Maternal and Child Health Advisory Task Force
Friday, September 13, 2013
MEETING SUMMARY
Members Present:
Carolyn Allshouse
Ken Bence
Mary Braddock
Joan Brandt
Carol Grady
Stephanie Graves
Neal Holtan
Julie Jagim
Nancy Jost
Michelle O’Brien
Martha Overby
Kristin Teipel
Angela Watts
Rosemond Owens
Deb Purfeerst
Wendy Ringer
Melissa Winger
Members Absent:
Tanya Hagre
Wendy Hellerstedt
Joel Hetler
John Hoffman
Daphne Lundstrom
Susan Morris
Guests:
Tricia Brisbine
Anna Gamboa
Atshushi Sorita
Lindsey Wimmer
MDH Staff:
Jeanne Ayers
Ellen Benavides
Jeanne Carls
Susan Castellano
Barb Dalbec
DeeAnn Finley
Sara Hollie
Janet Olstad
Megan Waltz
INTRODUCTIONS AND CHAIR’S REMARKS
Julie Jagim welcomed members and introductions were made around the room. Dee Finley noted that
Tanya Hagre will no longer serve on the Task Force. Ken Bence made a motion to approve the June
Task Force meeting minutes. Carol Grady seconded the motion. Motion carried.
FAMILY STORY
Ana Gamboa shared the story of her journey with her son Danny. Danny is Ana's adult son with
complex medical needs. Ana is a Parent Support Navigator for the Parent to Parent Program with
Family Voices of Minnesota. Ana shared her experiences in trying to find support and services for
Danny. She stressed the importance of the support she received from Family Voices.
MDH UPDATE
Assistant Commissioner Jeanne Ayers provided an update on MDH activities. Following is a summary
of her remarks:
Governor’s Children’s Cabinet
• The Governor’s Children’s Cabinet’s strategic plan focuses on three areas: collaborating to
better serve teen parents and their children, babies and toddlers in poverty, school children with
unaddressed mental health needs.
• The Children’s Cabinet was involved in the development of Minnesota’s Race to the Top (RTT)
application. This grant involves significant interagency work around data and increasing qualityrated child care centers in four transformation zones.
• Working during the legislative session, the Children’s Cabinet secured funding in several areas
related to its strategic plan, including early learning scholarships, children care assistance for all
teen parents completing their education, and doubling funding for school-linked mental health
grants.
• As noted above, the Children’s Cabinet had targeted teen parents and their children. This
includes increase high school graduation rates among pregnant and parenting teens, improve
health outcomes for infants and children of adolescent mothers, and lengthen intervals between
pregnancies.
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Adverse Childhood Experiences (ACEs)
• ACE data was released early 2013. Staff have been presenting the data around the state to
discuss the impact of toxic stress on brain development.
• The goal of sharing this information is to stress the need invest in creating environments where
children can be healthy (e.g. SHIP).
• The full report on the Adverse Childhood Experience in Minnesota is now available here:
http://www.health.state.mn.us/divs/cfh/program/ace/publication.cfm.
Health Equity
• During the past session (as part of the Health and Human Services Omnibus Finance Bill)
legislation was passed requiring the development of a health equity report. MDH, in consultation
with local public health, health care, and community partners, is required by this provision to
write a report on a plan for advancing health equity in Minnesota. The report is due to the
Legislature by February 1, 2014.
• The report is an opportunity to be intentional about a conversation on race and the inequities
within our systems.
• The plan is to gather input from a variety of sources including MDH staff and multiple
stakeholders. The groups will be asked to respond to the role their agency plays addressing
health equity.
• The report will be more of a status report by population group, not health condition, and will map
out where we have policies that create social inequity.
• Legislative language on the required Health Equity Report is available here:
http://www.house.leg.state.mn.us/comm/minls88/H1233A54-1.htm
Prenatal to Three
• The prenatal to three planning process released framework in January of 2013 and has moved
on to “phase 2” of the process.
• This involved regional meetings to bring leadership teams together to develop
recommendations and advance success for the prenatal to three period.
