Why Medicaid is Important to Advance Maternal Health in the United States
September 13, 2018 | ASTHO Staff
The United States has the highest maternal mortality rate of any developed country in the world and the rate is climbing higher each year. On average, between 700 and 900 American women die each year (and 65,000 nearly die) from pregnancy or childbirth-related causes. Moreover, there are pronounced racial and geographic disparities in the U.S. maternal mortality rate. Black women die from pregnancy-related causes at three to four times the rate of white women, even after controlling for socioeconomic factors. Women in rural areas also have higher maternal mortality rates than those of their urban counterparts.
Medicaid finances over half of all births each year in 25 states. All states provide Medicaid coverage for women with incomes up to 133 percent of the FPL while they are pregnant and 60 days postpartum; however, the scope of services and extended coverage beyond the postpartum period vary between states. As a result, some women may lose coverage or Medicaid eligibility after that 60-day period in states without Medicaid expansion.
Medicaid expansion is one avenue to ensure that women can stay healthy before a pregnancy begins and not lose their coverage immediately after a pregnancy. This means that women are more likely to be able to access contraception and plan their pregnancies, receive primary care services to manage chronic conditions prior to and between pregnancies, and access prenatal and perinatal care once pregnant.
State health officials and state Medicaid directors are utilizing flexibility to pursue innovative strategies that expand access to care and insurance coverage, as well as promote cross-sector data sharing and analyses that can help end preventable deaths and reduce widespread disparities.
As of 2017, 29 states have committees designed to review maternal mortality. For example, the Michigan Department of Health and Human Services has implemented a maternal mortality surveillance program since 1950. The data gathered includes medical and non-medical causes of death, which has increased awareness of racial disparities and the importance of screening for chronic illnesses, co-occurring mental and substance use disorders, and domestic violence. The data has also been used to identify potential gaps in services and connect women with state home visiting programs.
States are also pursuing innovative financing for reproductive and maternal health services. For instance, the South Carolina Department of Health and Human Services, the state Medicaid agency, formed the South Carolina Birth Outcomes Initiative, which is a collaborative involving more than 100 stakeholders—including the public health agency—to advance reductions in early elective deliveries; incentivize Screening Brief Intervention and Referral to Treatment; promote long-acting reversible contraception; and support vaginal births. As a result of this collaborative’s work, South Carolina was the first state in the nation to use waiver authority to include reimbursement for long-acting birth control devices provided in a hospital setting. The health department, in partnership with philanthropic funders and the state’s department of health and environmental control, has also implemented a statewide Pay for Success program to sustain the Nurse-Family Partnership program for Medicaid-enrolled mothers. The program has a demonstrated history of maternal mortality reduction through home visitation with low-income mothers and families throughout pregnancy and for two years after birth.