Promote Effective Statewide Public Health System

 

The MICA Board of Directors supports the belief that a responsive public health system is essential in promoting a healthy population through prevention and containment of threats that compromise the well-being of Minnesotans.  Further, the Board supports sufficient, stable state funding for Essential Activities and local public health emergency preparedness activities.

 

Protecting and promoting the health of the public is a fundamental responsibility of government at the federal, state and local levels.  To carry out this mission, state and local public health efforts must address threats on five fronts:  family health, emergency preparedness, health promotion, communicable disease and environmental health. 

 

To meet the needs of the citizens it serves, the local public health system requires support from the legislature regarding authority, responsibility, advocacy, accountability and funding.  The state's public health vision must continue to include counties and must commit to funding and maintaining Essential Activities, which includes support of a stable public health infrastructure.  The recent intensified interest in being prepared for emergencies or emergent threats highlights the importance of local public health efforts and a reliably responsive statewide system. 

 

County public health personnel are the first line of defense in our communities, yet federal and state funding for local public health has been inadequate to the task.  Local tax dollars are increasingly being used to carry out state-directed public health responsibilities.  Through the years, Community Health Services funding has only been increased once (in 1996).  To stabilize funding, the annual CHS distributions to counties should be indexed for inflation.

 

Support Statewide Public Health Information Network

 

The MICA Board of Directors supports:

 

·        State funding to support the development and maintenance of the Minnesota Public Health Information Network (MNPHIN)

·        The allocation of federal and state funding to counties to support access to public health data in response to public health emergencies, including bioterrorism.

·        A state data collection policy that facilitates the gathering and analysis of health data aimed at protecting and promoting the health and safety of all Minnesotans.

 

The Minnesota Public Health Information Network (MNPHIN) was established to support the collection and use of health data through a reliable, secure and comprehensive system.  Since its creation in 2005, progress has been made, but considerable work remains.  Technologically, state and local government public health departments continue to lag behind the private health care sector.  National and state data standards need to be adopted to ensure secure exchange and integration of data.  Local public health departments require technical and financial assistance to update their data management system so they are fully interoperable with a comprehensive state system. 

 

A solid public health information network depends on the effective and efficient management of data at the county level.  Local public health services are significant source of raw data, gathered from contact with individuals, families and communities.  State mandates to counties to report outcome measures requires up-front planning on how information should be collected and organized to provide quality surveillance and interpretive information while protecting the privacy of individuals.  Additionally, the urgency of protecting the public against infectious disease outbreaks, environmental threats and possible hostile attacks require that Minnesota strengthen the current statewide public health information system.  The collaborative effort of the Minnesota Department of Health and counties continues to be the best approach to managing public health information for the benefit of all Minnesotans.

 

Support Local Public Health Emergency Management

 

The MICA Board of directors supports state and federal funding and policy changes that facilitate local public health emergency preparedness activities.

 

Although much has been accomplished in public health emergency preparedness, a considerable amount of work remains to be done before we are fully capable of responding to public health emergencies.  The coordination of state and local government with all hospitals, clinics, and other medical entities, including mental health professionals, must continue.  Funding for local infrastructure, exercises, planning, training of health professionals and ongoing coordinated training is needed. 

 

In the last year, 3 emergencies - the collapse of the I-35 bridge in Minneapolis, the floods in south eastern Minnesota and a serious outbreak of Hepatitis A - demonstrated the important role played by local public health services, from immediate response to post-crisis assessments.  In recent funding cycles, state and federal funding allocated for public health emergency preparedness activities have overwhelmingly been expended at the state level, with little allocation to local public health partners.  Funding earmarked by the 2006 Minnesota Legislature for pan flu preparedness was retained entirely by the Minnesota Department of Health, with no distribution to counties.  Federal funding for public health preparedness for federal fiscal year 2008 was decreased by 11 percent, with no funding for 2008-09 for pandemic flu; additionally there is a potential that local funding matches will be required for federal public health emergency preparedness.  Additional funds need to be dedicated to counties for local public health preparedness activities, particularly to maintain and further develop public health infrastructure essential to protecting the public’s health in the midst of public health crises. 

 

Provide Stable Funding for Family Home Visiting

 

The MICA Board of directors supports the allocation of stable and sufficient funding for the state-administered, county-delivered targeted home visiting program. 

