pregnant – The National Academy for State Health Policy

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State Medicaid Coverage of Dental Services for General Adult and Pregnant Populations

October 20, 2022/in Policy Charts, Featured News Home, Maps Maternal, Child, and Adolescent Health, Oral Health /by Ariella Levisohn, Carrie Hanlon and Allie Atkeson

Eligibility Levels for Pregnancy-Related Coverage in Medicaid and CHIP

April 12, 2022/in Policy Featured News Home, Maps CHIP, Chronic Disease Prevention and Management, Eligibility and Enrollment, Eligibility and Enrollment, Health Coverage and Access, Health Equity, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Expansion, Medicaid Managed Care, Population Health, State Insurance Marketplaces /by Anita Cardwell

Eligibility Levels for Pregnancy-Related Coverage in Medicaid and CHIP

NASHP Maternal and Child Health Policy Innovations Program Policy Academy – Call for Applications

January 11, 2021/in Policy Blogs, Featured News Home Chronic Disease Prevention and Management, Health Equity, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Population Health /by NASHP Staff

The United States is facing a maternal mortality crisis. Rising maternal mortality rates in states have far reaching consequences for the health and well-being of women, children, and their families. States are grappling with a number of factors in their efforts to improve access to quality care for this population and strengthen the systems serving them.

Through the Maternal and Child Health Policy Innovation Program (MCH PIP), funded by the Health Resources and Services Administration’s Maternal and Child Health Bureau, the National Academy for State Health Policy (NASHP) is conducting a two-year policy academy (April 2021-March 2023) for up to eight states. Each state’s team should include representatives from Medicaid agencies, public health agencies, and other state stakeholders (e.g., mental health/substance use agencies, child welfare agencies, provider groups, Medicaid managed care plans, etc.) to build state capacity to address maternal mortality for Medicaid-eligible pregnant and parenting women.

Participating states will identify, develop, and implement policy changes or develop specific plans for policy changes and/or strategies with the ultimate goal of improving access to quality care. They will receive group and individual technical assistance to improve health care delivery systems and related supports for Medicaid-eligible pregnant and parenting women, with a particular focus on implementing policies or health system transformation that address racial disparities in maternal mortality.  

More details about the policy academy and NASHP’s application process are provided below. State officials interested in participating in the academy must contact Eddy Fernandez at efernandez@oldsite.nashp.org by Monday, Jan. 25, 2021, to receive the application materials. All state applications must be submitted by 5 p.m. (ET) on Friday, Feb. 26, 2021.

Expected Outcomes

The policy academy is designed to support states in implementing policy innovations that improve access to care for pregnant and parenting women through health care system transformation. As a result of participating in the academy, states will:

- Identify and clarify areas in need of change related to improving access to care for pregnant and parenting women to build state capacity to address maternal mortality;
- Select an overall goal for the two-year project period based on the identified areas of need,
- Identify policy innovations and strategies to achieve the state’s goal;
- Receive individual technical assistance (TA) from NASHP and other experts in support of state MCH policy innovations;
- Receive and participate in group TA, including state-to-state calls and annual meetings to learn from and share relevant experiences with other participating states;
- Implement the policy change or develop a specific plan for implementing the policy change to support access to quality health care services and supports for Medicaid eligible pregnant and parenting women;
- Strengthen partnerships with other sectors and convene multidisciplinary teams (e.g., Medicaid, public health, mental health, substance abuse prevention); and

Receive support in aligning with other state efforts/initiatives that are designed to provide access to quality health care services and supports to improve maternal health outcomes.

Focus: Building State Capacity to Address Maternal Mortality and Increase Access to Quality Care for Pregnant and Parenting Women

Pregnant and parenting women face challenges accessing quality care that have been heightened due to the COVID-19 pandemic. To facilitate access to quality care and improve maternal health outcomes, states may consider implementing policy innovations and changes to improve health care delivery, payment, coverage, and quality for systems of care for Medicaid-eligible pregnant and parenting women, as well as strategies to enhance collaboration across systems.

States may leverage existing Medicaid health system transformation efforts, including health homes, medical homes, accountable care organizations, or other innovative models (e.g., Centering Pregnancy and reimbursement for birth centers), which are designed to support coordinated and comprehensive care. States may also need to take extra steps to ensure there is an adequate workforce to serve this population and that existing providers have the capacity to effectively deliver and coordinate care.

