Geography, Demographics, and Economy

Michigan is the only state made up of two peninsulas and has the longest freshwater shoreline in the world. Comprised of 83 counties, Michigan is the 10th most populous state and 11th largest state by total square mileage. Over 10.1 million people live in the state, a new population high for Michigan (U.S. Census Bureau, 2024 Vintage). Compared to other states, Michigan ranked 18th among states for numerical growth from 2023 to 2024 and 34th in percentage of growth. From 2022 to 2023, urban counties experienced population increases, with 83.5% of the state’s population living in urban counties (U.S. Census Bureau, 2023). Most of Michigan’s population resides in the southern half of the Lower Peninsula, with approximately half of the population residing in Southeast Michigan (U.S. Census Bureau, 2023). The state’s largest cities are Detroit, Grand Rapids and Warren.

Over 1.8 million people live in rural areas of the state (U.S Census Bureau, 2020). From July 2020 to 2023, Michigan’s rural population experienced an increase of 9,736 people (0.6%) across 40 counties after decreasing almost every year for a decade (Michigan Center for Data & Analytics, 2024). Despite these short-term population gains, Michigan was estimated to have the 37th lowest birth rate compared to other states (U.S. Census Bureau, 2023 Vintage) with a fertility rate of 1.57 in 2022, well below replacement level (Michigan Center for Data & Analytics, 2024). The median age of the population is 40.1 years old (U.S. Census Bureau, ACS 2019-2023). Out of the total population, 21.0% of residents are less than 18, 34.7% are 18 to 44 years old, and 44.3% are 45 and older (MDHHS, 2022). Within Michigan, 73.7% of the population identifies as White,14.1% as Black or African American, 6% as Hispanic or Latino, 3.6% as Asian, 2.8% as two or more races, and 0.8% as American Indian and Alaska Native (U.S. Census Bureau, 2023 Vintage). Michigan has the country’s second largest population of residents who identify as Middle Eastern or North African (U.S. Census Bureau, 2020).

Michigan’s economy saw improvements over the nine years leading up to 2020, after enduring almost a decade of job losses. While the seasonally adjusted unemployment rate decreased from 14.0% in June 2009 to 3.8% in January 2019, the unemployment rate spiked to 22.6% in April 2020 at the start of the COVID-19 pandemic (U.S. Bureau of Labor Statistics). The economic impact of COVID-19 was significant, but Michigan’s 2023 labor market continued to show improvement with an annual jobless rate one-tenth of a percentage point below the 2019 pre-pandemic rate of 4.1 percent. As of November 2024, Michigan has added back about 1.11 million jobs from the pandemic low point in April 2020 and is about 1.2% above the pre-pandemic level in February 2020 (House Fiscal Agency, 2025). Despite these gains, personal income has slowed in Michigan from 5.4% growth in 2023 to an estimated 4.9% in 2024 (Senate Fiscal Agency, 2025). Michigan’s seasonally adjusted unemployment rate rose from 4.1% in December 2023 to 5.0% in December 2024, maintaining a labor force participation rate of 62.2% at the end of 2024 (U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics, 2023-2024).

While aspects of the state’s economy have rebounded, 41% of Michigan households cannot afford the basic cost of living in their county, such as housing, childcare, food, transportation, and health care (2024 ALICE Update, Michigan Association of United Ways). From 2021 to 2022, financial hardship was influenced by three key factors: costs, public assistance, and wages. For a family of four with an infant and preschooler, the survival budget needed in 2022 was $73,488 up from $59,016 in 2021 and $45,738 more than the federal poverty level (FPL) of $27,750 for this household. The buffer provided to families by stimulus payments and increased tax credits ended with the expiration of the 2021 American Rescue Plan. Even though wages increased for most low-wage jobs, from $13.81 per hour in 2021 to $14.38 per hour in 2022, 75% of the most common jobs in Michigan still paid less than $20 per hour.

Not all Michigan households have experienced financial hardship in the same way; there are notable differences due to social and geographic factors that impede access to resources and opportunity for financial stability. For example, in 2022, 33% of young households (under 25 years old) lived below the FPL, whereas 33% lived above the FPL and could not afford the basic cost of living. In 2022, 43% or 302,845 Michiganders in rural communities and 41% or 1,368,351 Michiganders in urban communities were unable to afford the basic cost of living. Financial stress impacts mental health, according to the Household Pulse Survey; 20% of respondents unable to afford the basic cost of living reported feeling nervous, anxious, or on edge nearly every day over the prior two weeks in October 2023, compared to 11% of households able to afford the basic cost of living.

