Jeff Schiff MD MBA Medical Director Minnesota Health Care Programs, DHS 23 April 2015

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1 Jeff Schiff MD MBA Medical Director Minnesota Health Care Programs, DHS 23 April 2015

2 DHS Mission The MN Dept of Human Services, working with many others, helps people meet their basic needs so they can live in dignity and achieve their highest potential. We serve people with a variety of characteristics which put them at a disadvantage in health care and other arenas. Minnesotans are eligible either due to low income (often very low income) or a disability. Disadvantages often come in bundles, and we serve a high proportion of people of color on our programs.

3 DHS Recipients In 2011, DHS public health care programs had over 300,000 people of color enrolled. (They made up 40% of our enrollees.) Over one-third of all people of color in our state are enrolled in our programs. Over half of African Americans and American Indians are enrolled.

4 2011 Racial/Ethnic distribution in MA/MNCare and in Minnesota

5 How prevalent are family risk factors among Minnesota children who receive Medical Assistance (MA) or MinnesotaCare? This report describes the family risk factors among children on MA and MN Care, and includes reports by Race/Ethnicity. /defaultcolumns/dhs16_ pdf You can also access our main DHS webpage at mn.gov/dhs/ and search under Family Risk.

6 DHS Language Data Sources: Parent speaks language other than English most of the time. We included children in this category if they met any of the following criteria: Parent indicated they need an interpreter on MAXIS enrollment application, Parent gave a language other than English as the one they speak most of the time on MAXIS enrollment application, or Child s MHCP claim or encounter indicates that child had an interpreter at a health care visit in 2013.

7 Prevalence of parental language other than English 25% of children lived in homes where a language other than English was spoken most of the time This indicator was most common among MHCP children identified as Asian (72 percent), Hispanic (63 percent) or Black (33 percent). These three groups were also most likely to have a parent who immigrated to the U.S. We considered this to be a risk factor which might make it difficult to get a child all necessary health care.

8 DHS Immigrant Status Data Sources: Child/parent immigrated to U.S. We took this indicator from MAXIS enrollment forms, which ask for a person s entry date into the U.S. If there was any entry date, we categorized that person as having immigrated.

9 Prevalence of Immigration 4% of children immigrated to the U.S. 28% of children had a parent who immigrated to the U.S. 82% of Asian children had an immigrant parent 67% of Hispanic children had an immigrant parent 45% of Black/African American children had an immigrant parent

10 Race and Ethnicity data source Race/ethnicity data come from enrollment forms, which ask applicants to identify the child as any one or more of these racial groups: Asian, Black/African American, American Indian/Native American, Pacific Islander or Native Hawaiian, or White. It also asks whether or not the child is Hispanic or Latino. MNSure form includes expanded racial and Hispanic categories.

11 Children s Race and Ethnicity A child s race/ethnicity is conceptualized as a demographic factor, not as a risk factor in this report. Here is the distribution of children on MA and MN Care in 2013: White: 45% Black/African American: 21% Hispanic: 14% Asian: 7% American Indian: 3% Multiple/Other race: 9%

12 Children s Race and Ethnicity This report investigates the prevalence of family risk factors among children of different racial/ethnic groups. The next slide shows a few of the most serious risk factors. We can report this type of data for children in different regions, ages, and racial/ethnic groups. Please contact us if you have a use for this type of data and would like to collaborate with us.

13 Children s Race and Ethnicity and prevalence of Family Risk Factors Non-Hispanic American Black White Asian Hispanic Indian Homelessness past 5 years 22% 16% 5% 2% 4% Parental chemical dependency diagnosis 35% 8% 12% 3% 5% Parental Serious and Persistent Mental Illness 6% 5% 6% 7% 2% Parental Serious Mental Illness 17% 12% 14% 16% 6% Child Protection involvement in past 5 years 40% 20% 20% 8% 15%

14 Minnesota Health Equity Report MN-Community-Measurement-Health-Equity-of-Care- Report.pdf asthma colorectal cancer vascular care, and diabetes

15 Policy and Programs New payment models Integrated Health Partnerships Accountable communities Health care homes Payment linked to outcomes Not REL specific, but increasingly community integrated

16 Policy and Programs New para professional provider types Doulas Community Health Workers Peer support specialists Community paramedics And Advanced dental therapists Medication therapy management pharmacists

17 Policy and Programs Targeted interventions Neonatal opioid exposure Low birth weight Autism treatment Diabetes prevention incentive study Colorectal screening

18 Measurement Key infrastructure Development of accountable community models Use of CHW services Process measures Screening rates for colorectal cancer Screening rates for social emotional screening for children Application of fluoride varnish Sentinel measures New chronic users of opioids Opioid exposed infants

19 Diversifying Input into DHS Cultural and Ethnic Communities Leadership Council Advises DHS on reducing disparities that affect racial and ethnic groups within DHS programs Stakeholder Engagement Community of Practice A forum for DHS staff to network and share best practices on working with external and internal stakeholders, including removing barriers to effective participation by the people and the families that DHS serves