Additional priorities may be identified as part of the state’s application and project planning processes. States should also consider disparities and inequities in access to care and outcomes among Medicaid-eligible pregnant and parenting women regardless of their selected areas of focus.

State Team Requirements

Each state team must meet the following criteria:

Identify three to five team members with roles or expertise that would be beneficial to the state’s identified goals/priorities, including the following representatives:
- Required team members: State Medicaid agency senior staff member (required team lead) and other key Medicaid staff (e.g., managed care lead, etc.), state Title V MCH program director or designee
- Optional team members: State mental health/substance use agency lead on women’s health, state child welfare agency, Maternal, Infant, and Early Childhood Home Visiting Program director, epidemiologist or data specialist, state legislator/staff, nonpartisan researchers, and representatives from provider groups, Medicaid managed care plan(s), consumers/families, community organizations, and others.
Have the capacity to receive TA and participate in collaborative learning, including regular check-in calls and webinars, a listerv, and annual meetings (NASHP will support travel for up to three state team members; states may bring up to two additional team members at the state’s expense);
Have a state commitment to addressing maternal mortality among Medicaid-eligible pregnant and parenting women, advancing health care system innovations for MCH populations, and addressing racial disparities in maternal health outcomes; and
Demonstrate a history of (or commitment to future) cross-agency collaboration.

Policy Academy Timeline

Actions	Date
Call for applications released	Jan. 12, 2021
Deadline for states to request application materials	Jan. 25, 2021
State applications due to NASHP	Feb. 26, 2021
Selected state teams notified	March 2021
Policy academy kick-off call	April 2021*
Targeted TA, peer-to-peer webinars and calls	April 2021 – March 2023
Annual in-person meetings	August 2021 and August 2022*

*Exact dates will be confirmed at a later date as well if the annual meetings will be virtual due to COVID-19.

Application Process

Email Eddy Fernandez (efernandez@oldsite.nashp.org) by 5 p.m. (ET) on Monday, Jan. 25, 2021 to indicate your state is interested in NASHP’s MCH PIP Policy Academy. The email should include your state’s team lead and/or key point of contact, and their contact information (title, agency, work phone, and email).
After emailing to express interest, a state team lead/key contact will be provided with a brief application. Each state team must complete this application and submit it to Eddy Fernandez (efernandez@oldsite.nashp.org) by 5 p.m. (ET) on Friday, Feb. 26, 2021.
NASHP will review states’ applications and select states to participate in the policy academy. All states that applied will receive notifications in March 2021.

Any questions about MCH PIP, the policy academy, or NASHP’s application process should be directed to Eddy Fernandez (efernandez@oldsite.nashp.org).

How New York Is Safeguarding Pregnant Women during the COVID-19 Pandemic

November 16, 2020/in Policy Blogs, Featured News Home Care Coordination, Chronic and Complex Populations, COVID-19, Eligibility and Enrollment, Health Equity, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Physical and Behavioral Health Integration, Population Health, Social Determinants of Health /by Taylor Platt

A Centers for Disease Control and Prevention (CDC) study published in September found that pregnant women, especially Black and Latinx, are at increased risk of severe illness from COVID-19 compared to non-pregnant individuals. They are more likely to be admitted to intensive care units (ICU), receive invasive ventilation, and are at increased risk of death.

In response to COVID-19, several states, including New York, are working closely with the CDC to collect data on COVID-19 and pregnancy and implement guidelines to improve women’s outcomes and address disparities. Earlier this year, the New York COVID-19 Maternity Task Force submitted a report with recommendations to the governor, who is now implementing these actions.

Background

At the start of the COVID-19 pandemic, little was known about the impact of the disease on pregnant women. CDC and the American College of Obstetricians and Gynecologists (ACOG) have been monitoring data about pregnant women infected with the coronavirus and publishing updated guidance as new information comes to light. Recently, the CDC determined that pregnant women are at increased risk for severe illness from COVID-19. In response, last April New York Gov. Andrew Cuomo formed the COVID-19 Maternity Task Force.

In a recent report, the CDC summarized maternal and birth outcomes of hospitalized pregnant women with confirmed COVID-19. Between March and August, 598 hospitalized pregnant women tested positive for COVID-19:

Approximately 55 percent were asymptomatic at the time of admission;
42.5 percent self-identified as Hispanic or Latino;
26.5 percent were non-Hispanic Black; and
20.6 percent had at least one underlying condition – asthma and hypertension were the most prevalent.

