Characteristics of Minnesota

Demographics and Geography

Known as the Land of 10,000 Lakes, Minnesota (MN) is a medium-sized state, covering slightly over 84,000 square miles across 87 counties and 11 Tribal Nations, typically referenced across eight regions of service (Figure 1). In 2022, 5,717,184 people lived in MN, with over half of residents living in the seven-county Minneapolis-St. Paul metropolitan area.[1]

Figure 1. Map of MN State Community Health Services Advisory Committee Regions

For most of the twentieth century, MN had a relatively homogeneous population. While non-Hispanic whites made up 97.8% of the state’s population in 1960, they made up 76.7% in 2021. Between 2010 and 2020, the state population of people of color (Asian/Pacific Islander, Black, multiracial, and/or Hispanic) and American Indians increased by over 57.5% while the number of non-Hispanic white residents fell by 3.8%. Black, American Indian, and people of color (BIPOC) are distributed unevenly across the state, being more likely to live in urban than rural areas. Between 2010 and 2020, the fastest growing racial group in MN was the multiracial population, which grew by 176%, adding 220,576 people. Second fastest was the Black population, which grew by 45.2%, adding 124,022 people, followed by the Asian population, which grew by 39.7%, adding 84,956 people. While less diverse than the United States as a whole, in 2020, 33.7% of MN births were to pregnant people who identified as BIPOC. Furthermore, 33.8% of children under age 5, and 32.4% of children under age 20, are members of BIPOC communities.

As of 2022, 58% of MN’s foreign-born population were naturalized United States citizens. MN’s largest foreign-born groups were born in Mexico, Somalia, India, Laos (including Hmong), Ethiopia, Vietnam, China, and Thailand (including Hmong). MN is home to more refugees per capita than any other state, and the state has the largest Somali and urban Hmong populations in the nation. Over half of MN’s Asian population identifies as Southeast Asian (compared to 20.7% nationally). Over 100 languages are spoken at home in MN, and 12.3% of Minnesotans ages 5+ spoke a language other than English at home in 2019.

Although birth rates are at historic lows, MN had a population growth rate of 7.6% between 2010 and 2020, adding 402,569 residents (net). Most growth has been in the seven-county Twin Cities metropolitan area. The fastest growing counties by population between 2010 and 2020 (net growth) were Carver (17.4% increase), Scott (16.2%), Wright (13.3%), Olmsted (12.9%), and Washington (12.4%). The counties that added the most residents between 2010 and 2019 were Hennepin (+129,140), Ramsey (+43,712), Dakota (+41,330), Anoka (+33,043), Washington (+29,432), and Scott (+21,000). Thirty-six counties have lost population since 2010.

In 2022, MN was home to 1,288,213 children under age 18, representing 22.5% of the population. There were 64,459 live births in the state in 2021, down from the peak of 73,675 in 2007, but up from the low of 63,426 in 2020. MN’s age distribution is like the United States overall. In 2022, children under 5 accounted for 5.7% of the state’s population, 18+ comprised 77.5%, and people 65+ comprised 17.4%. By 2035, the number of those ages 65+ is expected to surpass the number of those under 18 for the first time in history. MN’s diverse cultural groups have very different age distributions. Our state’s large Baby Boomer generation, born between 1946 and 1964, is overwhelmingly white. In contrast, most BIPOC are much younger, particularly among Somali and Hmong Minnesotans, with half or more of the population under the age of 22. While Minnesotans ages 18-64 are most of the present-day workforce, children under 18 represent the workforce of the future and their preparation is critical to the continued economic success of the state. Key demographic changes in MN include an aging population, decreasing birth numbers, growing BIPOC communities, growth concentrated in urban areas, and a rising ratio of dependent elderly people and children to the working-age population. These changes will impact the need for and type of healthcare services, housing, education, business, commerce, and social services.

MN’s Indigenous Communities

MN is home to 11 federally recognized tribal nations and communities, including seven Anishinaabe (Ojibwe) Tribes (Figure 2):

Bois Forte Band of Chippewa
Fond du Lac Band of Lake Superior Chippewa
Grand Portage Band of Lake Superior Chippewa
Leech Lake Band of Ojibwe
Mille Lacs Band of Ojibwe
Red Lake Nation
White Earth Nation

As well as four Dakota (Sioux) communities:

Lower Sioux Indian Community
Prairie Island Indian Community
Shakopee-Mdewakanton Sioux Community
Upper Sioux Community.