The latest Kids Count Michigan profile demonstrates improvements for 13 out of 19 key indicators of child well-being across the domains of early childhood, health and safety, education, economic security, and family and community. For indicators with the latest data in 2022, declines experienced in child poverty (17.8% in 2022 compared to 19.6% in 2017), early childhood poverty (19.9% in 2022 compared to 25.0% in 2017), high housing cost burdens (26.1% in 2022 compared to 28.3% in 2017), and students experiencing homelessness (32,762 in 2022 compared to 34,014 in 2017) may have been influenced by COVID-19 pandemic supports provided by the federal government to states. Notable child well-being improvements included infant mortality reduction (671 in 2022 compared to 760 in 2017) and students graduating on time (81.8% in 2023 compared to 80.2% in 2017). Notable indicators trending in the wrong direction included declines in preschool enrollment for three- and four-year-olds (44.3% in 2022 compared to 47.1% in 2017) and third grade reading proficiency (42.1% in 2022 compared to 44.1% in 2017). Michigan’s recent budget priorities work to mitigate worsening child well-being trends by providing a 15% increase in the childcare reimbursement rate and increasing the capacity of the state’s public preschool program, Great Start Readiness.

Roles and Priorities of the State Health Agency

The Title V program is housed in the Division of Maternal and Infant Health (DMIH), which is in the Bureau of Health and Wellness (BHW) in the Public Health Administration. DMIH includes the Family Planning program, Maternal Infant Health Program, Michigan Perinatal Quality Collaborative, Early Hearing Detection and Intervention program, infant safe sleep, breastfeeding, maternal and fetal morbidity and mortality reduction, Fetal Infant Mortality Review, Doula Initiative, Safe Delivery of Newborns, Fetal Alcohol Spectrum Disorder efforts, and more. DMIH works in partnership with the Children’s Special Health Care Services (CSHCS) Division and the Division of Child and Adolescent Health (DCAH) to administer Title V. CSHCS oversees the Title V CSHCN components and requirements. CSHCS includes CSHCS Customer Support, Policy and Program Development, Quality and Program Services, and the Family Center for Children and Youth with Special Health Care Needs (Family Center). DCAH oversees school-based health centers, oral health for children and pregnant women, teen pregnancy prevention, the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, the Early Childhood Comprehensive Systems grant, and the Local Maternal Child Health (LMCH) Program which provides Title V funding to Michigan’s 45 local health departments. Title V works collaboratively with other programs in the Michigan Department of Health and Human Services (MDHHS) which includes Medicaid; Local Public Health; Women, Infants and Children (WIC); Bureau of Epidemiology and Population Health; Bureau of Children’s Coordinated Health Policy and Supports; environmental health; emergency preparedness and response; communicable and chronic disease; food and cash assistance; and Child Protective Services (CPS).

MDHHS and MCH Goals

The MDHHS mission is “MDHHS provides services and administers programs to improve the health, safety and prosperity of the residents of the state of Michigan.” Twelve goals for 2025-2029 support this mission, several of which align with MCH work including the following:

• Public health investment
• Address food and nutrition, housing, and other community factors that impact health
• Improve maternal and infant health by addressing root causes
• Reduce lead exposure
• Expand and simplify safety net access
• Reduce drug overdose related deaths

Michigan’s MCH programs help to support these goals especially in relation to maternal, infant, and child health. The 2024-2028 Advancing Healthy Births plan builds on previous work to address social drivers of health, build strong collaborative relationships statewide, and improve maternal and infant outcomes. The plan focuses on sustainable actions and multifaceted approaches to advance outcomes for women and their infants. Michigan continues to strive toward the goal of zero preventable deaths. The new plan was developed collaboratively by MDHHS and maternal infant health partners and was informed by input garnered from regional town hall meetings, Mother Infant Health Collaborative meetings, Regional Perinatal Quality Collaboratives (RPQCs), Michigan families, healthcare providers, community leaders and partners.