• A more comprehensive update on the Prenatal to Three planning process can be found on the
MCH Advisory Task Force webpage:
http://www.health.state.mn.us/divs/fh/mchatf/meetings.html
State Health Improvement Partnership (SHIP)
• SHIP RFPs are currently being reviewed.
• SHIP is a comprehensive effort to support policy, system and environmental change through
community-based primary prevention.
• Healthy Minnesota 2020 has three primary themes:
o Capitalize on the opportunity to influence health in early childhood.
o Assure that the opportunity to be healthy is available everywhere and for everyone.
o Strengthen communities to create their own healthy futures
 SHIP is clearly aligned with this theme.
• More information on SHIP and the new SHIP grantees can be found on the SHIP website at:
http://www.health.state.mn.us/divs/oshii/ship/index.html
UPDATE ON THE AFFORDABLE CARE ACT IN MN
Assistant Commissioner Ellen Benavides provided an over view of implementation of MNSURE and the
Affordable Care Act in Minnesota. She will also discuss the SIM grant awarded to Minnesota for
innovation in health care. Copies of her slides providing more details can be found on the MCH
Advisory Task Force website at: http://www.health.state.mn.us/divs/fh/mchatf/meetings.html. Following
are highlights from her presentation.
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ACA/MNsure
• The Affordable Care Act (ACA) was implemented to address the issue that the state and nation
are spending increasing amounts on health care. Additionally, the health outcomes in the U.S.
are not good compared to other countries. We have more uninsured and significant health
inequities.
• The goals of the ACA and an exchange (MNsure) are to have more people insured, increase
benefits, and reduce costs.
• Minnesota is building on health reform activities that started in 2008. This includes:
o Payment reforms
o Mandatory reporting relationships between hospital and clinics through community
measures
o Provider peer grouping to address the total cost of health care from a consumer
perspective. For example, how do you get information about cost and quality that is
understandable?
• It is anticipated that after January 1, 2014 there will still be approximately 210,000 people still
uninsured. This includes undocumented persons, employees in businesses that are not offering
insurance, and the newly uninsured.
• Some of the highlights of ACA insurance changes include:
o Children can stay under their parents’ coverage until age 26.
o There are no annual benefit limits.
o There will be more access to preventive services w/o copay.
o The Medicare donut hole will be closed.
o Depending on income, there are tax credits offered to offset costs.
• In February 2013 Minnesota implemented Medicaid expansion:
o This included an increase in the percent of poverty to qualify. This expansion will be
covered 100% by federal dollars for three years, and then will decrease to 90%.
o The coverage will be a basic health plan that offers a set of 10 services.
o MinnesotaCare (for now) is that basic health plan in Minnesota.
• Roles of state agencies in MNsure:
o As of early September, MNsure is its own entity with a governing board.
o The MDH will be involved through the HMO Unit that licenses and regulates HMOs. This
Unit will be responsible for network adequacy quality of coverage.
o The Department of Human Services is responsible for rate negotiations.
o The Department of Commerce is responsible for rates and assures all health plans are
solvent.
• More information on Mnsure can be found on the web at: http://www.mn.gov/hix/
• The AMCHP handout on “The Patient Protection and Affordable Care Act: Summary of Key
Maternal and Child Health Related Highlights with Updates on States of Implementation” is
available on the web at: http://www.amchp.org/Policy-Advocacy/healthreform/Pages/default.aspx
The Minnesota Accountable Health Model (SIM Grant)
• Minnesota has received a $45 million grant to provide more coordinated, high quality care at a
lower cost from the Centers for Medicaid and Medicare Services (CMS) as part of the State
Innovation Model (SIM) Initiative.
• Minnesota will use the funds to drive health care reform in the state and to test the Minnesota
Accountable Health Model.
o The goal of this model is to ensure that every citizen has the option to receive teambased, coordinated, patient-centered care that increases and facilitates access to
medical care, behavioral health care, long term care, and other services.
• The model will expand Minnesota's current Medicaid Accountable Care Organization (ACO)
demonstration and include 15 accountable communities for health. These communities will
develop and test models for integrating care across the health care system.
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By 2016, nearly 3 million Minnesotans are expected to receive care through the model. The
model is projected to save $111 million over three years and lay the foundation for additional
savings in years to come.