Figure 2. MN Tribal Nations and Communities

As of 2022, approximately 155,080 people in MN identified as American Indian and/or Alaska Native (either alone or in combination with one or more other races) representing 2.7% of the state’s population. About 40,333 (30%) American Indians lived on a reservation/community according to 2017-2021 Census estimates, while approximately 50,870 (37.9%) American Indians/Alaskan Natives live in the Minneapolis-St. Paul metro area.[2] The additional 32.1% of American Indians live in greater MN.

Structural and systemic racism play an integral role in perpetuating poor health outcomes among American Indian women, children, and families, who experience the greatest health disparities in MN. These disparities are caused by historical and ongoing trauma, racism, and colonial practices and policies that create barriers to opportunity and thriving. Into the 20th century, Anishinaabe and Dakota peoples were continuing to experience displacement, broken treaties, and exploitation of their land by the United States and MN State governments, often through violence and coercion, including genocide.[3] These practices over several centuries created and continue to maintain the disparities seen in American Indian MCH populations in MN today.

In recognition of MN American Indian tribes and communities as sovereign nations – as well as acknowledgement of the harmful relationships of distrust and corruption with the federal and state governments – MDH is committed to centering healing, trust, and strength as we work to rebuild relationships to support a thriving American Indian population. Rebuilding healthy nation-to-nation relationships means honoring the lived experience and voices of MN’s American Indian community members while honoring tribal government and research authorities, including Tribal IRBs and research boards. Given the history and ongoing use of research on American Indian peoples without permissions and to further harmful ideations and stereotypes of American Indian peoples, tribal nations and communities are cautious and particular about who, when, and how they choose to provide or engage in data driven efforts. The Title V program can only ensure representation in our program data insofar as tribal nations and communities give us this permission. Additionally, MN is not alone in the challenges around data disaggregation for American Indian and Alaska Native populations due to federal and state policies and practices that deem data around these populations as too small a sample size, statistically insignificant, and other areas of issue.

“American Indians and Alaska Natives may be described as the ‘Asterisk Nation’ because an asterisk, instead of a data point, is often used in data displays when reporting racial and ethnic data”.[4]

While these challenges are often referring to quantitative data, efforts to collect qualitative data presents its own set of challenges due, again, to historically harmful relationships with those who request this data, such as state government. This requires extensive, meaningful, and authentic relationship-building at not only a nation-to-nation level, but also at the population, community, and individual levels. Much of this relationship-building is happening across the programs supported through Title V. Staff and programs have built successful relationships with tribal nations and communities and engage in a variety of data collections efforts in partnership with American Indian communities. However, this becomes difficult at an overarching Title V level to effectively engage with tribal nations and communities for the purposes of Title V data efforts when no Title V dollars are currently distributed directly to MN’s tribal nations and communities. MN’s Title V program has begun exploring innovative approaches to ensure engagement and representation through relationship-building with our current funding structure, based in legislative statute.

Economics and Urbanization

MN’s seasonally adjusted unemployment rate dropped to 1.8% in MN in June 2022 and is lower than the national unemployment rate of 3.6%. In 2022, the median household income for Minnesotans was $84,313. From 2010 to 2018, the number of part-time workers in MN decreased by 88,900 whereas the number of full-time workers increased by 296,900 (59% to 64%). In June 2020, MN’s unemployment rate rose to 9.9% due to the impact of lay-offs related to the COVID-19 pandemic. Approximately 26% of MN’s workforce was eligible for unemployment benefits between March 2020 and March 2021. Over half of those workers were able to return to their former employer. MN is on course to continue adding jobs – if employers can find workers to fill them. The state is down more than 75,000 people in our labor force since before the pandemic.

Since 2020, MN has seen steady progress toward greater economic stability for BIPOC communities. However, there remain significant disparities in the median household income, employment, and poverty between and within racial and ethnic groups. The number of MN children and families living in poverty remains a concern. In 2022, an estimated 540,079 Minnesotans, including 133,237 children under 18 had family incomes below the official poverty threshold, and the overall poverty rate was around 9.6%. More alarming is the persistent disparity in poverty for BIPOC communities. Among children ages 0-17, poverty rates in 2019 were highest among those identifying as American Indian (40%), Black (40%), and Hispanic (17%), which was 3.4- to 8.0-times greater than seen among non-Hispanic white children (5%).

