How the Walz administration hopes to address health equity in Minnesota through proposed budget

Minnesota has glaring health disparities, and state officials want to shrink them. 

American Indian women in Minnesota, for example, are eight times more likely to die from pregnancy complications than white women. In efforts to reduce disparities like that, the governor has proposed several health programs in his proposed two-year budget that the Legislature would need to approve before July 1. 

The Minnesota Department of Health has weighed in on many of the proposed programs, which cover areas from funding patient care to COVID responses, research and increasing access to various health care services. While none of these proposals have been approved, they are being considered by the legislature this session – as a part of Walz’ broader proposed $72 billion budget.

“In this budget, what you’ve seen is we value our people, we value our children, we value our environment, we value our opportunity to be innovative and we value fairness in the things that we do,” said Gov. Tim Walz at a press conference in January for the budget’s rollout. “It puts Minnesota in a position to care for our children, whether that be through education, through housing, through access to health care.” 

Patient Care

• About $55 million to go toward the “Comprehensive Drug Overdose and Morbidity Prevention Act” 

Minnesota had 1,286 drug overdose deaths in 2021, a 22% increase from 2020. In Minnesota, African Americans and American Indians are more likely to die of drug overdoses than white Minnesotans. 

This recommendation proposes funding for the Minnesota Department of Health to address the drug overdose epidemic in seven specific ways, including advancing access to non-narcotic pain management services, providing culturally specific outreach to increase awareness about overdose, reduce stigma, and provide training for community members on overdose education and naloxone distribution, enhancing overdose prevention and supportive services for people experiencing homelessness, strengthening and equipping employers to promote health and well-being of employees in recovery or with a history of substance use, improving surveillance and identification of substances involved in overdoses and strengthening existing epidemiologic capacity and data sharing to support community-level prevention efforts, providing grants, implementation technical assistance, and evaluation expertise to multidisciplinary public health/clinic/community coalitions to implement prevention teams, recovery organizations and other supports and address substance use disorder (SUD) in pregnant and postpartum women and infants. 

The Minnesota Department of Human Services would also get $45 million to address opioid addiction. 

• $30 million to go toward “Home Visiting”

Family home visiting is a service for pregnant women and child caregivers where a professional does home visits prenatally or shortly after the baby is born and continues until the family is connected to supportive resources. Minnesota is only serving approximately 10% of eligible families who would benefit from home visiting services, according to MDH. 

The programs improve prenatal health, reduce childhood injuries, prevent subsequent unplanned pregnancies, improve school readiness, increase intervals between births, and increase maternal employment, according to MDH. The proposed services aim to serve 3,000 families each year with children under age 5, focusing on unhoused people, families experiencing incarceration and children with special health needs. 

• Nearly $24 million to go toward “Healthy Beginnings, Healthy Families” 

In Minnesota, Black and Indigenous women and their children are disproportionately burdened in every perinatal measure, from preterm births to maternal mortality and morbidity, according to MDH. 

This proposal aims to send funds to focus on health outcomes during the early years of a child’s life to ensure access to health care, mental health services, early care and education.  The funds will go toward sustaining the Minnesota Perinatal Quality Collaborative, which provides a platform for health agencies to intervene through data collection and applying system changes to improve care in perinatal health and allowing local, state, and community partners to align strategies for a population-level impact. 

The funds will also help establish the Minnesota Partnership to Prevent Infant Mortality, aimed to increase access to culturally-relevant electronic developmental and social-emotional screening for children up to age 6 and provide grants to community-based organizations and public health to offer follow-up services for those families. 

This proposal also recommends expanding the Jail Model Practices Learning Community, where MDH staff will partner with 15 county jails to implement a parent education curriculum, build community partnerships, train staff and adopt other practices to expand services and support for justice-involved families. 

• Around $4.5 million to go toward “HIV Prevention Health Equity Programming – Ryan White HIV Funding”

American Indian/Alaska Native, Black and Latinx people, along with those in the LGBTQ+ community are disproportionately impacted by the HIV outbreaks and by HIV in Minnesota generally, according to MDH. 

This recommendation proposes funding HIV prevention programs that directly address the health inequities of communities experiencing the greatest rates of HIV. The funding will support community-based organizations and clinics to offer HIV testing, linkage to care for those newly infected with HIV and prevention services for those at greatest risk. 

• Around $3 million to go toward “MN Uninsured and Underinsured Adult Vaccine (UUAV) Program”

While Minnesota’s uninsured rate fell to its lowest-ever measured level (4%) because of federal and state policies and funding through the COVID-19 pandemic, racial disparities in coverage worsened, according to MDH. The uninsured rate among Minnesotans of color and American Indians rose from 7.6% in 2019 to 10.2% in 2021. 

This recommendation proposes funding a vaccine program for those Minnesotans who are least likely to seek preventative care with an aim of reducing disparities that adult people of color face in accessing immunizations for preventable diseases. MDH will purchase 32,000 doses of routine immunizations, at a reduced price, for 173 provider sites throughout the state to vaccinate uninsured and underinsured adults aged 19 years and older.

COVID

• $4.7 million to go toward “Community Mental Well-being”

COVID-19 put increased burden and stress on individuals and families who needed to navigate and contend with multiple health and socioeconomic impacts, including physical and mental health, housing, education, child care, and unemployment. 

This recommendation proposes for funds to go toward community organizations and health departments through grants to develop solutions for mental health resources and post-COVID-19 recovery for communities disproportionately impacted. 

