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.
Confronted with a pandemic that impacts the health of women and children – ranging from pregnancy and delivery to access to substance abuse treatment – a consortium of New Jersey state and health care experts launched a Project ECHO (Extension for Community Healthcare Outcomes) initiative to share COVID-19 expertise between specialists and primary care to meet the needs of women during the crisis.
Last week, the Centers for Medicare & Medicaid Services (CMS) released two highly anticipated initiatives — the Maternal Opioid Misuse (MOM) Model and the Integrated Care for Kids (InCK) Model — which will provide multi-year funding to states to improve integrated care for maternal and child health populations enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
NASHP has been tracking these important initiatives since they were first announced by the CMS Center for Medicare and Medicaid Innovation (Innovation Center) last year and has compiled and promoted exemplary integrated care delivery models, strategies, and innovations for pregnant and postpartum women and children that states can consider as they develop their applications for these initiatives.
The MOM Model is designed to:
- Improve quality of care and reduce costs for pregnant and postpartum women with opioid use disorder (OUD) and their infants;
- Expand access, service-delivery capacity, and infrastructure based on state-specific needs; and
- Create sustainable coverage and payment strategies that support ongoing coordination and integration of care.
The CMS Innovation Center will award a maximum of $64.5 million through up to 12 cooperative agreements with state Medicaid agencies and their care delivery model partners for a five-year period. Applications for the MOM Model are due to CMS by 3 p.m. (EST), May 6, 2019. A CMS webinar about the MOM Model Notice of Funding Opportunity was held Feb. 21, 2019. The recording, slides, and transcript from the webinar are available here.
The InCK Model is designed to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and CHIP through prevention, early identification, and treatment of behavioral and physical health needs. States and local organizations will work to conduct early identification and treatment of children with health-related needs across settings to:
- Increase behavioral health access;
- Respond to the opioid epidemic; and
- Improve child health outcomes.
The CMS Innovation Center will award a maximum of $128 million through eight cooperative agreements with state and local participants for a seven-year period (awarding up to $16 million per recipient). Applications to implement the InCK Model are due to CMS by 3 p.m. (EST), June 10, 2019. A CMS webinar about the InCK Model NOFO is scheduled for 2:30 to 4 p.m. (EST) Tuesday, Feb. 19, 2019.
Nationally, Medicaid finances 45 percent of births and is a critical resource to improve maternal health and birth outcomes and lower avoidable costs. With an increasing number of initiatives focusing on pregnant and postpartum women, such as the federal Maternal Opioid Misuse (MOM) Model, states can learn from innovative programs, including Virginia’s BabyCare initiative. This new NASHP report explores how Virginia utilizes Medicaid’s reach to improve birth outcomes through behavioral risk screening, case management services, and expanded prenatal services.
View or download: Virginia’s BabyCare Program: Working to Improve Birth Outcomes through Medicaid
To learn about other state initiatives, visit NASHP’s Healthy Child Development State Resource Center.
The opioid epidemic is having a devastating impact on children and families and placing a significant strain on states as they work to develop effective programs and find new funding to respond to this crisis.
To address the crisis and promote healthy child development, states are implementing innovative whole-family approaches to prevention and treatment (see below). On the federal level, new funding is available and recently the federal Center for Medicare and Medicaid Innovation announced its Integrated Care for Kids model, which states can use to improve care and outcomes while reducing costs through early identification, integrated care coordination, and case management for physical and behavioral health care and non-clinical local services.
Children can experience many negative consequences as a result of their parents’ opioid use disorder (OUD). Prenatal opioid exposure can cause neonatal abstinence syndrome in infants, which is usually treated by costly hospitalizations and may increase the risk of developmental disabilities. Children affected by parental substance misuse are at increased risk of adverse childhood experiences and trauma, which can have significant short- and long-term physical, mental, and behavioral consequences.
A new National Academy for State Health Policy (NASHP) issue brief, written in partnership with the Alliance for Early Success, identifies the following promising state strategies developed by Kentucky, New Hampshire, and Virginia to support children and families:
- Facilitate access to and coverage of services by improving identification of at-risk infants and children, enabling rapid access to treatment, expanding coverage of services, and enhancing provider capacity. For example, New Hampshire’s Project First Step embeds licensed alcohol and drug counselors (LADCs) within its Division of Children, Youth, and Families (DCYF) district offices. The LADCs train child welfare and juvenile justice staff about substance misuse — including screening and facilitating access to treatment — to enable DCYF staff to better meet the needs of children and families affected by OUD.
- Implement family-focused care delivery models, such as providing family-centered treatment approaches for the family unit, offering care at home and in the community, coordinating care, and providing trauma-informed care. Virginia’s Medallion 4.0 Medicaid managed care program contract requires Medicaid managed care organizations to provide specialized care coordinators for substance-exposed newborns and align a mother’s and infant’s care plan. Additionally, Virginia’s Medicaid 4.0 contracts promote delivery of trauma-informed care, particularly for children impacted by the foster care system.
- Align and maximize resources across systems by sharing data and leveraging diverse funding sources. Kentucky’s Sobriety Treatment and Recovery Team (START) program is a family-centered, service delivery model within the state’s child welfare system that pairs families affected by substance use disorder (SUD) with a child protective services (CPS) worker and a family mentor who has lived experience with SUD. The CPS workers and family mentors coordinate care, offer rapid access to treatment, and provide comprehensive wrap-around services. The program weaves together funding from a Title IV-E waiver demonstration, Medicaid, the Temporary Assistance for Needy Families block grant, and state general funds. The state has also established a data-sharing agreement to advance the program between its Department for Community Based Services and its Department for Behavioral Health, Developmental, and Intellectual Disabilities.
An additional report and webinar exploring state strategies to support pregnant and parenting women affected by substance use disorders, including opioid use disorder, will be published in the weeks ahead.