Systems of Care in MN

Health Care Insurance Environment

MN’s healthcare system ranks in the top in overall performance according to the Commonwealth Fund. MN coordinates a comprehensive set of health insurance options intended to help meet the health and well-being needs of Minnesotans. However, not everyone in the state has equal access to health insurance coverage based on their race, economic situation, geographic location, and other factors.

Insurance Coverage and Cost

According to the most recent MN Health Access Survey, around 3.8% of Minnesotans lacked health insurance coverage in 2023. The maintained high rate of coverage seen since 2019 was consistent with levels experienced after the full implementation of the Affordable Care Act in MN in 2014 when 95.3% of Minnesotans had health insurance coverage.

Despite high levels of insurance coverage, historic disparities in coverage experienced by certain groups persisted in 2023 and health care is still unaffordable for many MN families. Systemic racism creates barriers to accessing health insurance. As a result of an unfair and unjust health insurance system, BIPOC communities are twice as likely to be underinsured than white people living in MN. The uninsured were also more likely BIPOC, a young adult (age 18 to 34), in a lower income bracket, or have a high school education or less.

MN Health Care Programs (MHCP)

MHCP provide health care coverage to eligible families with children, adults, people with disabilities, and seniors. MHCP include Medical Assistance (MA) and MNCare (MNCare). These programs are administered by the MN Department of Human Services (DHS).

MHCP financed 43.4% of all births (27,759 infants) in 2022, down slightly from 43.9% in 2018. Total spending on health care services for MCHP was approximately $13.4 billion in FY 2020 an 8.9% increase from FY 2019.

Medical Assistance (MA)

MA, MN’s Medicaid Program, is a state and federal program that provides health insurance that covers a broad array of health services for people, including families and children with low-incomes, older adults, and people with disabilities. MA covers one out of every four Minnesotans, a monthly average of 1.3 million people. As the third largest insurer in the state after self-insured employer-based coverage and Medicare, it makes up nearly 16% of the state’s health insurance market. The composition of enrollees is 65% families with children, 15% seniors and people with disabilities, and 20% adults without children (Figure 3). Children ages 0-18 are the single largest group, making up 49% of total enrollment.

Figure 3. Total Cost and Enrollment Counts by Eligibility Type, 2022 [5]

Income eligibility requirements for MA vary by age (Table 1). If someone makes more than the income limit, they may still be eligible for coverage using a spenddown (a cost-sharing approach that allows people with incomes greater than the applicable limit to “spend down” their excess income to the appropriate income limit by deducting certain health care expenses).

Effective Jan. 1, 2024, or upon federal approval and completion of state implementation requirements (whichever is later), a child under 19 years of age eligible for MA must remain eligible for 12 months. Effective Jan. 1, 2025, 12-month continuous eligibility will be extended to include children under age 21, and children under age six will remain eligible for MA without interruption from the time they are first determined eligible up until the month they reach six years of age. Continuous eligibility ensures that children who are already enrolled in MA do not lose their coverage due to administrative hurdles or minor fluctuations in their family’s income [6].

Table 1. MN’s Income Eligibility Levels for Medicaid

Most Minnesotans enrolled in MA receive services through managed care organizations, with the remaining enrollees receiving services through the traditional fee-for-service system (FFS), where providers receive a payment from the DHS directly for each service provided to an enrollee. Individuals who remain on FFS are primarily those who are not required to enroll in managed care or who have chosen to opt out of managed care. In general, this includes those with disabilities, people who are eligible with a spenddown, children receiving adoption assistance, and American Indians who live on a federally recognized reservation.

The American Rescue Plan Act, signed into law in March 2021, gives states the option to extend the Medicaid and Children’s Health Insurance Program (CHIP) postpartum periods for pregnant people from 60 days to 12 months. This option makes Medicaid and CHIP funds available for states to provide coverage during an extended postpartum period. This gives providers opportunities to assess physical recovery from pregnancy and childbirth, and to screen for and provide care to address conditions that can lead to morbidity and mortality in the later postpartum period. High quality, comprehensive postpartum care should address chronic health conditions (e.g., diabetes or hypertension), mental health and psychological well-being (e.g., postpartum depression, interpersonal violence), and family planning. Postpartum visits are also a time for providers to counsel individuals on nutrition, breastfeeding, tobacco and other drug use, and other preventive health issues that affect both the postpartum individual’s longer-term health and that of the infant. The 2021 MN legislature enacted a law to adopt this option provided and extend the MA and CHIP-funded MA postpartum period effective July 1, 2022. Though this policy does not apply to MNCare, or to Emergency Medical Assistance (EMA) which covers labor and delivery costs.

