State Overview

1. Geography

Nevada is the most mountainous state in the U.S. with over 150 named ranges and several mountain peaks exceeding 11,000 feet. The state has a unique topography, with vast distances separating frontier, rural, and urban communities. With a land mass of approximately 110,000 square miles, Nevada is the 7th largest state by land mass in the U.S. The State Demographer indicates Nevada has three urban counties (Carson City, Clark, and Washoe), three rural counties (Douglas, Lyon, and Storey), and eleven counties designated as frontier (Churchill, Elko, Esmeralda, Eureka, Humboldt, Lander, Lincoln, Mineral, Nye, Pershing and White Pine). The three rural counties (Douglas, Lyon, and Storey) also meet “micropolitan” classification due to their proximity to the urban (metropolitan) counties (Carson City and Washoe). 

Figure 1. Map of Nevada with Counties

The distance between Washoe and Clark counties is 448 miles (approximately 7.5 hours by car); between Washoe and Elko counties is 290 miles (approximately 4.5 hours); and between Elko and Clark counties is 433 miles (approximately 7.5 hours by car). Residents in the rural and frontier counties are spread across 95,421 square miles or 86.9% of the state’s land mass. Population density ranges from 396 people per square mile in Carson City to 0.27 people per square mile in Esmeralda County. Approximately 90% of Nevada land is publicly owned and administered by federal, state, and Tribal entities, with the remaining 10% privately owned.

Figure 2. Map of Nevada with Cities

2.  Population 

In 2020, the Nevada State Demographer’s Office and the U.S. Census Bureau estimated Nevada’s population at 3,145,184. Between 2010 and 2019, Nevada had the sixth-highest percentage growth in the nation (14.1%, U.S. Census Bureau). While Nevada’s population continues to grow, some rural and frontier counties lose population annually. The most densely populated area in the state is Clark County, home to 73.8% (2,320,107 persons) of all Nevada residents (tax.nv.gov). The population in the rural and frontier counties ranges from approximately 982 (Esmeralda County) to 55,116 residents (Elko County). In 2019, the child population (Nevadans under 18 years) made up 22.9% of the population, similar to the proportion across the U.S. (22.4%). 

The U.S. Census Bureau also indicates Nevada is an ethnically diverse state, with over 29% of the state’s population in 2019 documented as Hispanic Origin of Any Race. In comparison, Nevada’s population is 73.9% White alone, 10.3% Black alone, 8.7% Asian alone, 1.7% Native American or Alaskan alone, 0.8% Hawai’ian and Other Pacific Islander alone, and 4.6% two or more races https://www.census.gov/quickfacts/NV.

According to the most recent Kid’s Count Data Center (2019) approximately 36% of Nevada’s children are from non-U.S. national families or reside with at least one foreign-born parent, and of these children, 70% are from Latin America. These numbers have been holding steady over the last five years. Health concerns for Nevada’s diverse MCAH population include physical, reproductive, behavioral, mental, psychosocial, chronic disease concerns, health disparities, and care of CYSHCN. Language barriers, cultural differences, equitable access to insurance and service availability can influence the use of clinics, hospitals, doctors, and other health care and ancillary services. Nevada Title V MCH-funded partners provide bilingual referrals and resources to community events. Along with providing printed materials, staff link diverse populations to programs providing culturally informed services. 

3.  Public Health System/Organizational Structure

Governor Steve Sisolak is Nevada’s Governor, currently serving the third year of a four-year term. Nevada DHHS is the largest of the State’s departments and the Director is appointed by and reports directly to the Governor. The current DHHS Director is Richard Whitley, MS. DHHS is comprised of five divisions, with multiple stand-alone programs falling under the DHHS Director. Divisions include: Division of Public and Behavioral Health, Aging and Disability Services Division (ADSD), Division of Child and Family Services (DCFS), Division of Health Care Financing and Policy, and the Division of Welfare and Supportive Services (DWSS).

Nevada’s three urban counties have their own health authority: Carson City Health and Human Services (Carson City), Washoe County Health District (Washoe County), and Southern Nevada Health District (Clark County). The rural and frontier counties: Humboldt, Elko, Pershing, Lander, Eureka, White Pine, Churchill, Mineral, Esmeralda, Nye, and Lincoln counties do not have their own health authority; therefore, DPBH OPHIE and the DHHS Chief Medical Officer serve as the health authority for those counties. Additionally, some of the rural and frontier counties have or are forming their own boards of health. Nevada Community Health Services (CHS) has community health nursing clinics and behavioral health clinics in various rural and frontier counties to provide family planning services, related preventive health services, public health, and infectious disease services.

