature unanimously passed House Bill 927, amending the comprehensive newborn screening program to align with the Recommended Uniform Screening Panel (RUSP). Under this new state law, the MSDH is required to update the newborn screening panel to include all conditions within three years of inclusion on the RUSP and adopt any rules and regulations needed to accomplish the program or submit a report to the legislature on the status and reasons for the delay. As the Mississippi Panel was already largely compliant with the RUSP, this law will mainly ensure the panel remains current with the advances in science as new diagnostic tests and treatments for conditions are developed. Mississippi is the eighth state in the nation to adopt RUSP alignment legislation.

 

Maternal Mortality Review Committee

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

 

Child Death Review

The Mississippi Child Death Review Panel (CDRP) was established by House Bill 560 becoming in 2006. The legislation is intended to foster the reduction of infant and child mortality and morbidity in Mississippi and to improve the health status of infants and children. The review of these fatalities provide insight on factors that lead to the death, trends of behavior patterns, increases or decreases in the number of causes of death, and gaps in systems and policies that hinder the safety and wellbeing of Mississippi’s children. Through the review process, the CDRP develops recommendations on how to most effectively direct state resources to decrease infant and child deaths in Mississippi. The CDRP reviews all child deaths from birth to under 18 years old due to unnatural causes.