MNCare

MNCare is a state and federal program that provides a low-cost health insurance option to people who do not have access to affordable employer-sponsored health insurance and have higher income levels than those eligible for MA. MNCare coverage is more affordable and comprehensive than insurance available on the individual market, delivering a broader set of benefits than those required by federal law, including dental, vision and comprehensive behavioral health services. MN is one of two states with this type of insurance coverage program, which is known as a Basic Health Program. On average, 83,000 Minnesotans purchase their coverage through MNCare, who pay no more than $80 a month in premiums and are guaranteed low out-of-pocket costs. Income eligibility is for adults with incomes over 133% federal poverty line (FPL) up to 200% of FPL.

Additional Assistance for Families of Children with Disabilities

MN allows parents who have a child with a disability the option to obtain MA through the Katie Beckett provision under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) if they are over the Medicaid income limit. Prior to this, families of children with disabilities who needed MA coverage but wanted care at home faced significant eligibility barriers due to the consideration of the income and assets of the parents. Oftentimes, parents with a household income above eligibility requirements would have to place their child with a disability in an institutional setting to be able to obtain MA. Under MN’s TEFRA program, higher income families raising a child with a disability can access MA by paying a fee. The payment amount is determined using a sliding scale based on the family’s annual adjusted gross income. Fees do not exceed the cost of services delivered. However, during the 2023 legislative session, legislation was passed in MN to provide parental fee relief – including the elimination of parental fees under both MA TEFRA and Home and Community-Based Services (HCBS) waivers [7].

Children’s Health Insurance Program (CHIP)

CHIP supplements existing federal Medicaid funds that provide health care coverage for low-income families (Table 2). When the program was created in 1997, MN already covered most of the children Congress intended to cover through CHIP. Therefore, the MN Legislature chose to use CHIP funds to extend benefits to a small group of children who did not have coverage at the time (children under age 2 with family incomes between 275% and 283% of the FPL). Over time, MN obtained a federal Section 1115 waiver to allow the state to use CHIP funds to add coverage for parents of some children on MA and Congress revised the Title XXI of the Social Security Act to allow states to extend CHIP coverage to pregnant women who were ineligible for MA.

Table 2. Populations Covered by Federal CHIP Funding in MN

Advanced Premium Tax Credit

Another public program that assists with health care coverage is the Advanced Premium Tax Credit, a federal program that reduces the cost of premiums for individual health insurance based on income, available through federal or state marketplaces, such as MNsure (MN’s health insurance marketplace). In 2023, a record number of Minnesotans signed up for private health insurance plans using MNsure, MN’s official health insurance marketplace. At the close of MNsure’s annual open enrollment period on Jan. 15th, 146,445 people had successfully signed up for private health plans for 2024.

Healthy Start Performance Improvement Project

Five MN Health Plans – Blue Plus, Health Partners, Hennepin Health, South Country Health Alliance, and UCare – launched the Healthy Start Performance Improvement Project in 2021. The project focuses on ensuring a “healthy start” for MN children and families by improving services provided to pregnant women and infants, with a particular focus on reducing racial and ethnic disparities. The project includes working with a wide variety of partners to improve access to and coordination of resources to help mothers and children get the right care at the right time in the right setting. The aim is to close healthcare disparities in the following:

Timely prenatal and postpartum care
Well Child visiting in the first 30 months of life
Childhood immunization status
Low birth weight.

Comprehensive Systems of Support

Hospitals

MN is home to many excellent hospitals, including the number one ranked hospital in the United States, according to U.S. News and World Report – the Mayo Clinic. As of Nov. 2023, there were 127 community state licensed hospitals with 16,139 beds, of which 76 are designated Critical Access Hospitals (CAHs). CAHs are smaller hospitals (fewer than 25 beds), mostly in rural areas, which receive higher reimbursement from Medicare, as long as they maintain certain services. Unfortunately, MN hospitals are finding it increasingly difficult to sustain themselves. Since 2000 the number of community hospitals in the state decreased by 5.9% (from 135 to 127).

Pregnant persons living in rural areas have experienced declining availability of hospital services – 12 counties lost hospital birth services between 2012 and 2022.[8] This is especially concerning because giving birth in a hospital without obstetric services can lead to higher rates of hemorrhage, emergency surgery, and maternal death. Continued disruption to rural hospitals’ ability to offer birth services further deepens disparities in access to prenatal and birth care.