DHHS programs helping to promote Title V MCH priorities in Nevada include: Nevada 211, Office of Consumer Health Assistance, NGCDD, the Office of Health Information Technology (HIT), Individuals with Disabilities Education Act (IDEA) Part C Office, Nevada Early Intervention Services (NEIS), the Nevada Office of Minority Health and Equity (NOMHE), Tribal Liaisons (DHHS and DBPH partner with 27 Tribes across Nevada through a Tribal Consultation Process Agreement to strengthen ties and relationships with Tribal Governments), Primary Care Office (addresses access to health care and identifies workforce shortage areas), Oral Health, CHS/CHNs, DPBH OPHIE, Office of Analytics, Substance Abuse Prevention Treatment Agency (SAPTA), Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), DCFS, Nevada Medicaid, CDPHP Section, Nevada WIC, and the Nevada State Immunization Program (IZ).

Nevada Revised Statute (NRS) Chapter 442 (http://www.leg.state.nv.us/NRS/NRS-442.html) details the Title V MCH public health authority of DPBH. The DPBH Administrator is Lisa Sherych. The Community Services Branch of DPBH is led by Julia Peek, MHA, CPM. The Bureau of Child, Family and Community Wellness (CFCW) within the Community Services Branch is led by Bureau Chief Karissa Loper, MPH. Ms. Loper oversees WIC, IZ, CDPHP and MCAH. The MCAH Section is led by Title V MCH and CYSHCN Director, Vickie Ives, MA. MCAH programs include: Maternal, Infant, and Early Childhood Home Visiting (MIECHV); Personal Responsibility Education Program (PREP); RPE; Sexual Risk Avoidance Education Program (SRAE); Nevada PRAMS; Early Hearing Detection and Intervention (EHDI); SSDI; and the Title V MCH Program. The MCAH Section also administers the Maternal and Child Health Advisory Board (MCHAB), Nevada Maternal Mortality Review Committee (MMRC), Alliance for Innovation on Maternal Health (AIM) and Account for Family Planning (AFP). The MCAH Section addresses health and social issues among the populations served by coordinating efforts with Nevada DHHS programs, LHAs, public and private partners, universities, MCH Coalitions, Community Coalitions, Family Resource Centers, Federally Qualified Health Centers (FQHCs), regional hospitals, and a variety of other traditional and non-traditional partners.

The MCAH Section includes the Title V MCH Program, led by Mitch DeValliere, DC, MCH Manager. Title V MCH Program fiscal staff include two partially funded Management Analyst II positions and a part time Accounting Assistant III. The SSDI Manager is Tami Conn who leads all MCH and PRAMS data efforts. Nevada Title V MCH Program staff and topic units include:

• The CYSHCN Program Coordinator administers and promotes the MHP, serves family and self-advocates for CYSHCN, provides services and supports for CYSHCN, provides and coordinates health education for CYSHCN and their families, administers the CCHD Registry, and provides trainings for families and health professionals. Partners working with the CYSHCN Coordinator include the University of Nevada, Reno (UNR) Craniofacial Clinic, Children’s Cabinet TACSEI, Family TIES of Nevada, partners providing transition activities for older CYSHCN, NGCDD, and NCED.
• The Title V MCH Epidemiologist is responsible for MCH data needs for annual reporting and the five-year needs assessment. Additionally, the MCH Epidemiologist analyzes data and writes reports for federal, state, and local use, including for the Nevada PRAMS and other MCAH programs. Funding for this position is provided through the Title V MCH Block Grant (0.7 FTE) and CDC PRAMS (0.3 FTE).
• The RPE Coordinator collaborates with statewide partners to prevent sexual violence and intimate partner violence among youth and young adults ages 12 to 24 years. Funding for the RPE Coordinator position and related prevention activities is provided through the Title V MCH Block Grant (0.25 FTE), Preventive Health and Health Services Block Grant (PHHSBG) set-aside, and CDC (0.75 FTE).
• The Adolescent Health and Wellness Program Coordinator collaborates with community partners on improving access to health insurance, increasing utilization of adolescent well visits and general health and wellness services, including trauma informed yoga, increasing daily physical activity by adolescents, and administering school-based health center Medicaid certification and related technical assistance.
• The Maternal and Infant Health Program Coordinator collaborates with diverse community partners on a variety of perinatal and interconception care initiatives, including substance use prevention, breastfeeding promotion, injury prevention, IM CoIIN 2.0 lead, perinatal mood and anxiety disorders, safe sleep, and FIMR. 