In 2024, Michigan was also selected to participate in the National Governors Association Improving Maternal and Child Health in Rural America State and Territory Policy Learning Collaborative. The Collaborative supported nine states in identifying and pursuing goals related to maternal and child health in rural areas. MDHHS’s short term goals included crafting statewide, universally accessible childbirth education and launching a media campaign about maternal warning signs. Michigan’s RPQCs received one-time funding to allocate to community-based organizations through a Request for Proposal process. A portion of those funds was required to be utilized to further childbirth education in their region. Additionally, funding was received from MDHHS to conduct a statewide media campaign to promote awareness of urgent maternal warning signs. These warnings signs were also embedded into inpatient and outpatient care systems, with additional efforts to make these signs general knowledge for Michigan families.

Michigan also participated in the Health and Human Services Postpartum Maternal Health Collaborative in 2024. Six states, including Michigan, worked to address critical gaps in maternal healthcare to address preventable causes of maternal morbidity and mortality. Michigan’s project was led by DMIH to increase early identification of cardiac issues and ensure timely follow-up care within six months postpartum, highlighting a need to strengthen diagnostic and ongoing management protocols for at-risk mothers in Southeast Michigan. Key partners included Detroit Medical Center Hutzel and Sinai-Grace Hospitals and the Southeast Michigan Perinatal Quality Improvement Coalition. Partners worked toward aligning resources through the establishment of referral criteria, developing data tracking tools, and piloting the process with small patient groups using Plan-Do-Study-Act (PDSA) cycles. Challenges and successes were experienced during the year-long project. Barriers identified by partners included lack of available staffing, funding, and electronic medical record incompatibilities that render data collection and analysis challenging. Despite challenges, strong relationships were formed with nurses, specialty providers, and inpatient department leaders. The collaborative introduced resources to the inpatient clinicians to assist with early identification and diagnosis of cardiac conditions among the perinatal patient population. Overall, opportunities remain for advancement of this project and similar work related to identification of cardiac issues during the perinatal period.

Advancing maternal and infant health outcomes continues to be a priority for Gov. Whitmer. In 2020, Gov. Whitmer released the Healthy Moms, Healthy Babies initiative to provide all women with access to high-quality health care. Expansion of Healthy Moms, Healthy Babies continues through allocations in the state budget. The 2021 and 2022 budgets allocated funds to increase access to evidence-based home visiting and continuous postpartum Medicaid coverage for 12 months postpartum. The 2023 budget allocated funds to support doula infrastructure and increase investment in Early On. The Governor’s FY 2024 budget allocated funds to expand access to family planning services, support for the Michigan Perinatal Quality Collaborative, expansion of CenteringPregnancy, support for birthing hospitals’ participation in Levels of Maternal Care verification, and additional support for birthing hospital participation in the Michigan Alliance for Innovation on Maternal Health (AIM) program.

The FY 2025 budget provides continued support for the Michigan Perinatal Quality Collaborative, expansion of CenteringPregnancy, strengthening the doula workforce, and birthing hospital participation in Maternal Levels of Care verification and with the Michigan AIM initiative. Gov. Whitmer also signed the Reproductive Health Act to help remove barriers to healthcare as well as legislation to codify the Michigan Perinatal Quality Collaborative and Maternal Levels of Care verification; support of licensing for birthing centers; and the requirement of private insurers and Medicaid to cover blood pressure cuffs for pregnant and postpartum women.

Home visiting is also part of a coordinated system of care and is delivered in all 83 Michigan counties, with some urban and highly populated counties implementing multiple models, encouraging maximum family choice. Michigan served over 19,000 families in FY 2023 through evidence-based home visiting, and efforts to improve family connection to home visiting are ongoing. Initiatives are underway to support better connection for families to the home visiting model that will best fit their needs including through Help Me Grow (early childhood resources connection hubs) and through activities completed by Local Home Visiting Leadership Groups (community level home visiting system building groups) and Regional Perinatal Quality Collaboratives. Michigan also funds Great Start Collaboratives through the Michigan Department of Lifelong Education, Advancement, and Potential (MiLEAP) whose work includes building coordination among early childhood system providers. Representatives from the collaborative groups meet frequently to support awareness and coordination of activities.