Additionally, symptomatic pregnant women were at an increased risk for ICU admission and mechanical ventilation. This new data continues to highlight how COVID-19 disproportionally impacts Black and Latinx populations and has implications for providing care to pregnant women during the pandemic.

New York’s Actions

New York’s COVID-19 Maternity Task Force report includes the following recommendations:

Diversify birthing site options to support patient choice to deliver at a hospital or a birthing center;
Authorize at least one support person to accompany an individual during labor, delivery, and recovery;
Universally test all pregnant patients for COVID-19;
Ensure equity by continuing to engage community members and community-based organizations;
Increase messaging and education of pregnant patients about COVID-19 and perinatal care; and
Encourage the New York State Department of Health to continue collaborating with academic institutions, regional perinatal centers, and medical organizations to review the impact that COVID-19 has on pregnancy and newborns.

Gov. Cuomo accepted all of the task force’s recommendations and New York’s Department of Health (DOH) has begun to implement the recommendations. The original executive order issued in March addressing having support people present during labor has been amended to include support during labor, delivery, and recovery, and now includes doulas as part of the care team.

Following the task force recommendations, hospital and health systems have rolled out universal COVID-19 testing for pregnant women, and DOH has approved two new temporary birthing centers as a result of the streamlined process to establish additional birthing centers during the pandemic. DOH will continue to accept applications for midwifery birth centers and provide emergency approvals during the public health emergency to ensure access to safe perinatal care and provide a variety of birthing options to parents.

DOH partnered with the University at Albany School of Public Health to conduct an early literature review on the impact of COVID 19 and pregnancy. Results were shared with staff from regional perinatal centers across the state for feedback and discussion. The final version of the literature review was posted on the New York State Perinatal Quality Collaborative website in June 2020.

The New York State Perinatal Quality Collaborative, in partnership with the American College of Obstetrics and Gynecology District II, hosted statewide interactive webinars on obstetrical care and implicit bias within the context of the COVID-19. Educational webinars related to the management of pregnant people during the COVID-19 pandemic featured state obstetric leaders sharing their experiences, successes, and challenges related to treating pregnant and postpartum people during the COVID-19 pandemic. Webinar participants were able to submit questions during the live event or prior to the event by email. In addition to the obstetric-focused webinars, the collaborative also hosted a neonatal-focused webinar relating to COVID-19 that addressed the testing and care of newborns. All webinars were recorded and each has been posted on the public section of the collaborative’s website.

Resources to Improve Maternity Care during COVID-19

Throughout its response to COVID-19, New York’s DOH has been committed to promoting health equity, especially as it relates to maternity care. It convened a workgroup that included community members to provide input and oversight into the development of education and messaging materials related to COVID-19, which is under development. A webinar conducted in partnership with the collaborative. on COVID-19 and Maternal Equity was held on June 5, 2020. This webinar features a panel discussion of maternity and racial justice experts led by Joia Crear-Perry, MD, FACOG, of the National Birth Equity Collaborative on the impact of COVID-19 on the birth equity and included stories of lived experience shared by a Rochester mother who had given birth during the pandemic and a community health worker supporting pregnant women in the Bronx.

As states continue to confront COVID-19 and its impact on health care delivery, it will be important for states to consider new CDC data on pregnant women and best practices for how to protect women and children, especially pregnant women of color. The National Academy of State Health Policy will continue to track state actions on COVID-19 and pregnant women. For more information on COVID-19 and pregnancy explore this NASHP Infographic: How State Medicaid Programs Can Use Telehealth to Serve Pregnant Women during COVID-19 and blog, States Implement Strategies to Safeguard Pregnant Women during the COVID-19 Pandemic.

State Strategies to Address the Black Maternal Health Crisis

October 12, 2020/in Policy Blogs, Featured News Home Eligibility and Enrollment, Eligibility and Enrollment, Essential Health Benefits, Health Coverage and Access, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care /by Taylor Platt, Eddy Fernandez and Carrie Hanlon

The inequities laid bare by COVID-19 underscore the importance of states’ efforts to develop policies and interventions to address all health disparities. Systemic racism, a driver of these inequities, also fuels disparities in maternal morbidity and mortality – Black women are four-times more likely to die from pregnancy-related causes than White women.

States are on the frontlines, working to improve maternal health outcomes and address racial disparities through strategies such as work force development, implementing policies to dismantle structural racism and address its consequences, extending postpartum coverage, collecting stratified data, and implementing quality improvement initiatives. States have developed several strategic approaches to address maternal health disparities.