 

Home visiting programs address the state’s responsibility to provide basic protections and support when families are at risk or are not able to provide basic and essential developmental support.

 

The 2007 Legislature allocated $4.5 million per year in TANF funds to support home visiting.  While this funding will help reinvigorate home visiting programs, this funding source has proved to be unreliable.  Most of the $21 million in TANF reserves appropriated for targeted home visiting by the 2000 Legislature was subsequently redirected in the following legislative sessions before it could be spent.  Base funding from the state’s general fund is essential for supporting effective home visiting programs. 

 

Home visiting for at-risk families is a proven and efficient means of investing in the self-sufficiency, health and wellbeing of families, and of avoiding high-cost remedial programming required when children are neglected and abused.  Families who have voluntarily engaged in quality home visiting programs which include the involvement of public health nurses, show patterns of improved school readiness, higher employment rates and lower public assistance utilization.  Because child abuse and neglect rates are lowered, emergency health and health care problems are minimized.  Additionally, special education, out-of-home placements, and corrections services are also lower for at-risk families receiving home visits.

 

Research indicates that early childhood deprivation and abuse often results in life-long dysfunction including mental health and learning problems, criminal activity, a proclivity for violence and employment difficulties.  In human and financial terms, ameliorating the effects of abuse and neglect are far more difficult and expensive than preventing abuse and neglect.

 

Several Minnesota counties have funded their own home visiting programs, yielding the same kind of success produced by long-running programs in other states and countries.  These counties should not be punished for their efforts by maintenance of effort (MOE) requirements, which are currently attached to state funding.  Adequate base funding from the state needs to be allocated to support solid, preventive services to at-risk children in all Minnesota counties. 

 

Improve Health Care Outcomes and Access

 

The MICA Board of Directors supports a state/federally funded system to address the lack of access to health care for a significant portion of our state's population - especially children.   The Board supports the allocation of sufficient federal and state funds to sustain a health care system that promotes prevention, early intervention, on-going access and the establishment of best practices. 

 

Limited access to preventive or ongoing health care creates problems that reverberate throughout our society.  Lower-cost care that identifies and treats health care problems early on significantly reduces deep-end services, such as emergency care, hospitalization and long-term care for chronic conditions.  Access to care also enhances quality of life and productivity, especially for vulnerable populations.  Lack of adequate insurance closes the door to most avenues of care except limited public clinic services and emergency care, which are disproportionately delivered by a limited number of providers.  Under the current system, the funding provided by the federal government through the disproportionate share element of MA has failed to keep pace with the cost of services to the uninsured poor.  Lack of insurance creates uncompensated care, straining vital sectors of the health care system and frequently shifting the cost to county property taxes. 

 

Intensified efforts to enroll all eligible persons in private and government-sponsored access programs are the first step in addressing the growing problem of uncompensated care.  Expanded eligibility and sliding fee co-pays based on ability to contribute and higher reimbursement rates for those who disproportionately provide care to the un- and under insured would improve the system.   Presumptive eligibility also promotes access by allowing reimbursement for care given to un-enrolled but eligible persons.  Establishing best practices and limiting reimbursements for elective procedures would increase the efficient use of health care appropriations. 

 

Public Health Workforce Shortages

 

The MICA Board of Directors supports efforts to address health care workforce shortages.

 

Counties have a vested interest in factors affecting the availability of healthcare services to the communities they serve.  The ability of counties to carry out their responsibilities as spelled out under the Local Public Health Act, MS 145A, is challenged by the chronic shortage of health care professionals.  Community-based services, which are needed for caring for the frail elderly and others with disabilities, are critically absent in many communities due to low reimbursement rates and low wages.  For highly trained and experienced public health professionals, demands are much higher than their numbers, which drives up their wages in the private market but prices them beyond the reach of many public health departments.  For example, many counties, especially in rural areas of the state, have open positions for public health nurses they have been unable to fill. 

 

The emerging threat of public health emergencies and communicable diseases highlights the importance of public health.  Additionally, the burgeoning number of those reaching older and older ages and the survival of more high-needs infants is expected to require a 40 percent growth in the current health care sector.  Efforts need to be made at the state and federal levels and in the public and private sectors to avert the deterioration of our health care system. Increasing MA rate reimbursements and wages for public health and community-based workers and creating educational incentives are examples of efforts that may help address the problem of workforce shortages. 

