In partnership with the Blue Cross Blue Shield Association, the National Academy for State Health Policy (NASHP) recently held a virtual roundtable discussion of state officials to discuss maternal health initiatives in Illinois and Georgia and explore strategies to improve maternal health outcomes for Medicaid enrollees.
One approach proposed by a number of states is extending Medicaid postpartum coverage for women beyond the current 60-day period. As highlighted in NASHP’s interactive map and chart, Each State’s Efforts to Extend Medicaid Coverage to Postpartum Women, 23 states and Washington, DC have initiated efforts to extend postpartum coverage, and currently four states are in the process of seeking federal approval to do so through a Section 1115 demonstration waiver.
Georgia’s Extension of Postpartum Coverage
Georgia is one of those states and the state’s Medicaid director explained during the discussion that they are planning to submit a waiver proposal to the Centers for Medicare & Medicaid Services in December to extend postpartum coverage there. The state’s efforts began in 2010 when Georgia was ranked 50th in the nation for maternal mortality rates. Officials first formed an advisory committee to focus on the issue. As they examined specific maternal mortality data and rates, Georgia found that close to 60 percent of the maternal deaths were actually preventable. In 2019, the Georgia House passed a resolution to create a committee to study maternal mortality, which led directly to the state’s current efforts to pursue an extension of postpartum Medicaid coverage.
While Georgia’s study committee initially suggested extending postpartum coverage for 12 months, due to budget constraints the state was unable to pursue that recommendation. Instead, the state opted to seek extended coverage for individuals with income up to 225 percent of the federal poverty level for four months, which when added to Medicaid’s 60-day postpartum coverage period, will provide a total of six months (180 days) of coverage postpartum. Overall, the state legislature allocated $59 million for the proposed five-year demonstration project.
Services under the extended postpartum coverage will be provided through managed care, and after Medicaid’s 60-day postpartum period, individuals will be seamlessly transferred to coverage under the waiver. During the first year, the state anticipates that there will be approximately 151,000 enrollees, and it is expected that enrollment will grow to about 186,000 by the final year of the demonstration.
Blue Cross Blue Shield of Illinois Pilot Program
The discussion also featured maternal and child health improvement initiatives in Medicaid that Blue Cross Blue Shield of Illinois (BCBSIL) is currently pursuing. BCBSIL is conducting a 12-month, multi-pronged pilot program in partnership with community organizations and medical providers that is designed to address factors that negatively impact health outcomes in the maternal and child population. The goals of the pilot program are to reduce the number of elective, non-medically necessary Caesarian sections (C-sections) and newborn intensive care unit (NICU) admissions, as well as improve Healthcare Effectiveness Data and Information Set (HEDIS) rates in both prenatal visits and child immunizations.
Under the pilot program’s first goal of reducing unnecessary C-sections, BCBSIL plans to enhance care coordination efforts between providers, Medicaid agencies, and community organizations. As part of its second goal to improve prenatal and postpartum care visit rates, BCBSIL will target efforts in areas of Illinois with high rates of maternal and child health disparities. Within these regions, BCBSIL will identify at least three obstetrics practices that are willing to partner with BCBSIL. These providers will be connected with BCBS care coordinators to help ensure access to care delivery resources, because often providers lack the capacity to provide social service referrals for their members. BCBS enrollees will also have the opportunity to engage in an incentive program that will offer rewards for completion of prenatal care visits.
In addition to promoting better maternal health outcomes, the BCBSIL pilot program is also working to improve pediatric immunization and dental care rates. Through partnerships with Chicago public schools and community organizations, the pilot program will disseminate information about the importance of immunizations and preventive dental care and also create a referral system for children in need of these services and other preventive health care. The planning phases of the pilot program began this fall, and the initiative will continue through the end of 2021.
Along with tracking states’ initiatives to expand postpartum Medicaid coverage, NASHP has a wide range of resources related to maternal health and healthy child development, and will be continuing to follow states’ efforts to improve maternal and child health outcomes.
The online meeting and this blog were sponsored by Blue Cross Blue Shield Association,
with content development at the sole discretion of NASHP. To view a slide deck highlighting materials from the online meeting, please click here.