Maternal Mortality Review Committees are multidisciplinary groups in states and cities comprised of health officials, obstetric, gynecological, and maternal-fetal medicine specialists, behavioral health providers, hospital association leaders, and community-based organization representatives. Cases of maternal mortality are identified in partnership with the committee, the state’s vital records office, and epidemiologists to determine whether each death was pregnancy-related and what factors contributed to the death. The data produced by these boards, often stratified by race and ethnicity, is crucial for identifying causes and for tailoring policy solutions at the state and local level. The Louisiana Pregnancy-Associated Mortality Review (LA-PAMR) recently published a new report outlining policy recommendations for changes at the structural, hospital, provider, and patient level. One of five recommendations the committee made is to identify and address racial and cultural biases across the network of care that serves pregnant and postpartum women, as well as in institutions that influence or coordinate with that network (e.g., public health and Medicaid).

Perinatal Quality Collaboratives (PQCs) are state or multi-state networks comprised of perinatal health care providers and public health professionals, such as pediatricians, obstetricians, and midwives. These collaboratives work to improve maternal and infant health by identifying health care processes that require quality improvement and offering expertise to improve these processes. Many PQCs are currently focusing on reducing racial, ethnic, and geographic disparities in health outcomes, improving identification of and care for infants with neonatal abstinence syndrome due to maternal substance abuse, and reducing preterm births. The California Perinatal Quality Collaborative (CPQC) was the founding organization of the state’s maternal mortality review committee and has multiple quality improvement projects underway that focus on health disparities, for example in preterm birth and low birthweight in newborns, and women and substance use during pregnancy. In 2018, CPQC launched the Health Equity Taskforce to achieve and improve outcomes for newborns and their families. Additional information on specific state collaboratives can be found at the Centers for Disease Control and Prevention’s webpage on perinatal collaboratives.

Person-centered maternal care models are strategies states can implement to provide high-quality care to pregnant women. Care coordination for pregnant women can help increase access and utilization of health care services and improve maternal and infant health outcomes

One care coordination model is Community Care of North Carolina’s Pregnancy Medical Home (PMH). PMHs in general provide evidence-based, high-quality care to patients and focus care management resources on pregnant women who are deemed high-risk. State Medicaid agencies are increasingly developing and deploying non-licensed, non-master’s-level treatment and support providers, such as peers and counselors, to provide a range of services to address the factors affecting maternal health. These peer support services and community-based teams are additional resources that can help improve maternity care while also addressing other social determinants of health. North Carolina and Wisconsin both have implemented the PMH model to deliver services to pregnant women.

Supporting doula services for pregnant women is another approach many states and the federal government are considering to address disparities in maternal health outcomes. A doula is a “trained professional who provides continuous physical, emotional, and informational support to a mother before, during, and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.” Currently, two states, Minnesota and Oregon, cover doula services for pregnant women enrolled in Medicaid. Doulas can improve overall health outcomes for and reduce disparities among pregnant women, for example by lowering the rates of cesarean sections and preterm births. For more information on financing doula services, read the National Academy for State Health Policy (NASHP) report, Four State Strategies to Employ Doulas to Improve Maternal Health and Birth Outcomes in Medicaid.

Postpartum Medicaid Coverage Extensions: Lapses in insurance coverage or losing insurance coverage during the postpartum period can disrupt care and result in untreated and serious health threats. More than half of pregnancy-related deaths occur during the postpartum period, and currently under federal law, pregnancy-related Medicaid coverage ends 60 days after delivery. To promote continuity of coverage and care and address maternal morbidity and mortality, many states, such as Illinois and Missouri, are turning to 1115 demonstration waivers to extend Medicaid coverage and certain benefits beyond 60 days postpartum. In one case, California used state funds to extend Medicaid coverage for women with postpartum depression. Policy options to extend Medicaid coverage can be especially beneficial for women of color, who are more likely to experience higher rates of no insurance coverage than White, non-Latinx women. For more information about this topic, explore NASHP’s interactive map highlighting States’ Efforts to Extend Medicaid Coverage to Postpartum Women.

NASHP will continue to track state efforts to address the impact of systemic racism on maternal and infant health and document how states are working to advance maternal health equity by implementing alternative payment models, addressing social determinants of health, expanding telehealth, partnering with community-based organizations, and improving data collection to improve maternal health outcomes broadly and during COVID-19.