MN’s hospitals voluntarily participate in a statewide trauma system by attaining designation as a Level 1, 2, 3, or 4 trauma hospital. These designation levels reflect the resource capabilities of the hospital (with Level 1 facilities having the most capabilities). As of 2023, around 99% of Minnesotans lived within 60 minutes of a trauma hospital [9], which is an important predictor of survival after sustaining a traumatic injury or needing life-saving care.

Health Care Homes (HCHs) and Behavioral Health Homes

HCHs, designed to coordinate care among the primary care team, specialists, and community services, are a cornerstone of MN’s bipartisan health reform efforts of 2008. The voluntary program continues to support primary care providers, families, and patients who work in partnership to improve health outcomes and quality of life for patients, including those with chronic conditions or disabilities. By 2014, MN’s HCH efforts reduced MA costs by 9% and helped to reduce inpatient hospital admissions, hospital outpatient visits, skilled nursing facilities and pharmacy costs. Racial disparities were significantly smaller for Medicaid, Medicare, and Dual Eligible beneficiaries served by HCHs versus those served in non-certified clinics. As of December 2022, a total of 388 clinics in MN were certified as HCHs, serving 69 counties (79%).

Behavioral Health Homes (BHHs) were implemented in 2016 for eligible people with serious and persistent mental illness, emotional disturbance, or severe emotional disturbance - a subpopulation of persons known to have a higher likelihood of experiencing poor health outcomes and fragmented care. BHH services build upon the successes of HCH and create a comprehensive care coordination service that integrates physical health, mental health, the health concerns of substance use, long-term services and supports, and social services. As of 2024, there are currently 50 provider locations certified to provide BHH services.

Family Planning

The MN Family Planning Program (MFPP) and Sexual and Reproductive Health Services (SRHS) – formerly Family Planning Special Projects (FPSP) – provide vital family planning services to low-income/underserved people.

Established by the MN Legislature in 1978, the FPSP grant funds support essential pre-pregnancy family planning services for people with the least access. In 2023, the state legislature enacted several changes to the program, effective July 1, 2023, including changing the name of the program to SRHS. Funding is focused on people who would have difficulty accessing services because of barriers such as poverty, discrimination, lack of insurance, or transportation. The legislature’s 2023 actions also included extending eligibility to the 11 tribes in the geographic area of MN. Grants are awarded to counties, cities, community health boards, tribes, or 501(c)(3) non-profit organizations to provide family planning services in communities throughout the state. The legislature also removed the prohibition on using funding to provide services to unemancipated minors in schools. Effective July 1, 2023, the SFY 2024 appropriation increased to $13,500,125 million per year.

The SRHS program is administered by MDH and provides pre-pregnancy family planning services for people whose incomes are below the federal poverty level and placed at increased risk for unintended pregnancy. MDH receives state and federal funding for Temporary Assistance to Needy Families (TANF) to provide statewide family planning services and infrastructure support to clinics that provide family planning services. In 2023, SRHS reached around 91,165 people through outreach activities and provided 15,741 clients a range of contraceptive methods – with 22% of clients choosing Tier 1 (most effective), long-acting reversible contraceptives.

The MFPP, administered by DHS, is an insurance program that pays for family planning services and transportation services to and from providers of family planning service for people between 15 and 50 years old, who are not eligible for other public programs, and who have an income at or below 200% of the FPL.

Family Home Visiting (FHV)

FHV is a voluntary, home-based service ideally delivered prenatally through the early years of a child's life. FHV provides social, emotional, health-related, and parenting support and information to more than 7,000 of MN’s families that are economically and socially disadvantaged, and links them to appropriate resources. By participating in home visiting, some examples of services a family may receive are:

Connections/referrals for pregnant persons to prenatal care
Early support to parents in their role as a child’s first teacher
Help in creating a safe and healthy environment for a young child to thrive in
Parenting skills and support that decrease the likelihood of child abuse.

FHV services in MN are supported by several funding streams, including state, federal, and local resources. At the state level, MDH oversees and distributes funding for home visiting services provided under TANF funding, the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, MN evidence-based home visiting funding, and MN's Nurse-Family Partnership legislation. Funding administered by MDH is granted to Community Health Boards, tribal governments, and non-profit organizations. Local tax levies and Medical Assistance reimbursement also fund FHV in MN. All 51 Community Health Board Title V grantees administer home visiting services in their communities.