• Around $6 million to go toward “Supporting Long COVID Survivors and Monitoring Impact”

The pandemic disproportionately impacted Black, Indigenous, and other non-white communities and low-income, rural, disabled and elderly populations. 

This recommendation proposes investing funds to better understand the impacts of long COVID in Minnesota and to support those most affected.  MDH plans to use these funds to raise awareness of long COVID and develop statewide guidance for long COVID diagnosis, treatment, and care coordination, among other things. It will also give grants to community and nonprofit organizations and long COVID survivor groups to support those impacted.  

Offices/Committees

• $4.4 million to go toward an Office of African American Health 

African American Minnesotans face unique issues arising from cumulative disadvantage due to discrimination in housing, persistent racial gaps in education achievement and employment and exposure to high levels of concentrated poverty. 

This recommendation proposes for funding to go toward establishing an Office of African American Health at MDH to address the root causes of health inequities that disproportionately impact Minnesota’s African American communities. 

The recommendation includes funding to support initiatives like creating an African American Health State Advisory Council to advise the health commissioner and to develop policy solutions to improve the health of U.S.-born Black Minnesotans, conduct analysis and develop policy and program recommendations and solutions to improve Black health outcomes. It will also award grants to health and community-based organizations to develop effective solutions to address identified system issues. 

• $4.2 million to go toward the Office of American Indian Health 

American Indian women, children, and families experience some of the largest health disparities in Minnesota – many of which relate to systematic barriers that led to poor access to adequate health care, a lack of high-quality culturally affirming education, non-sustainable employment and food & nutrition insecurity. As a result, American Indians experience the highest rate of poverty, highest rate of health disparities, smallest graduation rates, high unemployment, and lowered access to nutritional foods, according to MDH. 

This recommendation proposes funding the existing Office of American Indian Health further to address the specific needs of American Indians in Minnesota. The proposal includes giving American Indian Special Emphasis Grants to Minnesota’s tribal nations and urban American Indian community-based organizations to plan and develop programs to improve American Indian health outcomes. 

• Around $1 million to go toward “Sentinel Event Reviews for Police-Involved Deadly Encounters”

From 2016-2020, there were 135 civilian deaths in Minnesota that resulted from encounters with law enforcement, according to an MDH investigation. During those years, Black, African, and African American Minnesotans, and American Indians and Alaska Natives were over four times as likely to die in an encounter with law enforcement than their white counterparts. 

This recommendation proposes funding committees to review law enforcement-involved deadly force encounters. The committees, composed of the Department of Public Safety (DPS), Department of Human Services (DHS), Department of Human Rights (MDHR), and other state agencies and nonprofit organizations, would meet twice a year to identify opportunities for prevention and make actionable recommendations to state policymakers.

Access

• Around $3.4 million to go toward “Cultural Communications” 

The recommendation proposes funding a cultural communications program that focuses on tailoring messaging for audiences most impacted by health disparities. Hmong, Somali, and Spanish-speaking patients have significantly lower rates of optimal care compared to the statewide average, according to 2021 data.

The program would standardize processes at MDH to maintain the National Standards for Culturally and Linguistically Appropriate Services and coordinate translation and American Sign Language/computer-assisted real-time translation services. 

• Around $1.8 million to go toward a Telehealth in Libraries Grant Pilot Program 

This recommendation proposes giving grants to community-based organizations to build enclosed telehealth stations/pods and utilize community health workers to assist individuals with appointments, care coordination, and access to other resources/services in libraries. 

A 2020 Minnesota Department of Human Services report showed that telehealth improved equity in access to health care. Telehealth services are still not widely available to vulnerable and marginalized people, especially those who don’t have reliable broadband access at home. In Minnesota, 15.2% of households have no broadband internet subscription, and 41.5% have no broadband internet subscription among households where the annual income is under $20,000. 

The proposed program will award up to six two-year annual grants of $125,000 per year to libraries to manage telehealth locations. 

Research

• $800,000 to go toward “Increase Joint Initiative Funding” 

This recommendation proposes additional funding for MDH to fund more positions and projects related to air toxic pollutants to allow for better risk estimation and protection of vulnerable populations. The funding would support the agency in addressing those health risks. 

• Around $283,000 to go toward a Homeless Mortality Study

This proposal recommends funding a study to measure the state’s progress in reducing preventable deaths among people experiencing homelessness. It would be a follow-up to MDH’s 2022 study, which compared deaths among people experiencing homelessness in Minnesota to the total state population from 2017-2021. The requested funds would allow MDH to conduct a similar analysis of homeless mortality for 2022-2024. 

• Around $1.5 million to go toward a “Equitable Health Care Task Force”

Most Minnesotans report a very high level of trust in their providers and a high level of satisfaction with their care, according to MDH. But not everyone has the same type of experience when they seek care. Data shows that 35.5% of Black Minnesotans reported that they perceived discrimination in the care they received compared to 6.6% of all Minnesotans. 

This proposal recommends creating a task force to examine inequities in how people experience health care based on race, religion, culture, sexual orientation, gender identity, or disability and identify strategies for ensuring equitable healthcare outcomes. 

The task force would conduct a literature and data review to understand the frequency and types of inequitable care or treatment received by individuals in the target communities in Minnesota and nationally, gather those stories, and compile successful models to address inequities in treatment or care to then recommend to health care providers. 

• Around $1.7 million towards “Fetal and Infant Mortality Review”

American Indians and Black infants are respectively 2.7 and 2.3 times more likely to die in infancy than white infants, according to MDH. 

This recommendation proposes funding for a Fetal and Infant Mortality Review to look at fetal and infant deaths in hopes of reducing the significant disparities.