A Home Visiting Leadership team and a Home Visiting Advisory are charged with building an integrated home visiting system to support maternal, infant, child, and family health. Michigan’s evidence-based home visiting (EBHV) system includes the Maternal Infant Health Program, Nurse-Family Partnership, Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Infant Mental Health, Play and Learning Strategies, and Family Spirit. The Leadership team includes funders of all EBHV in Michigan, aligning activities such as professional development and supporting coordinated referrals. Michigan hired a statewide home visiting professional development coordinator and has utilized technical assistance to develop and pilot family outreach strategies. The Home Visiting Advisory has an active role in system development through discussions about policies, access to services, and professional development for the home visiting workforce. Title V participates in both the Leadership team and the Advisory.

Michigan is expanding EBHV to better support families who have been impacted by child welfare involvement and family separation. Home visiting programs, including three specifically serving indigenous families, have expanded to support families through the Thriving Futures program. Thriving Futures is a coordinated approach to support families who are impacted by the child welfare system and/or substance use and is part of the Families First Prevention Services Act. Professional development is being provided to programs to ensure staff have access to information and training that will improve service delivery for families. Michigan is piloting peer navigators within the healthcare system to break down barriers of shame and stigma. Peer navigators will connect families to resources, including EBHV, and will provide support for 12 weeks postpartum. Nine agencies are currently implementing the program, supporting pregnant and postpartum women, with an additional 10 proposed for FY2026, if additional funding is allocated.

In 2021, Michigan was awarded an Early Childhood Comprehensive Systems (ECCS) Grant which is housed within the Public Health Administration, in DCAH. This five-year project is intended to foster the development and integration of maternal and early childhood systems of care that are sustainable, comprehensive, and inclusive of the health system. The ECCS Advisory Committee is finalizing their strategic action plan which focuses on two priority areas: better coordinated infrastructure that supports young families and setting a vision for addressing funding mechanisms that cause barriers for families and communities. Goals within this plan support alignment between early childhood, Title V, MIECHV and MIHEIP, and move the system toward integration. The draft plan recognizes the need for systemic support of family leadership, and will work to foster relationships between leaders, state staff, and partners around issues that are parent/caregiver driven. 

Advancing Healthy Outcomes

Supporting healthy outcomes for all residents is a priority within the State of Michigan and MDHHS. A range of initiatives are underway through MDHHS to support healthy outcomes across all populations. Since 2022, MDHHS has led development of a collaborative, statewide strategy to improve the health and social outcomes of all Michigan residents. It has focused on housing stability, food security, community health worker expansion, and community information exchanges. In 2024, MDHHS launched hubs to bring together community-based partners to address health and health-related needs. Hubs are a network of community partners including health care and social service providers, government partners, and business leaders that work together to help residents get the care they need to be healthy. Each hub is co-designed by communities to meet their unique needs and priorities. MDHHS provides technical assistance with the long-term goal to increase alignment across health and social care and support community-driven work.

To support access to and utilization of preventative care, MDHHS expanded Medicaid coverage to include Community Health Worker services as of January 1, 2024. In March 2024, MDHHS requested public input on potential services designed to address health-related nutrition needs through health plans participating in the Medicaid and Healthy Michigan Plan. A Produce Prescription Pilot Program addresses food security in partnership with Michigan Tribes.

Strategies to support healthy outcomes are also being implemented within MCH programs, including and beyond Title V. In addition to strategies discussed in Title V state action plans in this application, MCH activities include:

• The Medicaid doula reimbursement policy went into effect January 1, 2023. The policy allows for reimbursement of doula services for individuals covered or eligible for Medicaid insurance. A Doula Advisory Council with statewide representation, including tribal doulas, was created to inform the advancement of doula services in Michigan.
• The Infant Safe Sleep program allocates funds and provides technical assistance in a data-driven manner. Funding is allocated to five local health departments (LHDs) and the Inter-Tribal Council of Michigan (ITC). The counties in which the five LHDs are located account for 51% of sleep-related infant deaths in the state. ITC serves American Indian families throughout the state; American Indian babies die at 2.6 times the rate of White babies.
• At the local level, the Maternal Infant Health Program (MIHP) provides services tailored to family needs. Licensed social workers and registered nurses who provide MIHP case management services assist in referring families to community supports like healthy food, transportation, and housing.
• The Michigan Early Hearing Detection and Intervention (EHDI) Program works to ensure all newborns receive timely hearing screenings, diagnostic evaluations, and early intervention services. The program conducts education, site visits, and technical assistance for healthcare professionals while overseeing data tracking, surveillance, and family follow-up to improve outcomes. These efforts support early identification and promote optimal language and developmental outcomes for infants who are born Deaf or Hard of Hearing.
• To advance healthy birth outcomes, Regional Perinatal Quality Collaboratives (RPQCs) actively address health outcomes and community health factors through quality improvement efforts, convening a range of partners to support efforts and collaborate with regional partners, and authentically engaging families as key partners so that efforts address family needs and resonate with communities.
• The DMIH received $500,000 to raise awareness of uterine fibroids through education and outreach programming. A social media and education campaign was developed and launched in 2024. Education infographics and posters are available in the internal clearinghouse. Additionally, through partnership with the Region 9 Perinatal Quality Collaborative, women who have experienced uterine fibroids participated in a storytelling project and produced videos.
• DCAH has worked with two home visiting programs that participated in the MIECHV Collaborative Improvement and Innovation Network (CoIIN) to understand how the program is integrating continuous quality improvement and family engagement to best achieve family goals/supports. This process has prompted changes in policy for practices such as transportation support, access to health care, and improved family interviews to ask better questions about access to resources within neighborhoods.
• DCAH expanded use of the Rapid Adolescent Prevention Screening tool + additional public health questions within Child and Adolescent Health Centers (CAHCs) to assess need and connect to local resources.

Within Title V, the 2025 five-year needs assessment identified three key “pillars” that are important to all MCH populations: advancing strategies so all children and families can flourish; fostering collaboration to strengthen coordinated systems; and engaging and elevating family and community voices. Strategies related to these pillars are included in the NPM and SPM state action plans in this application.

Strengths and Needs that Impact the MCH Population

The Title V five-year needs assessment was completed in 2025, with most assessment activities completed in 2024. It identified strengths and challenges that impact the MCH population which are discussed in detail in the Needs Assessment section of this application. Strengths include community organizations and programs; family support; safe, accessible and clean natural environments and community spaces; access to food and nutrition support and education, including breastfeeding; financial support and economic assistance programs; access to home visiting services; access to healthcare and providers with strong referral networks; schools and school-affiliated health services; mental health services for youth and CSHCN; and care coordination and connection to resources for CSHCN.

Needs and concerns identified through the 2025 needs assessment included mental health; substance use; the postpartum period; breastfeeding and lactation; accessible and affordable transportation, childcare, and housing; financial instability and financial challenges including high out-of-pocket costs for CSHCN; lack of affordable healthcare and gaps in coverage; a lack of safe and inclusive community spaces; reproductive health; children’s developmental health; mobility supports; managing chronic health conditions; and specialty care for CSHCN.

Strengths and needs related more specifically to elevated performance measures (e.g., postpartum visit, infant safe sleep, breastfeeding, bullying, medical home, immunizations, childhood lead poisoning prevention, medical care and treatment for CSHCN) were also assessed through the needs assessment and are discussed in the Needs Assessment section and within related NPM and SPM state action plans.

Findings related to partnership and program capacity also emerged and are discussed in the Needs Assessment section. Strengths included trusted partnerships while challenges such as time and resource constraints limit collaboration. Workforce challenges including turnover, burnout, and compensation affect staff retention. Efforts to elevate family voices are occurring, but financial and logistical barriers can affect sustained engagement.

Systems of Care

Components of the state’s systems of care—including health services infrastructure, Health Professional Shortage Areas (HPSAs), local public health, Medicaid, and the Healthy Michigan Plan—are discussed in the “Health Care Delivery Systems” and “Relationship with Medicaid” sections of this application. Michigan’s system of local public health which is comprised of 45 local health departments is a critical partner in Title V MCH and CSHCS programs and service delivery. Additional information related to the integration of behavioral health services, beyond information provided in the two aforementioned sections, is discussed below.