Women, Infants, and Children (WIC) Special Supplemental Nutrition Program

WIC is a special supplemental nutrition program for pregnant and post-partum women, infants, and children up to age 5 who have an increased risk of developing malnutrition and meet specific income guidelines or who are enrolled in TANF, SNAP or Medicaid. The program is funded by USDA and provides the following services to influence lifetime nutrition and health behaviors:

Nutrition Services & Breastfeeding Support
- Participants receive an individualized nutrition assessment along with education and referrals to community resources.
- WIC promotes and supports breastfeeding, including exclusive breastfeeding for the first six months of an infant’s life.
- WIC supports healthy diets and infant feeding practices. These practices can help prevent obesity and anemia among other benefits.
- Many local WIC programs provide peer breastfeeding support to mothers and infants.
Healthy Foods

WIC provides healthy foods including fruits, vegetables, whole grains, and low-fat dairy. The WIC food package contributes to healthy diets, which aid in preventing obesity and chronic disease.

During FFY2023, an average of 106,100 low-income women, infants, and children up to age five participated monthly in the MN WIC program. In 2022, MN WIC served an estimated 38.4% of all infants born in MN.

MN’s Government

Children’s Cabinet

MN’s Children’s Cabinet is an interagency partnership the Governor tasked with making MN the best place for children to grow up. The Children’s Cabinet was established in 1993 (MN Statute § 4.045) and is a broad interagency partnership of 22 state agencies that utilizes a whole-family systems approach to support the healthy development of children and families. The Children’s Cabinet engages with two external advisory bodies: Children’s Cabinet Advisory Council and the State Advisory Council for Early Education and Care. These groups, made up of individuals with the perspective of youth and families, diverse and underrepresented communities, and tribal and county leadership, provide guidance to inform the priorities and activities of the Children’s Cabinet. The State Title V MCH Director represents MDH on the State Advisory Council for Early Education and Care.

The Cabinet utilizes a results-based accountability lens in these priority areas:

Children and Families
Thriving Communities, Housing, and Workforce
Healthy Minnesotans
Equity and Inclusion
MN’s Environment
Fiscal Accountability, Customer Experience, and Measurable Results.

The Children’s Cabinet established work groups of Assistant Commissioners, Division Directors, and subject matter experts from each agency, to address the priorities. The CFH Division Director, along with Title V staff, participate fully in these initiatives, bringing subject matter expertise; coordination of data; programs and services; and a developing health and racial equity perspective to the work.

Maternal and Child Health Advisory Task Force

The MCH Advisory Task Force was created by the MN Legislature in 1982 (MN Statute § 145.8811) to advise the Commissioner of Health on:

The health care needs of mothers and children throughout MN.
The type, frequency, and impact of maternal and child health services in the state.
Program guidelines and criteria considered essential to providing an effective maternal and child health care program to populations below the federal poverty threshold and placed at risk of not having access to essential health care services and fulfilling the purposes of the state and federal maternal and child health statutes.
The use of federal and state funds available to meet maternal and child health needs.
Priorities for funding the following maternal and child health services:
1. Prenatal, delivery and postpartum care
2. Comprehensive health care for children, especially from birth through five years of age
3. Adolescent health services
4. Family planning services
5. Preventive dental care
6. Special services for children with chronic illness or disabilities
7. Any other services that promote the health of mothers and children.
Establish statewide outcomes that will improve the health of mothers and children.

The Task Force consists of 15 legislatively authorized members appointed by the Commissioner of Health to four-year terms with equal representation in three categories:

Professional representatives with expertise in maternal and child services
Community health boards representatives
Consumer representatives interested in the health of mothers and children.

For a complete list of members please refer to the MCH Advisory Task Force webpage.

MN Department of Health

The mission of MDH is to protect, maintain and improve the health of all Minnesotans. MDH has broad responsibilities in the areas of health protection, health improvement, and reforming the health care system around a public health framework. Historically, MN is cited consistently among the top 10 states for overall health, best run state, and best state to raise a family. However, these overall ratings mask the significant inequities and the persistent health disparities based on race, geography and/or economic status within MN. While significant attention has been given to health equity and the need for safe, stable environments for our children, the disparities persist.