Four State Strategies to Employ Doulas to Improve Maternal Health and Birth Outcomes in Medicaid

July 13, 2020/in Policy Indiana, Minnesota, Nebraska, Oregon Featured News Home, Reports Health Equity, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Population Health, Social Determinants of Health /by Taylor Platt and Neva Kaye

Infographic: How State Medicaid Programs Can Use Telehealth to Serve Pregnant Women during COVID-19

May 4, 2020/in Policy Featured News Home COVID-19, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Population Health /by Eddy Fernandez and Taylor Platt

This infographic highlights what states need to consider when providing pregnancy-related services to Medicaid enrollees through telehealth during the pandemic. Links to more tools and resources are listed below the infographic.

States can use the following flexibilities and tools to increase access to pregnancy-related services via telehealth:

Medicaid State Plan Disaster Relief State Plan Amendment: States can use these streamlined templates to add telehealth services.
State Medicaid and CHIP Telehealth Toolkit
Medicaid and CHIP Telehealth Toolkit Checklist for States
Section 1135 Waiver Flexibilities: States can use this waiver to waive provider enrollment and prior authorizations requirements to expand access to telehealth services.
The Office of Civil Rights at the Department of Health and Human Services issued guidance that allows for enforcement discretion for noncompliance with HIPAA regulatory requirements related to providers and telehealth (e.g., using non-HIPAA compliant systems like Zoom).
Information letters can provide guidance on billing and covered services to managed care organizations.
NASHP blog: States Rapidly Build their Telehealth Capacity to Deliver Opioid Use Disorder Treatment, April, 2020

States Implement Strategies to Safeguard Pregnant Women during the COVID-19 Pandemic

April 20, 2020/in COVID-19 State Action Center Blogs, Featured News Home COVID-19, Health Coverage and Access, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Workforce Capacity /by Taylor Platt

Across the nation, states are taking steps during the COVID-19 pandemic to protect pregnant women and their infants during delivery. States, whose Medicaid programs cover nearly half of all births in the United States, recognize the importance of ensuring all pregnant women have safe and healthy deliveries. The Centers for Disease Control and Prevention (CDC) reports that based on available information, pregnant women appear to have the same risk of infection as others.

Background

Nearly all pregnant women in the United States deliver their babies in hospitals, which are currently also treating numerous COVID-19 patients. As a result, states and health care facilities are taking extra precautions to support pregnant woman as they are treated and admitted for delivery to help protect them and their infants from COVID-19 and promote healthy birth outcomes.

Racial disparities already exist in maternal and infant mortality rates, and early COVID-19 reporting shows similar racial and ethnic disparities in mortality rates. The following are some actions states are taking to ensure healthy birth outcomes and support health equity for mothers during childbirth.

Supporting Women during Delivery

To ensure the safety of patients and health care workers during the pandemic, hospitals have begun limiting the number of visitors a patient may have. Because this policy resulted in women being alone during labor and delivery, states and hospital systems have taken steps to ensure women can have support systems in place during delivery.

New York’s governor was the first to issue an executive order to ensure no person delivered a baby alone. The order, issued in late March, requires all hospitals to allow one support person in labor and delivery settings.
In early April, Oregon’s governor issued an executive order that identified a spouse, partner, or other support person accompanying an individual giving birth as an essential individual for hospital visitation.
Michigan went a step further when Gov. Gretchen Whitmer declared that pregnant women could have their partner and a doula accompany them during delivery if both individuals passed a health evaluation.

Supporting mothers during delivery is a critical step states can take to ensure safe deliveries and healthy outcomes for women and their newborns.

Expanding the Perinatal Workforce

With the spread of COVID-19, states are experiencing an unprecedented strain on their health care systems. To ensure a sufficient health care workforce, the federal government is providing new flexibilities to states, and states in turn are beginning to relax rules and regulations on provider requirements. Currently, at least six states (Maine, New Jersey, New York, Pennsylvania, Tennessee, and Texas) have emergency orders to expand midwifery care to pregnant women. These orders lift some regulations on out-of-state providers, continuing education requirements, and practice oversight.

In Pennsylvania, Gov. Tom Wolf has temporarily suspended a requirement that certified nurse-midwives file a collaborative agreement with the State Board of Medicine and wait until it is processed and approved before engaging in midwifery care. Nurse-midwives may now immediately begin providing care once they have a collaborative agreement with the state board, which bypasses the lengthy processing and approval steps.