Integration of Services

MDHHS and Michigan’s MCH programs recognize the importance of integrating physical and behavioral health services to improve health and address individual or family needs. In March 2022, MDHHS announced a behavioral health restructuring to support services across community-based, residential, and school locations. The changes were intended to benefit people of all ages; to prioritize addressing the needs of children and their families; to streamline and coordinate resources; and to improve policies and processes to make them more effective. Additional information is provided in the “System of Care for Mothers, Children, and Families” section. MDHHS initiatives to address behavioral and mental health needs include:

• The Michigan Peer Warmline is a statewide, anonymous line for any Michigander experiencing a mental health or substance use condition. The warmline is staffed by certified peer support specialists and recovery coaches. Additionally, the Michigan Crisis and Access Line (MiCAL) is now available statewide after being piloted in the Upper Peninsula and Oakland County. MiCAL is staffed 24/7 and provides crisis and warmline services, information, and coordination with local systems of care such as Community Mental Health Services Programs.
• The second anniversary of the 988 Suicide and Crisis Lifeline was recognized in July 2024. According to the MDHHS press release, “More than 48% of callers had high or overwhelming stress at the beginning of a call, which was reduced to 12% by the end of the call after speaking with a 988 specialist. The 988 Lifeline connects callers to behavioral health services, resources and referrals to follow-up care.” More than 88,000 calls were answered over the prior year and 19,000 hours were spent on the phone with residents.
• In Summer 2024, MDHHS announced two initiatives to support the behavioral health workforce in Michigan. First, as part of the Bachelor of Social Work to Master of Social Work Program, MDHHS announced provision of “$5 million to 12 Michigan universities to provide $30,000 stipends to students seeking to obtain a master’s degree in social work and who commit to working in behavioral health in the state upon graduation.” Second, MDHHS announced the Behavioral Health Internship Stipend Program which “provides up to $15,000 per student intern to cover costs such as tuition, fees, books and living expenses, allowing them to concentrate on professional growth and practical experience” in certain behavioral health professions. It is anticipated that 230-700 interns could qualify for the program.
• The Expanding, Enhancing Emotional Health (E3) model helps to address the need for mental health services for children and youth. E3 is a designated model through the Child & Adolescent Health Center (CAHC) Program. E3 programs provide on-site comprehensive mental health services from mild to moderate severity of need by a licensed Mental Health Professional. Services include assessments, brief intervention, ongoing therapy, referrals, and follow-up. E3 sites are open year-round and provide telehealth when school is not in session. Services are designed for children and adolescents 5-21 years of age when access to behavioral health resources are limited or inaccessible in a community. Currently, 106 E3 sites operate in 40 counties.
• The Child & Adolescent Health Center program includes both a school-based health center model (clinical model) that funds an Advanced Practice Provider paired with master’s level mental health staff. The School Wellness Program (SWP) model pairs an RN with a master’s level mental health staff. Currently there are 122 Clinical sites and 54 SWP sites across the state. These programs provide primary care, nursing, and mental health services to children and adolescents throughout the state.
• Michigan continued to roll out expanded coverage for nursing and mental health services for general education students through a CMS approved Medicaid waiver. The Caring 4 Students (C4S) expansion allows schools that provide mental health and nursing services to general education students to receive Medicaid reimbursement. All 56 Intermediate School Districts participate in C4S. Michigan is one of 16 states that have expanded eligibility to include general education students.
• In August 2020, MDHHS was approved for a two-year CMS Certified Community Behavioral Health Clinic (CCBHC) Demonstration. In 2021, the demonstration was extended an additional four years. CCBHC demonstration sites provide nine core behavioral health services, including care coordination with primary care providers, and must meet standards for service provision, staffing, governance, and quality and financial reporting. The FY 2025 state budget included $161.5 million to establish new CCBHC sites across the state and expanding accesses for up to 35,000 additional Michigan residents.
• The Michigan Clinical Consultation and Care (MC3) provides psychiatric consultation to primary care providers who have patients with behavioral or mental health concerns. Consultation includes guidance to providers on diagnostic questions, medication recommendations and appropriate psychotherapy. Recommendations for local resources are also provided. MC3 provides behavioral health education for primary care providers. MC3 partners are MDHHS, the University of Michigan, and Michigan State University.
• The MC3 Perinatal Patient Care program is being implemented in six counties in southeast Michigan. The program offers free same-day access to behavioral health consultants who provide virtual counseling and care coordination for perinatal patients. Patients complete an electronic screening tool and are offered a same-day brief intervention. The screening results are used to create short-term plans of care which may include virtual counseling and care coordination.
• DMIH received State Opioid Settlement funds to support ongoing ‘rooming in’ efforts at two birthing hospitals. The family-centered model encourages parent-infant bonding and uses non-pharmacological care of infants born substance-exposed, ensuring they remain with their parent or caregiver in a private hospital room. Hospital staff provide support for breastfeeding, skin-to-skin contact, calming techniques, and referrals to services. The funds will also support the expansion of the program to two additional hospitals in 2025.
• CSHCS continues to work with Behavioral Health partners to identify challenges accessing services experienced by populations served by the mental/behavioral health, intellectual/developmental disabilities, and physical health systems. Work includes regular meetings to discuss program changes and brainstorm how to address systemic access issues.