Nevada’s Title V MCH activities occur at the local, regional, and statewide levels and MCH cooperates with programs and sections within DPBH supporting women of childbearing age, infants, children, CYSHCN, adolescents, and their families. Examples of Title V MCH-funded partners administering programs congruent with the priorities indicated in the five-year plan, include:

• Children’s Cabinet TACSEI provides technical assistance and facilitates parent involvement in social emotional Pyramid Model activities.
• Family TIES of Nevada serves CYSHCN and supports families and health professionals who work on their behalf. They provide advocacy, education, training, and other supports including a toll-free hotline.
• Washoe County FIMR evaluates elements impacting the health in pregnancy and perinatal outcomes, as well as fetal and infant birth outcomes to reduce fetal and infant mortality.
• Money Management/Nevada 211 provides information and referral via https://www.nevada211.org,  a toll-free phone number, text support, as well as hosting the Title V MCH toll-free line, supporting the MHP resource sections, and educating on the priority status of pregnant persons at SAPTA-funded treatment centers.
• Immunize Nevada supports training/workforce development, including the coordination of the statewide Nevada Health Conference with trainings to build topical MCH knowledge; they also conduct a variety of other trainings and public media campaigns which support MCH population health and immunization needs. The Nevada Health conference is traditionally held in the fall and was delayed due to COVID. However, the conference occurred virtually in March 2021.
• Nevada Broadcasters Association provides airtime and support for the Sober Moms Healthy Babies (SMHB), PRAMS, and Safe Sleep campaigns. DP Video supports adolescent wellness, transition to adult care, tobacco quit line, and Medical Home Portal social media campaigns.  KPS3 updated the Nevada Breastfeeds website.
• Nevada PRAMS’ partner is UNR’s Center for Surveys, Evaluation and Statistics in the School of Community Health Sciences.
• The Statewide MCH Coalition supports website maintenance, disseminates communications, advocates for MCH populations across public and private health entities in Nevada, conducts or refers to maternal mental health trainings, and supports planning with statewide partners for meeting the community needs of diverse populations.
• UNR NCED provides training on leadership, advocacy, transition education, and the medical home model for parents of CYSHCN.
• Urban Lotus provides trauma-informed yoga to youth who are experience disparities.

Program management and fiscal staff meet weekly to discuss and coordinate all Title V MCH activities across Nevada, while program personnel meet weekly to discuss the status of funded program activities and outcomes. Program and fiscal goals, potential barriers, training needs, and technical assistance are all topics for discussion and action. New activities are considered as funding allows. Nevada Title V MCH Program staff work with community partners to determine the scope of work and budget needed for community-level activities annually. This includes monthly check-in calls and annual site visits to monitor subawardee program deliverables and fiscal processes. 

Culturally and Linguistically Appropriate Services (CLAS) Standards

Nevada Title V MCH-funded programs provide outreach and culturally-informed services and ensure funded products are ADA-compliant. Cultural humility Tribal trainings are a valuable component to the success of the Title V MCH Program and are offered to case managers, nurses, and other professionals. Licensed personnel provide CLAS trainings and CHWs, Home Visitors, and various support staff access CLAS and related trainings. 

Nevada’s Title V MCH Program works with partners in remote areas to increase the number of sufficiently trained staff in the rural/frontier areas of Nevada. The Title V MCH Program staff, including funded partners, work with diverse communities across Nevada, including other partners who have greater understanding of the communities in which they live. Partners offer language and translation assistance, either through local community organizations or over the phone. Several partners have personnel with language skills who can provide language assistance and translation. Title V MCH provides bilingual information and media to serve Spanish language speakers. Nevada State Purchasing provides additional assistance with the capacity to work with diverse entities who provide translation assistance and can aid with translation of documents. Family TIES of Nevada, a Title V MCH-funded Family Voices partner, provides interpretation and translation services at the UNR Craniofacial Clinic. Title V MCH also funds a bilingual CHW in Elko County. Information and materials disseminated by these partners are required to be culturally appropriate. Internal translation support is provided by bilingual MCAH and CFCW staff.