This is a joint project between the Minnesota Department of Health and the Minnesota
Department of Human Services.
Partners in the project include six Medicaid ACOs and Hennepin Health.
DHS will implement a new way of contracting with providers to take provide healthcare to
Medicaid clients.
The idea of the grant is a “total cost of care arrangement” through a direct relationship between
DHS and providers.
The assumption is that the participating organizations will integrate behavioral health,
community services, public health, and social services.
Sixteen accountable communities for health will be created in the second year.
The goal is to involve all systems that are involved in those communities (e.g. education,
housing, transportation) to address how to create and support what a community says it needs
to be healthy.
In the past, leadership for health reform used to come from the health plans and providers. The
SIM grant gives the opportunity to expand the leadership.
More information on the SIM grant is available here:
http://www.health.state.mn.us/healthreform/sim/
COMMUNITY & FAMILY HEALTH DIVISION UPDATE
Maggie Diebel, CFH Division Director, Susan Castellano, MCH Section Manager and Barb Dalbec,
CYSHN Section Manager provided updates on activities taking place in the Community and Family
Health Division. Following is a summary of their remarks.
Susan Castellano
• Infant Mortality: The MDH hosted an Infant Mortality stakeholder meeting on July 22.
Additional meetings are scheduled for October and November. The goal is to create a state
infant mortality plan. The process will engage a large number of partners in identifying issues,
establishing priorities, and identifying and implementing action steps. More information can be
found on the Infant Mortality Reduction Work Group website at:
http://www.health.state.mn.us/divs/fh/mchatf/InfantMortality.html.
• Family Home Visiting: The MDH will be convening a FHV advisory group as a way to maintain
an open dialogue with local public health about home visiting. There will also be a subgroup on
FHV evaluation. This includes getting input on upcoming changes to the evaluation
infrastructure.
• ECCS: The MDH received a renewed federal Early Childhood Comprehensive Systems (ECCS)
grant. The grant involves supporting the development of a “Help Me Grow” model system in
Minnesota. The grant focuses on expansion of developmental screening. Funding is $140,000
for three years. The Minnesota Great Start Committee will serve as the steering committee for
the grant.
• Maternal Depression Screening: MDH is implementing a grant to support pediatric clinics
screening for maternal depression during well child visits. The funding for the project is from
DHS.
• Preconception Health: A Preconception Health Work Group will be starting in October. The
work group will focus on preconception through the life course. The Task Force will be kept
updated on the work group as it moves forward. More information can be found on the
Preconception Health Work Group website at:
http://www.health.state.mn.us/divs/fh/mchatf/PreconceptionWG.html.
• Adolescent Health: Kristin Teipel and Sara Hollie provided an update on the Adolescent Health
Work Group. This is a two-tiered planning process. Initially, a small group will develop the
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planning process and a larger group will develop the plan. The intent is to develop a simple,
action oriented plan that is possible to implement and determines the capacity to better address
adolescent health versus a developing a health issue specific plan. The Task Force will be kept
updated on the work of the group as it progresses.
Barb Dalbec
• CYSHN Strategic Plan: The CYSHN Strategic Plan is available in hard copy and on the web.
The plan will be used to direct the work of the section and establish priorities. One of the
outcomes of the plan is the development of parent advisory group that will begin later in the
year. The group will be designed to bring together parents of special needs children – and youth
with special health needs – to help in decision making on improving systems that MDH can take
action.
• CYSHN Website: The CYSHN Section has updated their website
(http://www.health.state.mn.us/mcshn/).
• Screening: The MDH is hosting an in-depth training session on childhood screening at the
Health Care Home Learning Days for certified Health Care Homes in MN in November.
• MNsure: The CYSHN Section is monitoring the impact of MNsure implementation on children
with special health needs to determine if there are any issues for that population.
• Autism: MDH applied for an autism state implementation grant but was not funded. The
number of grants was reduced from five to four due to sequestration. We were are number five
with a score of 94 out of 100 and are still hopeful that once additional funding is available we will
be funded. The MDH continues to work with the U of M on the Minneapolis Somali Autism
Prevalence Study. The hope is to release the report in October, but this timeline is dependent
on data analysis.
