Substance use disorders (SUD) and mental health conditions are prevalent among pregnant and postpartum people in the United States, and they have far-reaching consequences for the health and well-being of parents and their children. During the COVID-19 pandemic, there has been a heightened need to ensure access to pregnancy-related and behavioral health care for pregnant and postpartum people. Through the Maternal and Child Health Policy Innovation Program (MCH PIP), funded by the federal Maternal and Child Health Bureau, Health Resources and Services Administration (MCHB, HRSA), the National Academy for State Health Policy (NASHP) worked with eight states (Alabama, Colorado, Kentucky, Mississippi, New Jersey, South Carolina, Texas, Virginia) to support and advance innovative policy initiatives that improve access to quality health care for Medicaid-eligible pregnant and parenting people with behavioral health needs.
Over the past two years, the multidisciplinary state teams worked together and received technical assistance from NASHP to strategize and implement policies and programs to improve care for pregnant and postpartum people with SUD and/or mental health conditions. Many state teams shifted their focus to respond to emerging needs of pregnant and postpartum people, such as access to telehealth services, due to the COVID-19 pandemic. All states were able to advance several efforts including the addition of new SUD treatment sites, trainings to increase screening and referrals to treatment, and development and dissemination of a survey on telehealth use. Highlights of states’ achievements include the following.
- Alabama: The Office of Substance Abuse Treatment Services within the Alabama Department of Mental Health will be implementing a pilot project with peer doula services for pregnant mothers with SUD. Currently, two certified peer support specialists are scheduled to undergo doula training with the implementation of the peer doula service projected for 2022. Also, Alabama Medicaid expanded opportunities for Screening, Brief Intervention, and Referral to Treatment (SBIRT), which is an approach used to deliver early intervention and treatment of SUD. The Agency coordinated training opportunities for the managed care networks’ staff, the Alabama Coordinated Health Networks (ACHN). The trainings were completed in March in 2021.
- Kentucky: The state Medicaid agency is currently updating the policy for the Kentucky Moms Maternal Assistance Towards Recovery (MATR) Program to extend case management services from 60 days post-partum to 6 months post-partum for women experiencing SUD.
- South Carolina: The state developed a reciprocal referral and linkage model for parenting and/or pregnant women in South Carolina with or at-risk of SUD by coordinating services among the state’s Departments of Health and Human Services, Alcohol and Other Drug Abuse Services, and Health and Environmental Control. The model focuses on assessing women for SUD and providing a warm handoff for treatment.
- Virginia:The state Medicaid agency planned to require SBIRT screening for pregnant and postpartum managed care members in the health plan contracts. This initiative received support but was put on hold due to pandemic-related budget restrictions. However, because of the PIP, Virginia established a multi-agency alliance that focused on SUD and maternal health, and supported several initiatives. This alliance included relationships with two large health systems in the Commonwealth. The policy academy enhanced alignment between state agencies and state SBIRT stakeholders serving pregnant and parenting people experiencing substance use. The state is also in the process of developing a doula Medicaid benefit with anticipated implementation this fall.
During the two years of the MCH PIP Policy Academy, participating states identified numerous lessons learned that may be of interest to other states interested in improving access to care for pregnant people with SUD. These strategies include the following:
- Early identification of substance use or mental health conditions is a critical component in ensuring individuals receive the support and necessary treatments for healthy pregnancies and their behavioral health needs.
- Providing enhanced support services (e.g., care coordination services, doulas, and case management) for pregnant persons with behavioral health conditions during the perinatal period can help improve health outcomes and birth experiences and promote health equity.
- Tracking telehealth utilization by pregnant populations due to the COVID-19 pandemic may help inform future policies and programs to increase access to services.
- Cross-sector partnerships (e.g., Medicaid, public health, behavioral health) are critical to advancing short- and long-term goals and initiatives given that pregnant persons with SUD are often served by multiple agencies and systems.
- State initiatives need to be nimble and flexible to meet the changing needs of pregnant people with behavioral health needs, especially in times of crisis (e.g., pandemic) that can exacerbate behavioral health conditions and require need for greater cross-agency collaboration and coordination.
NASHP thanks the eight state teams for their hard work and dedication to this project over the past two years. We will continue to work with states through a second policy academy cohort focused on improving access to quality care for pregnant and parenting people. Click here to learn more about the next cohort of the MCH PIP Policy Academy.