MCAH staff and partners received training related to equity, disparity reduction, and diversity and participated in webinars and trainings related to health equity, diversity, CLAS, intergenerational trauma, minority health and wellness, Tribal partnerships, social determinants of health, race and disparity, and health literacy. The SDOH IM CoIIN 2.0 included surveys related to implicit biases and readiness for change in support of enhancing capacity to address biases and disparities. Nevada’s Title V MCH Program works with community members to expand the MCH presence across populations to address gaps and expand service scope to engage all state MCH communities. The Title V MCH Program collects accurate statewide and regionalized demographic information and shares information and trends across all funded community partners.

4.  Healthcare

The Patient Protection and Affordable Care Act (ACA) and Medicaid expansion continue to have a positive effect in Nevada. The percent of children ages 0 to 17 years without health insurance from 2012-2019 was 16.6%, 13.9%, 9.7%, 7.6%, 6.1%, 7.1%, 7.9%, and 7.6%. From 2018 to 2019, the proportion of uninsured children in Nevada decreased by 3.8%. Nevada will continue to monitor insurance enrollment data for MCH populations. The Title V MCH Program will also review related Nevada PRAMS data. 

Nevada Medicaid is administered by DHCFP with enrollment administered by DWSS for Medicaid and Nevada Check-Up, Nevada’s Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Program. Both Fee for Service (FFS) and Managed Care Organizations (MCOs) operate in Nevada. Rural areas are served by FFS providers and the urban areas of Clark and Washoe counties are served by contracted MCO providers. 

As of September 2020, according to Medicaid and Nevada Check-Up enrollment (Medicaid.gov) an estimated 722,616 individuals were enrolled in Medicaid and Nevada Check-Up. This total has increased from December 2019, when an estimated 626,078 individuals were enrolled. Furthermore, in September 2013 only 332,560 individuals were enrolled. Open enrollment for the Affordable Care Act began in October 2013. These numbers demonstrate continued growth in enrollment, a net increase of 117.3% in Nevada’s Medicaid population over the past seven years. (https://www.medicaid.gov/medicaid/by-state/stateprofile.html?state=nevada).

Nevada continues to promote the utilization of EPSDT screenings among Medicaid-eligible children under the age of 21 years. Healthy Kids, the Nevada EPSDT Program, reimburses providers for well-child visits for all children enrolled in Nevada Medicaid and Nevada Check-Up. Outreach to providers and families to encourage EPSDT screenings is a continuing effort for the DHCFP and Title V MCH Program. Continued collaboration between DHCFP and Title V MCH includes education and outreach to promote available preventive benefits and EPSDT screenings, particularly as they relate to maternal, child, and infant health (http://dhcfp.nv.gov/Pgms/CPT/EPSDT/), CoIIN participation, SBHC certification, and well-visit increases for young adult initiatives.

Nevada’s Title V MCH Program is instrumental in advancing the Healthy Kids Program by funding parent education materials which encourage Bright Futures recommended preventive health services for infants, children, and adolescents and provide information on enrollment in Nevada Medicaid or Nevada Check-Up. The Title V MCH Program has also developed a growth chart based on Bright Futures recommended preventive pediatric health care visits. The growth chart includes important milestones, as outlined by Bright Futures guidelines. Title V MCH partners receive these materials to disseminate to their clients. In addition, a one-page version of the growth chart is included in the Protect and Immunize Nevada’s Kids “PINK” packets; across the state, hospitals distribute these materials to all new parents after the birth of a child. Title V MCH also funds other Bright Futures materials, including the Bright Futures tool and resource kit, and health care professional pocket guide, which are provided to partners statewide. The Title V MCH Program provides data related to MCH quality measures to DHCFP annually.

Nevadans who are uninsured continue to have difficulty with access to providers; however, Access to Healthcare Network (AHN) offers a medical discount program for members, who pay a membership fee to access the discounted provider network and case management services. Participating network providers agree to receive reduced payments to serve members. People in Nevada unable to pay for their health care needs can access limited financial assistance. The Mexican Consulate in Las Vegas provides information relating to health insurance for non-U.S. nationals. FQHCs in Nevada provide sliding scale fees for health care to all prospective patients, irrespective of citizenship status.

No-cost health care is provided in Northern Nevada through the University of Nevada, Reno, School of Medicine (UNSOM) Student Outreach Clinic operated by medical students. The clinic is operated in cooperation with the Family Medicine Center and UNSOM and made possible by faculty and community physicians who donate their time. Services include general and acute medical care, gynecological exams, immunizations, and discounted laboratory services. Currently, the Student Outreach Center operates four separate clinics (General and Pediatric; Geriatric and  Dermatology; Rural Outreach; and Women's) https://med.unr.edu/university-health/student-outreach-clinic/upcoming-clinics. An obstetrics and gynecology (OB/GYN) Department at UNSOM provides specific education for medical students. 