Title V and Medicaid

Michigan’s Title V and Title XIX programs are both housed within MDHHS and share the common goal to improve the health and well-being of the MCH population through implementation of affordable health care delivery systems, expanded coverage, and strategies to address community factors that influence health outcomes and achieve optimal health. Areas of collaboration include maternal and infant care, perinatal care, child and adolescent health, developmental screening and referral, home visitation, oral health, and CSHCS. Key partnerships are discussed in the “Relationship with Medicaid” section of this application.

As of January 1, 2025, 1,806,484 Medicaid beneficiaries were enrolled in Medicaid Health Plans and 642,551 beneficiaries were enrolled in fee for service. Medicaid uses a managed care delivery system to maximize the health status of beneficiaries, improve beneficiary experience, and lower cost. Medicaid contracts with nine Medicaid Health Plans (MHPs) to achieve these goals through evidence-based and value-based care delivery models; health information technology; strategies to prevent chronic disease; and coordination of care that includes assessing community health factors such as transportation, housing, and food access. MDHHS requires MHPs to annually report the Healthcare Effectiveness Data and Information Set (HEDIS) and uses a Pay for Performance Incentive Program with access, process, and outcome metrics for all managed care populations, including women and children. Each MHP governing body must either have a minimum of 1/3 representation of Medicaid enrollees or the plan must establish a consumer advisory council that reports to the governing body. The council must include at least one Medicaid enrollee, one family member or legal guardian of an enrollee, and one consumer advocate. MHPs must recruit CSHCS beneficiary parents/guardians to participate in non-compensated governing bodies or consumer advisory councils.

To help achieve integrated care, MHPs are required to work with MDHHS to develop initiatives to better align services with Community Mental Health Services Programs/Prepaid Inpatient Health Plans (PIHPs) to support behavioral health. Medicaid incentivizes performance by MHPs and PIHPs on shared populations and metrics. MHPs must also provide or arrange for the provision of community health worker (CHW) or peer-support specialist services to enrollees who have behavioral health needs and complex physical co-morbidities. CHWs serve as a liaison between the health/social services and the community to facilitate access to services and improve the quality of service delivery. CHW services focus on preventing disease, disability, and other chronic health conditions or their progression, and promoting physical and mental health.

Several programs that serve Medicaid-eligible MCH populations—including the Maternal Infant Health Program (MIHP) and Children’s Special Health Care Services (CSHCS)—are jointly administered by Michigan Medicaid and MCH/CSHCN program areas. Details about these and other programs are provided in the “Relationship with Medicaid” section.

Information Systems

MDHHS utilizes CareConnect360 (CC360), a statewide web-based care management system that allows for the bi-directional exchange of health care information. CC360 allows for the identification and coordination of services to Medicaid beneficiaries, particularly in relation to physical and behavioral health information, by sharing information between state health plans and the Community Mental Health/Prepaid Inpatient Health Plans. CC360 makes it possible to analyze healthcare program data, manage and measure programs, and improve enrollee health outcomes.

MI Bridges is also a key component of the MDHHS service platform to meet consumer needs. MI Bridges is an online site managed by MDHHS that enables users to apply for benefits including healthcare, food and cash assistance, childcare, and state emergency relief. It also helps users find resources such as transportation, food, and utility assistance. MI Bridges users can review and access their benefits information; renew benefits; and share beneficiary information. In 2020, functionality was built into MI Bridges to include home visiting. In 2022, the self-referral function was updated so that families receive a custom list of home visiting models in their community for which they are eligible. Information on each model, including program descriptions and parent testimonials, is provided to help identify a model to best fit their needs.