 

Support Disease Prevention and Control Efforts

 

The MICA Board of Directors supports adequate state funding for disease prevention and control efforts, including:

• Restoration of ongoing funding for vaccines for MA-eligible young adults ages 18-21
• Reliable funding for TB treatment and control

 

Many factors contribute to the importance of addressing disease prevention and the containment of infectious diseases.  Medical advances and increased understanding of healthy behaviors have enhanced the life span of many Minnesotans, resulting in larger numbers of senior citizens and individuals with disabilities, who often require more health care services.  Recent outbreaks of E-coli, salmonella and hepatitis and increasing incidents of communicable diseases (i.e. TB) are clear indicators of an escalating threat of infectious disease which requires intensive response and coordination.   Inadequate infrastructure and lack of state and federal funding is stressing the ability of local public health to respond as disease spreads with the increased movement of people throughout the world.  Travelers on business trips or refugee families sometimes bring more than their hopes with them to Minnesota. 

 

Immunizations:  Vaccines and immunizations are essential in preventing outbreaks of communicable diseases.  Minnesota has worked hard to achieve one of the highest levels of immunization in the country.  However, inadequate funding for immunization clinics threatens to erode this success.  As a matter of good public health practice, many counties are picking up these costs.  It makes more sense to ensure statewide access to these immunizations by funding them with state dollars.  Additionally, all insurers should be pressed to include coverage for immunizations and vaccines. 

 

TB Treatment:  The incidence of Tuberculosis (TB) is on the rise, posing a significant threat to the public health, and requiring an immediate and ongoing response of local public health.  TB requires follow-up care that is expensive and staff-intensive.  Funds provided to states by the federal government, as well as incentives for the resettlement of immigrants and refugees, are very minimal, leaving county property taxpayers with the associated health care costs.  TB is also making a comeback in non-immigrant populations. The US Congress and the state should provide funding for all TB-related costs, including full reimbursement for the local public health departments that manage these cases. 

 

Update and Align Long-Term Care Services Funding and Policy

 

The MICA Board of Directors supports policy and funding updates that reflect the shifting roles of federal, state and local governments and private entities, which oversee or provide long-term care (LTC) services for the disabled and frail elderly.  The Board urges the legislature to provide adequate state funding for state-mandated LTC services.

 

An aging population and rising numbers of persons with disabilities is rapidly increasing the need for long-term care.  New delivery models have evolved in an effort to meet the high demands for services and to maximize the return on investments.  While cooperative efforts that involve federal, state and county governments, as well as private entities, have produced innovative, effective and efficient programs, the transitions from older to newer models requires careful rebalancing.  Counties are most concerned about preserving their core function in the public health and human services arenas:  Protecting vulnerable citizens and maintaining the infrastructure to carry-out this work.

 

A major shift to combine the medical and wrap-around supportive services, including case management, and to transfer programs and the populations they serve from a fee-for-service  to a prepaid medical assistance program (PMAP) structure is underway The Elderly Waivered Services (EW) program provided the first opportunity to put into action a cooperative, consolidated model.  Counties negotiated with DHS and the health plans to address issues of concerns.  As a result, the transition was phased in, allowing time to evaluate and develop collaborative models incorporating county/health plan partnerships.  The Minnesota Senior Health Option (MSHO) is also well into the process of change.  In 2007, Medical Assistance (MA) began to convert the remaining individuals on fee-for-service, who had previously been exempted from the required enrollment in a PMAP.  Except for individuals covered by waivered services, or targeted case management, these enrollees will have the option of voluntarily participating in Special Needs Plans (SNPS) offered by qualified PMAP’s beginning in January 2008.  In 2009, SNPS coverage will be mandatory for children and adults needing mental health treatment, with an opt out option for adults. 

 

Counties continue to have serious concerns about the transfer of some responsibilities to health plans, most notably case management.  Counties are fully engaged in the process of change, working to ensure that county oversight in long-term care provides a foundation for the expanded partnership with the private sector.  This oversight role must include the authority and funding to support county efforts to monitor and encourage a community network of services that will need to remain in place to serve enrollees no matter how LTC services evolve.  The state and counties must be able to track data to assess program effectiveness and to identify any emerging problems.