Volunteers in Medicine of Southern Nevada (VMSN) provides no-cost medical care in southern Nevada. The University of Nevada Las Vegas (UNLV) School of Medicine clinical practice provides Southern Nevadans with access to a full range of academic medicine faculty physicians delivering clinical patient-focused and collaborative services. The UNLV clinics are open to the public. Further, Rural Access Network (RAN) events provide oral health, immunizations, and other needed medical services at no cost to people who are medically underserved in Nevada. The Title V MCH Program staff support efforts related to CHS/CHNs and routinely share information with the Nevada Hospital Association, Nevada Rural Hospital Partnership, the Nevada Primary Care Association, and the Nevada Rural Health Network.

5.  Employment

According to the Bureau of Labor Statistics, there were approximately 1.5 million Nevadans in the work force as of February 2020. Nevada ranked 32nd in the nation for unemployment in February 2020, with an unemployment rate of 3.6% compared to the national average of 3.5% (https://www.bls.gov/web/laus/laumstrk.htm). The COVID-19 pandemic and subsequent response resulted in a dramatic increase in unemployment for Nevada. The average unemployment rate for Nevada in 2020 was 12.8% compared to the national average of 8.1%. Nevada ranked 51st in the nation for unemployment during 2020. Nevada’s unemployment rate has recovered from the highest point of 29.5% in April 2020 to 13.0% in September 2020, and the number of Nevadans in the work force increased from 1.05 million in April to 1.3 million in September.

Nevada’s traditional industries include tourism, gaming, and hospitality; logistics and operations; and agriculture. Other industries including manufacturing; information technology; aerospace and defense; energy; and health care have all historically experienced growth and helped stimulate the economy according to the Nevada Governor’s Office of Economic Development (GOED). However, according to GOED from July 2019 to July 2020, Nevada job loss was over 138,000 jobs and 56,000 were in the leisure and hospitality industry.( https://goed.nv.gov/wp-content/uploads/2021/01/Nevada-Recovery-and-Resiliency-Plan-FINAL.pdf).

The Kids Count Data Center data for 2019 reports the statewide median income of households with children was $69,300, an increase from $65,400 in 2018. For 2019, U.S. Census Bureau data indicate there were approximately 23,000 children who had at least one parent unemployed, and 89,642 children ages 6 to 12 years old with at least one parent not in the labor force during the year.

6.  Housing

Market forces continue to decrease the availability of affordable rental housing, increasing rates of rent burden for lower income households. According to the National Low-Income Housing Coalition, the 2020 Fair Market Rent (FMR) in Nevada for a two-bedroom apartment was $1,065. For a household to afford this level of rent without paying more than 30% of their income on housing, the household must earn at least $3,549 monthly or $42,592 annually. The estimated hourly mean renter wage in Nevada is $17.42, at which workers could realistically afford a rent charge of only $906.

(https://reports.nlihc.org/sites/default/files/oor/files/reports/state/NV-2020-OOR.pdf).

7.  Income

Economic distress indicators such as poverty rate, housing vacancy rate, and percent of adults not working are compared across communities to create the Distressed Communities Index (DCI). According to the Economic Innovation Group 2020 DCI, 16.2% of Nevadans reside in distressed zip codes. Compared to 2018, when four Nevada counties were considered “prosperous” (Douglas, Eureka, Storey, and Washoe), only two met this tier in 2020 (Douglas and Washoe). Furthermore, between 2018 and 2020, two counties considered to be at higher risk became distressed (Esmerelda and Pershing), joining Mineral County for this tier level. Three counties are considered to be at higher risk in 2020 (Lander, Lincoln, and White Pine). Eig.org/dci/interactive-map?path=state/NV&view=county

Nevada faced no recent budget shortfalls in the reporting FFY but is in the process of reckoning with statewide budget shortfalls in light of COVID-19.

The median annual household income for Nevada increased from $58,646 in 2018 to $63,276 in 2019, according to the American Community Survey (ACS). Between 2018-19, the U.S. median annual household income increased from $61,937 to $65,712.  According to County Health Rankings and Roadmaps, “Income inequality helps measure gaps in household earnings.” Income inequality is measured as the ratio of household income at the 80th percentile to income at the 20th percentile. In Nevada, the ratio is 4.3 overall and ranges from 3.2 (Lincoln County) to 8.3 (Eureka County) The two largest counties, Clark County and Washoe County, have a ratio of 4.3 (Income inequality in Nevada | County Health Rankings & Roadmaps).