• Immunizations: MMR immunization rates have decreased in the Somali community. Currently
they are below 50%. There is concern because many in the Somali community travel abroad so
there is a risk of measles outbreaks in the schools. There are several charter schools that have
an MMR immunization rate of almost 0%. This low rate is due to the fear in the community that
immunizations cause autism. The CYSHN section has hired staff to work jointly with the
Immunization, Tuberculosis and Intentional Health Unit to address that fear and develop a
communication plan.
• State Interagency Committee: The Minnesota State Interagency Committee (MNSIC) is a
committee focused on children age 3 to 21 in special education. They are currently mapping out
all of the groups working with that population and trying to identify the special role that the
MNSIC plays.
• Transition: The CYSHN Section has been working on issues related to youth with special
health needs transitioning to the adult health care system. MDH has issued a grant to Family
Voices of Minnesota to develop and spread best practices in certified health care homes.
• Minnesota’s Olmstead Plan: In 2009, the Civil Rights Division launched an aggressive effort to
enforce the Supreme Court's decision in Olmstead v. L.C., a ruling that requires states to
eliminate unnecessary segregation of persons with disabilities and to ensure that persons with
disabilities receive services in the most integrated setting appropriate to their needs. President
Obama issued a proclamation launching the "Year of Community Living," and has directed the
Administration to redouble enforcement efforts. The Division has responded by working with
state and local governments officials, disability rights groups and attorneys around the country,
and with representatives of the Department of Health and Human Services, to fashion an
effective, nationwide program to enforce the integration mandate of the Department's regulation
implementing title II of the ADA. In January 2013, Governor Dayton issued an Executive Order
establishing an Olmstead Sub-cabinet to develop and implement a comprehensive Minnesota
Olmstead Plan. The completed plan can be found online:
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&Revision
SelectionMethod=LatestReleased&dDocName=opc_home
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MEMBER NEWS AND ISSUES
Ken Bence: The Community Health Conference will be held at the end of September. There will be a
session at the conference to discuss collaboration between pediatricians and health plans to address
childhood obesity. Similar issues could benefit from this type of collaborative. Conference materials are
available on the conference website at: http://www.health.state.mn.us/divs/opi/pm/conf/schedule.html
DHS is leading an initiative to reduce low birth weight in Minnesota. The groups is defining a common
birth notification form for providers to send to health plans so the health plans’ care management
system can start as soon as possible.
The Minnesota Cancer Alliance is looking at improving the rates of HPV vaccination for boys and girls
as a cancer prevention strategy. They are tackling the issue of how to assure that all three doses of the
vaccine are received within the broader context of the adolescent immunization panel.
The Minnesota Chlamydia Partnership is working on increasing testing and addressing the
implementation of Minnesota legislation that allows for active partner treatment. When a woman is
treated she can get received two doses to treat her partner.
The Center for Community Health (previously the Center for Population Health) is being reestablished.
The group is bringing together metro representatives (health plans, public health and hospitals) to align
the work each is doing around community needs assessments. They are also discussing ways to
measure progress in population health.
The Dental Services Advisory Council is developing policies and guidelines on the use of general
anesthesia during dental treatment for children with special health needs.
Joan Brant: Ramsey County is also involved in the Low Birth Weight Initiative. Additionally St. PaulRamsey County Public Health is working with DHS and MDH to keep the teen MFIP pilot project
moving forward.
Stephanie Graves: Hennepin County IEIC had redesigned the developmental wheel. They are offering
to other IEICs for the cost of printing. The wheel is currently only available in English, but will soon be
available in Spanish and Hmong.
Minneapolis is working with the youth coordinating board and schools to develop a grant proposal to
the League of Minnesota Cities. The grant has no funding, but will support technical assistance for
partnering on early childhood coordination.
The Minneapolis Health Department is working with Hennepin County and Bloomington to work on an
ABCD project.
Nancy Jost: The West Central Initiative has given each of 10 early childhood initiative counties
funding to conduct community home visiting meetings. The funds can be used to map out home visiting
activities in their communities, identify gaps and determine how best to fill those gaps.