To help meet the needs of Michigan residents, MDHHS also partners with Michigan 2-1-1. Michigan 2-1-1 coordinates a network of seven regional contact centers that provide statewide assistance to people who are seeking resources and services. MI 2-1-1 supports statewide collaboration and service delivery through shared infrastructure, support of regional partners and community-based organizations, and data collection. According to the Report to MDHHS on Infrastructure, Data and Activities, in FY 2024 406,722 documented connections were handled by 2-1-1 and 200,685 unique searches for services/resources occurred via 211’s online directory database. Most connections (76%) were related to housing, utility assistance, income support/assistance, food/meals, and general information requests.

Michigan’s Title V program partners directly with Michigan 2-1-1 to help address MCH specific needs and to link callers to MCH-related services and programs. In FY 2024, a total of 6,180 MCH-related connections (i.e., a call or interaction by chat, text, etc.) occurred. Out of these connections, 7,050 needs were identified, and 6,732 needs (95.5%) were referred. The top needs were diapers and formula/baby food followed by general dentistry, child passenger safety seats, WIC, baby furniture, adult health insurance programs, and expectant/new parent assistance. In addition to MCH-related services, connections often require additional assistance for secondary services. In FY 2024, an additional 5,494 non-MCH related secondary needs were identified. The top five problem/need categories were Housing, Clothing/Personal/Household Needs, Food/Meals, Health Care, and Utility Assistance. These categories represented 79% of all secondary referrals. The Title V program works with Michigan 2-1-1 to identify opportunities for enhanced service delivery and resource sharing.

In 2023, the State of Michigan partnered with Michigan 2-1-1 to create a home visiting specific portal for families seeking supportive services that includes a self-referral function. Families receive a curated list of home visiting programs for which they are eligible and can self-refer. In 2024, an update was initiated to allow providers the ability to complete a referral to home visiting on behalf of a family. 2-1-1 provides access to a dashboard to track trends in referrals by families and providers, which will allow for system improvement strategies to be implemented.

MDHHS also uses health information systems to support the care and services provided to the MCH population. According to the Michigan Care Improvement Registry (MCIR) website, MCIR “is a database known as an Immunization Information System (IIS) that documents immunizations given to individuals in Michigan. MCIR was created in 1998 to collect reliable immunization information for children and make it accessible to authorized users…. MCIR benefits healthcare organizations, schools, childcare, pharmacies, and individuals by combining immunization information from multiple providers into one record. This reduces vaccine-preventable diseases and over-vaccination, allowing providers to view up-to-date patient immunization history in one system” (https://mcir.org/public/).

State Statutes Relevant to Title V (Effective July 24, 2024)

The Michigan Public Health Code, Public Act 368 of 1978, governs public health in Michigan. The law indicates the state health department shall “continually and diligently endeavor to prevent disease, prolong life, and promote the public health through organized programs” (MCL 333.2221). Furthermore, it shall “promote an adequate and appropriate system of local health services throughout the state and shall endeavor to develop and establish arrangements and procedures for the effective coordination and integration of all public health services including effective cooperation between public and nonpublic entities to provide a unified system of statewide health care” (MCL 333.2224).

For the fiscal year ending September 30, 2025, state funding for MCH and CSHCS programs was appropriated through Public Act 121 Enrolled Senate Bill 747, Article 6, Department of Health and Human Services. CSHCS is mandated by the Michigan Public Health Code, Public Act 368 of 1978, in cooperation with the federal government under Title V of the Social Security Act and the annual MDHHS Appropriations Act. State general funds for MCH programs are itemized in Sec. 116, Family Health Services, of Public Act 121 of 2024, and CSHCS is addressed in Sec. 117.

Additional MCH funding requirements and legislative reporting relate to evidence-based programs to reduce infant mortality (Sec. 1308); family planning/pregnancy prevention; health outcomes before, during, after pregnancy (Sec. 1301, 1314); grants to local collaborators in perinatal quality collaboratives to improve maternal and infant health outcomes (Sec 1325); rural home visiting (Sec. 1311); outreach program on fetal alcohol syndrome for health promotion, prevention and intervention (Sec. 1313); oral health initiatives (Sec. 1315-1316, 1343); drinking water declaration of emergency fund support services (Sec. 1306); and statewide immunization media campaign (Sec. 1349).

Requirements in the FY 2025 Health and Human Services budget for CSHCS included criteria in Sec. 1360 for MDHHS to provide services; Sec. 1361 authorizes that some funding be used to develop and expand telemedicine capabilities and to support chronic complex care management.