Nevada’s urban areas struggle with an unusually high cost of living relative to low wages and insecure work associated with service industry tourism economies. The poverty level in rural and urban areas is comparable; however, accessing medical and health care services is severely limited in rural and frontier counties due to geographic access barriers, as well as difficulties in recruiting and retaining providers. This translates into low rates of routine preventive health services being delivered to these regions, such as recommended EPSDT screening and childhood immunizations, and decreased access to preconception health services, including the screening and management of chronic conditions, counseling to achieve a healthy weight, and smoking cessation.

Overall, Nevada’s relatively strong economy has not offset other measures of state performance that rank poorly compared to other states, as evidenced by Nevada’s rankings in the 2021 Camelot Index. The Camelot Index ranks states on six quality of life measures: economy, health, crime, education, society, and state government.  Nevada ranks 29th for economy, which considers poverty rates, incomes, and tax bases. Nevada experienced a double-digit loss in ranking from 2020, dropping 10 spots. Nevada ranks 26th for prudent state government fiscal measures, the same as in 2020.  The state is in the bottom half for all other measures. Nevada ranks 38th for health of the state’s population; this measure encompasses age-adjusted death rates, infant mortality rates, and health insurance coverage rates. When comparing crime rates across states, Nevada ranks 40th, and for measures of a healthy society, such as home ownership rates and food security, Nevada ranks 45th. Finally, when comparing measures for education such as high school graduation rate, standardized testing scores, and pupil to teacher ratio, Nevada ranks 46th in the nation. Notably, Nevada is the bottom-ranked state for pupil-teacher ratio. These rankings are useful to know to help inform where Nevada can leverage its strengths to improve these and related measures in the future.

8. Policy/Legislature

The 80th Nevada Legislative Session ended June 3, 2019, and a key piece of legislation passed was Assembly Bill (AB) 169 which established a Maternal Mortality Review Committee and protections for the Committee. MCAH staff support the MMRC programmatically and administratively. Nevada’s Title V MCH Program shared information relating to MCH populations from legislation passed in the session with partners statewide, particularly in relation to any changes to the Nevada Check-Up and Medicaid programs which broaden allowable billing codes or reimbursement and creation of a Diapering Committee and Family Planning account, as well as on newborn screening fee change and panel addition pathways. A bill was passed funding a study on home visiting which includes MCAH participation and the passage of the Account for Family Planning created opportunities to improve reproductive health statewide.

NRS Chapter 442 codifies statutes related to Title V MCH. NRS 442.133 provides the membership and terms of the MCHAB. The MCHAB is comprised of nine members appointed to two-year terms by the State Board of Health, with two legislators appointed by the Legislative Counsel. MCHAB is staffed by the Title V MCH Program Manager and an Administrative Assistant III. MCHAB advises the DBPH Administrator on objectives related to primary care, infant mortality, preventing fetal alcohol syndrome and substance use by pregnant persons, and increasing immunizations. The MCHAB meets at least quarterly.

The CYSHCN Director served on the Association of Maternal and Child Health Programs (AMCHP) Policy Committee with a two-year term ending January 2020. Chapter changes under review by Medicaid relevant to MCH populations are shared widely with MCH partners and coalitions, and DHCFP has worked with the Title V MCH Program on provider draft chapter changes related to preterm birth.

The MCAH Section and Title V MCH Program worked in close partnership with DCFS and SAPTA to support efforts to align and implement federal and state legislative changes to the Infant Plan of Safe Care and are active in Infant Plan of Care efforts as a key partner. Title V MCH Program staff function as core members of the Nevada ASTHO OMNI team on substance use in pregnancy and NAS reduction efforts.

9. State Title V Emerging Issues

COVID-19

The Nevada Health Response Center, Nevada DPBH, and the CDC are closely monitoring the outbreak of the respiratory illness caused by the 2019 novel coronavirus (COVID-19). DPBH is encouraging healthcare providers to refer to the CDC’s Health Alert Network (HAN) and DPBH Technical Bulletins and DHHS efforts inform the state COVID-19 information hub at https://nvhealthresponse.nv.gov/. The latest Nevada COVID-19 statistics and response efforts are also located at the website and kept updated through the efforts of the DHHS Office of Analytics and DPBH OPHIE office.  Local health authorities, including Southern Nevada Health District (SNHD), Washoe County Health District (WCHD), and Carson City Health and Human Services (CCHHS) are also key responders monitoring and providing information related to COVID-19.