Healthy MN Partnership

MDH facilitates the Healthy MN Partnership, which brings together community partners to improve the health and quality of life for people, families, and communities. The partnership is responsible for developing a statewide health improvement plan based upon a statewide health assessment. The 2017 Statewide Health Assessment gave us a picture of the health and well-being of people across the state and resulted in increased emphasis on the persistent inequities for the BIPOC community, the LGBTQ community, women and children, and for people with disabilities. The statewide health assessment set the stage for Healthy MN 2022, which identified three priorities: the opportunity to be healthy is available everywhere and for everyone; places and systems are designed for health and well-being; and all can participate in decisions that share health and well-being.

Health Equity at MDH

MN aims to address health disparities as part of a broad spectrum of public investments in housing, transportation, education, economic opportunity, and criminal justice. The Center for Health Equity (CHE) was created in 2013 to advance health equity within MDH and across the state (Figure 5). In 2022, the Health Equity Bureau (HEB) was created which includes the CHE - now known as the Health Equity Strategy and Innovation Division (HESI), the Office of Diversity, Equity, Inclusion and Belonging, the Office of American Indian Health and the Office of African American Health, along with the with MDH’s first Assistant Commissioner for Health Equity. The creation of the HEB reflects MN’s deepening commitment to health equity, an evolution of our equity strategy, a focus on internal culture change to embed equity in everything we do, and many lessons we have learned during the COVID-19 pandemic.

The mission of HESI is to connect, strengthen, and amplify health equity efforts within MDH and across the state of MN. Some highlights of HESI include:

Publishing the Eliminating Health Disparities Initiative (EHDI) impact report, Cultivating a Health Equity Ecosystem: Lessons Learned from the Eliminating Health Disparities Initiative.
Numerous initiatives which centered communities most impacted to address long-standing health disparities, such as infant health and early childhood development.
Catalyzing the transformation of how MDH does business by embedding equity into all we do.
Creating MDH’s Health Equity Advisory and Leadership (HEAL) Council for self-accountability to communities most impacted by inequities across the state.
Bringing together a diverse group of community members known as the Community Solutions Advisory (CSA) Council to guide in healthy childhood grants programs.
Working with MDH staff and community members to develop a 10-year update to the 2014 Advancing Health Equity Report – to be published end of 2024.
Establishing the Health Equity Strategist (HES) model - Ten MDH divisions each hired a HES who brings knowledge and expertise, equity resources and tools, and provides equity training opportunities to increase the capacity of all MDH staff to do health equity work.

Figure 5. MDH Health Equity Strategy and Innovation Division Mission, Values, and Approaches

Legislative Priorities and Wins

The 2023-2024 Legislative Session was historic for children and families in the state of MN. The House and Senate passed billions of dollars to support a transformative biennial budget for the state (2024-2025) and throughout prioritized programs and policies that support the health, well-being, education, and economic security of families to support Governor Walz’s goal to make MN the best state in the nation for kids to grow up. Among the many provisions that the Legislators passed the following during the first (budget planning) year of the MN 2023-2024 biennium [10][11]:

A nation-leading Child Tax Credit which provides up to $1,750 per child for lower income families, is expected to cut child poverty by 33%.
Invested a historic amount in education and schools including by indexing general education funding to inflation.
Established a statewide Paid Family and Medical Leave insurance program to provide partial wage replacement for up to 12 weeks of leave for medical reasons, bonding, or caring for a family member.
Made a $1 billion investment in housing access and affordability.
Increased food access by providing free school meals, and increasing funding for food banks, prepared meals, and food assistance outreach.
Expanded health coverage by providing continuous Medicaid coverage for young children up to age 6 and 12-month continuous coverage for all other children enrolled in Medicaid.
Invested nearly $100 million in children’s mental health supports.
Provided $64.4 million in FY24-25 and $117.7 million per biennium ongoing to increase the number of school counselors, social workers and other student support personnel across the state.
Established the Department of Children, Youth, and Families, a new cabinet-level agency to elevate child, youth, and family priorities and funding needs.