The Bremmer Foundation has approached the West Central Initiative to discuss replication of the
dental program.
Several early childhood initiatives have taken place. Nancy participated in a Prenatal to Three regional
meeting with Megan Waltz. Nancy is also chairing the prenatal to three subcommittee for Minneminds.
Lastly, Nancy has asked members of the regional early childhood network to talk with physicians in
their communities about being involved in early childhood initiatives.
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Kristin Teipel: Kristin participated in an Affordable Care Act webinar on health care for young adults.
The webinar was hosted by the federal Maternal and Child Health Bureau.
There is a new initiatives/websites called “Young Invincibles.” The purpose of the young initiative it to
help young people increase access to health care and help them be responsible for their own care.
More information is available here: http://younginvincibles.org/
Meredith Martinez: Melvin Carter started as director of the MDE Office of Early Learning in August.
Melvin was a former St. Paul city council member.
Meredith will be doing meetings with programs and people in the Race to the Top transformation zones.
She will be working on a pilot project to support an online screening system with the four transformation
zones and some additional communities outside of those areas. This project ties into the work of the
ECCS grant.
Angela Watts: Angela discussed a CNN/Soledad O’Brien special featuring the Northside Achievement
Zone. Information on the Series “Black in America” and the segment on “Great Expectations” can be
found here: http://newday.blogs.cnn.com/2013/08/30/watch-great-expectations-a-black-in-americaproduction-friday-10-p-m-et/
Martha Overby: The March of Dimes is working on a pregnancy weight management toolkit. The
toolkit will be available to providers in a few months after approval of from national March of Dimes.
Last week a group met that will be strategizing about the multiple groups that are convened to address
infant health, including the Prematurity Task Force, Preconception Health Work Group, Low Birthweight
Group, Minnesota Perinatal Association, and the Minnesota Council of Health Plans. The group talked
about awareness of each other, each group’s purpose, overlap, gaps, and opportunities for
collaboration. The group agreed on the need to continue meeting. The initial project will be to develop a
resource list that includes each group’s mission, goals, history, etc.
Julie Jagim: St. Louis County Public Health is planning schools-based vaccination clinics.
The county is expanding the Superior Babies program, including adding additional staff. They are able
to add four chemical health assessment staff and a public health nurse.
The county is coming to the end of an e-health initiative. There were six different entities who received
grant to address interoperability between hospitals, the county and nursing homes. They are working
on e-health continuity of care.
Public health is involved in a project within the Duluth community to address permanent supportive
housing environment for families. They are planning 44 units that will include wrap-around services.
TITLE V REVIEW AND APPLICATION
Susan Castellano and Barb Dalbec provided an update on Minnesota’s Title V activities and the federal
review of Minnesota’s Title V Block 2012 annual report and 2014 application. Following is a summary of
the discussion:
• The reviews were from National Family Voices and LEND CYSHN staff from Kansas University.
Therefore, there was a lot of focus on CYSHN.
• Strengths included the involvement of consumers and the diversity of the disciplines of Task
Force members. They also noted the strength of Minnesota’s cross state agency work.
• Overall the review was very positive and the reviewers struggled to find things that need to be
addressed. Some of the opportunities for improvement included a lack of mental health
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providers across the state. They also asked about how we seek community input into the block
grant process.
There was discussion at the review regarding about the need for Title V with the implementation
of the Affordable Care Act. This indicates a need to increase understanding of the role Title V
plays in the provision of direct services. In Minnesota, Title V funds are not used at the state
level to provide any direct services. MCHB and AMCHP are working on a project to document
how states use Title V funding and address the questions in congress about what is done with
the money.
TASK FORCE BUSINESS
Dee Finley provided a brief update on membership. Susan Morris, Isanti County Commissioner is has
been approved by the Commissioner as a CHS representative on the Task Force. Meredith Martinez
will serve as the ex-officio representative of the Minnesota Department of Education.
The members then brainstormed ideas for the 2014 MCH Advisory Task Force work plan. The
discussion will be reflected in the final version of the work plan presented to the Task Force for
approval at the December meeting.
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