In addition to the DHHS and DPBH efforts, Title V MCH Program staff posts MCH-specific COVID-19 resources on the program website; are engaged in COVID-in-pregnancy surveillance monitoring discussions with CDC as part of an OPHIE-led team; MIS-C efforts; share COVID-19 resources and technical bulletins to partners to support rapid information sharing; and have reached out to partners and subawardees to see how COVID-19 is affecting their efforts/activities and to assist with any technical assistance and/or adaptations or fiscal redirects as needed. MCH funded statewide clear face mask purchases for school districts and EHDI partners and supported a CHS immunization need, MCH and NHV staff were awarded pass through HRSA funds via AMCHP for a COID-19 related telehealth project for CYSHCN and prenatal care.  Fortunately, most MCH-funded partners have been able to function well and adapt to the challenges of using virtual platforms. MCH staff have adapted administrative and organizational processes to support program implementation while telecommuting. Title V MCH staff continue to facilitate a COVID-19 and MCH data presentation in concert with the Office of Analytics during the MCHAB meetings since August 2020.  MCAH staff have also discussed NOMHE-planned equity and COVID-19 toolkit distribution opportunities and shared materials from NOHME and other quality organizations about racism and public health, health equity, health disparities and racism, and racism and pregnancy outcomes.

Congenital Syphilis

In 2018, Nevada was the top ranked state for primary and secondary syphilis rates and ranked second for congenital syphilis (CS) rates. In 2019, Nevada remained the top ranked state for primary and secondary syphilis rates, while falling to fourth for CS rates. Primary and secondary syphilis rates have been increasing in Nevada since 2012. According to the CDC, Nevada’s rate of primary and secondary syphilis per 100,000 persons, from 2012-2019 are as follows: 4.1, 7.3, 11.0, 11.7, 15.3, 19.7, 22.7, and 26.6. With this increase of syphilis cases comes a rise in congenital syphilis. According to CDC, CS rates in Nevada have been rising since 2012. Nevada’s CS rates per 100,000 persons from 2012-2019 are as follows: 2.9, 5.7, 13.9, 22.0, 33.1, 57.9, 85.5, and 114.7; this represents a 34.2% increase from 2018 to 2019, and a 3855.2% increase over an eight-year span. MCAH staff are members of the CS Workgroup for Nevada and have been instrumental in CS prevention informational campaign development and resource distribution.

Teen Suicide

Teen suicide is an emerging issue in Nevada. Data from the National Vital Statistics System (NVSS) shows the adolescent suicide rate for those ages 15-19 years per 100,000 adolescents in Nevada was 15.6 for the reporting period of 2017-19; this represents an increase of 2.6% from the 2016-18 rate. Nevada’s 2017-19 teen suicide rate is higher than the U.S. rate of 11.2 suicides per 100,000 adolescents during the same reporting period. When stratifying adolescent suicide rates for those ages 15-19 years by urban/rural residence, the 2015-19 rate was 20.0 in non-metro (rural) areas compared to 14.4 and 13.1 in small/medium and large metro areas, respectively. Title V MCH will continue to be an active participant in the Healthy Tomorrows Grant with the Nevada Primary Care Association. The Healthy Tomorrows project is focused on creating adolescent-friendly spaces in FQHCs to increase repeat visits and a develop a patient-centered medical home for Nevada’s adolescents. Title V MCH Program funding also helped support the Nevada OSP with teen suicide prevention and systems-building projects, such as Youth Mental Health First Aid and Project AWARE, via funding for the OSP Manager and the crisis call line. Title V MCH staff also participate on the HRSA Mental Health Evaluation Committee and attend Statewide Children’s Mental Health Consortia meetings.  Title V MCH Program staff also wrote a letter of support for The Foundation for Positively Kids in their application to the Healthy Tomorrows Program grant.

