In the United States, pregnancy too often comes at a deadly cost, especially for women of color.
The country has the highest rate of maternal deaths in the industrialized world, with about 700 women dying every year because of pregnancy-related problems, according to the Centers for Disease Control and Prevention. However, 3 in 5 pregnancy-related deaths among all women are preventable.
The potential to prevent these deaths doesn’t vary by race or ethnicity. And yet, Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women, a disparity that increases with age.
Factors driving the nation’s maternal mortality rate include poverty and lack of health care coverage and access. Medicaid, which covers nearly half of all U.S. births, can bridge gaps in prenatal care by providing qualified, low-income pregnant women with health care, support services, counseling and two months of postpartum care.
But many new mothers become uninsured after that 60-day postpartum period and lose access to care that could prevent life-threatening physical and behavioral health conditions.
Extending postpartum coverage
The American Rescue Plan Act, enacted in March, allows states to extend pregnancy-related Medicaid coverage for 12 months after delivery.
Health Care Service Corporation (HCSC) was part of a coalition of health plan associations and managed care organizations that joined provider groups and patient advocates to press Congress to extend postpartum coverage. The new provision expires after five years, so the same coalition is urging Congress to make it permanent.
“Our members need a broad array of services, including medical care, long-term services and supports and medically related social services,” says Gloria Eldridge, HCSC Medicaid policy divisional vice president. “Allowing states the option to cover mothers in Medicaid through 12 months postpartum will substantially improve access to care for many of our members and tens of thousands of mothers nationwide.”
In April, Illinois became the first state to get a federal waiver to extend postpartum Medicaid coverage for a year. Meantime, Texas Gov. Greg Abbott recently signed legislation to seek federal approval to extend benefits to new mothers for six months after giving birth.
“This is really big news for Texas and means our STAR members could have six months postpartum coverage,” says Sara Daugherty, Texas Medicaid executive director.
Meeting needs for pregnant women and new moms
HCSC covers nearly 1 million Medicaid members through its plans in Illinois, Montana, New Mexico and Texas. The company’s nurses, social workers and others identify and reach out to Medicaid members with conditions such as obesity, hypertension, preeclampsia, depression or diabetes, that put them at higher risk for complications and preterm births. Medical managers and care coordinators help members access care and finding resources such as healthy food and transportation to help them reach full-term pregnancy.
“I’m trying to find solutions for everyone,” says Jennifer Flores, a Texas plan Medicaid nurse. “It’s different every day. I’m so blessed I can help people who need it.”
The company’s health plans also support community organizations and collaborate with providers to help ensure women with other types of coverage have access to high-quality and culturally competent care.
Illinois plan is partnering with health systems statewide to improve health care quality in minority groups, increase physician workforce diversity and cultural competency and address unconscious biases and stereotypes that influence behavior.
Under its Health Equity program, the Illinois plan is increasing the number of providers who receive value-based payments and including health equity as a core component of the quality program. It also will examine disparities in maternal care and telehealth services.
“While our grants support the underserved, we have a concurrent focus on improving the quality of care,” says Dr. Derek J. Robinson, the Illinois plan’s vice president and chief medical officer. “In our new hospital equity program, we are incentivizing a focus on improving outcomes and eliminating racial disparities in hospital care for pregnant moms with high blood pressure and bleeding problems.”
Better access to behavioral health care
Nationwide, as many as 1 in 5 women experience depression or anxiety during or after pregnancy, and research indicates these issues can lead to adverse pregnancy outcomes for mothers and their babies. Yet, many don’t receive referrals for mental health screenings and education because of lack of access to providers or health care coverage.
HCSC’s Montana plan is supporting the nonprofit organization Montana Coalition of Healthy Mothers, Healthy Babies in its efforts to increase use of telemedicine to access mental health care to boost outcomes for Montana women during and after childbirth. The organization wants to integrate mental health screenings into maternal and infant care and establish a Montana directory of experts to whom doctors could refer mothers for mental health care and support.
“There have been big gaps in continuity of care for woman after delivery because all of the focus is on the baby,” says Dr. David Lechner, the Montana plan’s chief medical officer and vice president of health care delivery. “Progress starts by recognizing that problems, including behavioral health issues, occur more frequently than we think and building treatment options for resolving those issues.”
He believes telemedicine services would be most useful to Montanans if they include local and regional providers who could direct residents to appropriate resources.
“I am optimistic these solutions can lead to real change,” Lechner says. “Business as usual is unacceptable. Depression is a fatal illness. Judging it is not contributing to a solution.”