During the first (budget planning) year of the 2023-2024 MN Biennium, the Legislature also created and expanded several MCH programs at MDH including:

Sustainable funding for the Help Me Connect electronic navigator.
Creation of the MN Partnership to Prevent Infant mortality including $3.5 million (in FY24 and FY25) in grants to local public health, Tribal nations, and community organizations to support upstream community-driving program to reduce infant mortality.
State funds to sustain the MN Perinatal Quality Collaborative.
Grant funds for county jails to implement a set of model practices to improve connections between incarcerated parents and their children, including parenting education, improved intake, and family-friendly visiting spaces.
Funding to increase access to culturally relevant developmental and social - emotional screening and connections to services during early childhood.
Grants to expand health education and health services to existing or new school-based health clinics (SBHC) and schools statewide to meet the health needs of students K-12. These grants will support schools in their response to physical, mental, and behavioral health needs of their students.
Creation of a Pregnancy and Substance Use Task Force to create guidance on toxicology testing in pregnancy and the postpartum period and requirements for reporting for prenatal exposure to a controlled substance and specific grants for community organizations addressing substance use in pregnancy.
Creation of student parent centers at institutes of higher education to conduct screenings and referrals for the health concerns of parents and children, including early childhood development, routine health screenings, and addressing concerns such as alcohol misuse, depression, intimate partner violence, and other health concerns.
Doubling the amount of grant funding available for family planning programs throughout the state.
$4 million per biennium ongoing for additional funding for Family Home Visiting.

During the second, non-budget year of the 2023-24 biennium, the MN legislature passed several legislative agenda items that impact children and families in MN. Among the many provisions that the Legislators passed during the second (budget planning) year of the MN 2023-2024 biennium are the following:

Funding for the prevention of and education on the risks associated with cannabis use among youth and pregnant and breastfeeding people.
A “Count the Kicks” campaign to educate pregnant people on the potential preventative utility of tracking fetal movement during the gestational period.
Grant to Chosen Vessels Midwifery Services to support the cultural tradition of mutual aid to support breastfeeding among African American people.
Grant to MN’s Birth Justice Collaborative to plan for and engage community in a plan for an American Indian Prenatal and Postnatal Birth Place.
Grant to MN’s Birth Justice Collaborative to plan for and engage community in a plan for an African American Prenatal and Postnatal Birth Place.
Mandate that where feasible, schools in MN provide space for private mental health treatment for students.
Requirement for established health education standards on cardiopulmonary resuscitation and automatic external defibrillator education, vaping awareness and prevention education, cannabis use and substance use education, sexually transmitted infections and diseases education, mental health education for students, and the possibility to include expectations on learning in the areas of sexual abuse prevention education, violence prevention education, character development education, and safe and supportive schools education.
Mandate that schools maintain a sufficient supply of epinephrine.
Ban on “making money off” social media accounts that feature children.
Permission for midwives to prescribe specific medications as part of their services.
Mandate requiring all health plans that offer physical and mental health services to cover medically necessary gender-affirming care.
Mandate that health plans cover amino-acid based formula for babies in medical need.

MDH will work closely with partners in the state enterprise, community, local public health, health professionals, and other stakeholders to quickly start-up many of these programs. With the robust new investment, MDH’s Title V program will expand in future reports and plan to reflect new grantees, partners, and activities.

Title V MCH Block Grant Specific Statutes

MN Statutes § 145.88 – 145.883 lay out requirements for the distribution of MN’s federal Title V Maternal and Child Health Block Grant award. Statutory language allows the Commissioner of Health to retain up to one-third of the block grant to:

Meet federal requirements of a statewide needs assessment and prepare the annual federal block grant application and report,
Collect and disseminate statewide data on the health status of mothers and children,
Provide technical assistance to LPH agencies in meeting statewide outcomes,
Evaluate the impact of maternal and child health activities on the health status of mothers and children,
Provide services to children under age 16 receiving benefits under Title XVI of the Social Security Act, and
Perform other maternal and child health activities as listed in federal code for the MCH block grant and as deemed necessary by the Commissioner of Health.

The remaining two-thirds of the approximately $9.1 million awarded annually to MN is distributed by formula to Community Health Boards (CHBs) that provide local public health services across the state. In addition, the statute requires that CHBs provide at least a 50% match for the Title V funds they receive. Title V funds allocated to LPH agencies must be used for programs that:

Address the populations who experience disparate health outcomes, particularly people with low-income and from minority groups with a high rate of infant mortality and children with low birth weight.
Specifically consider the needs of pregnant people whose age, medical condition, maternal history or chemical use substantially increases the likelihood of complications associated with pregnancy.
Address the health needs of young children who have or are likely to have a chronic disease or disability.
Provide family planning and preventive medical care for specifically identified populations of focus.
Address child and adolescent health issues.
Address child abuse and neglect prevention, reducing juvenile delinquency, promoting positive parenting and resiliency in children through public health nurse home visits.