Substance Use During Pregnancy and Substance Exposed Infants

Close monitoring of substance use during pregnancy and substance exposed infants will continue to be a priority for DPBH and Nevada’s Title V MCH Program. According to data from NVSS, the percent of women who smoked during pregnancy was 3.5% in 2019; a decrease from 5.4% in 2010, or a change of 35.2%. NVSS data also reflects a modest decline in the use of substances during pregnancy, as the percentage of women who reported smoking, alcohol use, and/or drug use decreased from 5.5% in 2016 to 5.3% in 2019. MCAH will continue to work on state efforts regarding Comprehensive Addiction Recovery Act (CARA) and the Infant Plan of Safe Care including education, training, OMNI work group participation, and increasing awareness. Nevada PRAMS staff make inquiries about substance use before, during, and after pregnancy and provide self-reported data in addition to vital statistics and hospital inpatient data to inform Title V MCH efforts/activities. To enhance other substance use prevention efforts, PRAMS data will be presented to both the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI) and Promoting Innovation in State/Territorial Maternal and Child Health Policymaking (PRISM) learning communities.

Title V MCH Program staff are also core members of the Nevada ASTHO OMNI NAS-related efforts in Nevada and  also participate in the AMCHP PRISM efforts.  MCH funds will support Infant Plan of Care material translation and distribution and the MCH Director will present on CARA referral pathways at a Project ECHO webinar in August and co presented at the Nevada Health Conference on Infant Plans of Care. 

Maternal Mortality Review Committee (MMRC) and Alliance for Innovation on Maternal Health (AIM) Efforts

Governor Steve Sisolak signed Assembly Bill (AB) 169 of the 80th Nevada Legislative Session into law in June 2020, establishing a Nevada MMRC. AB169 was codified in NRS 442.751 through 442.774, inclusive, and reflected the work of a wide vary of supporters and advocates. The MMRC is required to: 1) review incidents of maternal mortality and severe maternal morbidity (SMM) in Nevada; 2) disseminate findings and recommendations concerning maternal mortality and SMM to providers of health care, medical facilities, other interested persons and the public; 3) publish timely reports consisting of data relating to maternal mortality and SMM, descriptions of incidents reviewed by the Committee, and recommendations to reduce maternal mortality and SMM in Nevada.

Nevada established the state’s first MMRC and convened the first meeting in February 2020 and convened a total of four times that year. This MMRC will continue to meet at least twice annually to review all incidences of maternal mortality in Nevada. The Title V MCH Program will be involved in supporting MMRC-related meeting travel and ancillary costs for members, and in considering possible opportunities for implementing MMRC recommendations in MCH programmatic efforts for prevention, increased awareness of the existence and recommendations of the MMRC among the public, clinicians, and policy makers, and supporting dissemination of required reports and data-driven MMRC recommendations (e.g., evidence-based practices, screenings, and patient and provider education). The 2021 legislative session added a partnership between the MMRC and the NOHME Advisory Board in relation to recommendations of the MMRC in the biennial report to the legislature.

Reporting produced by the MMRC support staff is included in Nevada’s Title V MCH Block Grant reporting, and health equity in birth outcomes and maternal domain population health maximization will be key areas of topical intersect in priorities of the MMRC, MCAH Section, SSDI Program, and Title V MCH Program. Title V MCH Program staff will look for opportunities to create sustained funding for the MMRC as it was passed into law without dedicated funding. SSDI funds help support MMRC administrative support staff. The Title V MCH Program is in discussions with the Nevada Rural Hospital Partnership to launch Advanced Life Support in Obstetrics (ALSO), American College of Obstetricians and Gynecologists (ACOG) efforts to reduce rural maternal mortality by working with critical access hospitals.  Nevada is now an Alliance for Innovation on Maternal Health (AIM) State, which will help staff support activities reducing preventable maternal mortality and severe maternal morbidity (SMM), beginning with the hypertension patient safety bundle with the Nevada AIM launch June 24, 2021.

Early Childhood Continuum

Strengthening the early childhood education continuum to include public health is an emerging issue the Nevada Title V MCH Program will help address. The Title V MCH Program will continue and expand efforts to achieve the goal of NPM 6: To increase the percent of children, ages 9 to 35 months, who received a developmental screening using a parent completed screening tool. According to data from NSCH, Nevada has experienced an increase in the percent of children screened, from 27.9% during 2017-2018 to 30.6% during 2018-2019. Systems-level interventions are needed to address all components of child development. Title V MCH Program staff will continue to work with the Early Childhood Advisory Council, Pritzker initiatives, Nevada Early Intervention Services (NEIS), and NHV to engage diverse partners and leverage existing efforts to address the early childhood continuum. The MCH Director and NHV staff have been core participants in Pritzker efforts in Nevada also related to strengthening the early care continuum. Title V MCH funding replaced out of date audiological equipment.  The new audiological equipment will serve all NEIS children statewide.