In late March, Washington State submitted a 1115 waiver to allow some provider types, including doulas and community health workers, to provide Medicaid-reimbursable services, including preventive services, counseling, and case management during the public health emergency. The waiver seeks to establish a COVID-19 Disaster Relief Fund to stabilize the health care workforce as providers respond to COVID-19. Allowing doulas and community health workers to provide services and bill Medicaid would help ensure access to care and support services for pregnant women and promote health equity.

Monitoring for COVID-19 in Pregnant Women and Newborns

New information about the effects of COVID-19 on pregnant women and infants is emerging daily. Because of the unique needs of pregnant women, studies and data about the COVID-19 in the general population may not always apply to pregnant women. The Pregnancy Coronavirus Outcomes Registry (PRIORITY) Study, led by the University of California, San Francisco, is a nationwide registry designed to enhance understanding of how pregnant women are affected by COVID-19, including what their symptoms are, how long they last, and how COVID-19 may impact pregnancy and delivery.

Recently, Columbia University Irving Medical Center and New York-Presbyterian Allen Hospital in New York City, which has been hit hard by the pandemic, began screening all women admitted to delivery for COVID-19. Of 215 pregnant women screened, 33 women (15 percent) tested positive and most showed no symptoms, according to the New England Journal of Medicine report. As a result of the finding, more hospitals may consider screening pregnant women for COVID-19 when admitted for delivery.

As states begin to publicly report demographic information about COVID-19 cases, such as patient age, sex, and race, they can also choose to track and share information about COVID-19 in pregnant women and newborns, and perhaps identifying mother-to-baby transmission. Publicly reporting this information could help states and providers better understand best practices around treatment to ensure healthy pregnancies and outcomes. By also reporting race or ethnicity among pregnant women and infants with COVID-19, states can track and monitor disparities among these populations.

States are working rapidly to respond to the changing landscape for pregnant women during the pandemic. These policy measures are a few considerations to ensure women receive the care and support they need to have healthy pregnancies and deliveries during COVID-19. The National Academy for State Health Policy will continue to track state perinatal care policies, including Medicaid reimbursement for free-standing birth centers and home birth, postpartum coverage, and telehealth services for pregnancy-related care.

Virginia Advances Integrated Care for Pregnant and Parenting Women with Substance Use Disorder

December 16, 2019/in Medicaid Managed Care Virginia Blogs, Featured News Home Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Population Health, Special Populations and Services /by Melissa Caminiti and Ashley Harrell

To tackle the opioid epidemic, which has been the leading cause of unnatural deaths since 2013, Virginia recently developed an integrated physical and behavioral health continuum of care, which spans multiple treatment settings and includes case management and peer recovery support. The initiative, combined with increased access to naloxone and other efforts, has helped reduce fatal overdoses by 3.3 percent between 2017 and 2018.

In March 2016, with support from Virginia Gov. Terry McAuliffe, the Virginia General Assembly passed appropriations mandating transformation of the SUD Medicaid benefit entitled the Addiction and Recovery Treatment Services program or ARTS, which was implemented on April 1, 2017. Early results from Virginia’s ARTS program indicate success in increasing access to care for Medicaid-eligible pregnant women with SUD and opioid use disorder (OUD).

Data obtained from pre-ARTS implementation (covering April 2016-March 2017) compared to post-ARTS implementation (April 2017-March 2018) indicate that the percent of Medicaid-enrolled pregnant women with SUD who received treatment increased from 2 percent to 21 percent, while the rate of pregnant women with OUD who received treatment increased from 4 percent to 31 percent. In addition to increasing treatment rates, the number and types of treatment providers and treatment programs available to pregnant women with SUD and OUD also increased significantly in the post-ARTS implementation period.

Ashley Harrell, senior program advisor with Virginia’s Department of Medical Assistance Services (DMAS), recently shared the goals and highlights of the program with the Maternal and Child Health Policy Innovation Program (MCH PIP) Policy Academy, hosted by the National Academy for State Health Policy (NASHP). The academy, made up of eight cross-sector state teams, focuses on the mental health needs of pregnant and parenting women, particularly those with or at risk of substance use disorder (SUD). The ARTS program has six major goals:

Expand the short-term SUD inpatient detox benefit to all Medicaid/FAMIS enrollees (FAMIS is Virginia’s health insurance program for uninsured children);
Expand short-term SUD residential treatment to all Medicaid enrollees;
Increase reimbursement for existing Medicaid/FAMIS SUD treatment services;
Add peer support services for individuals with SUD and/or mental health conditions;
Require SUD care coordinators for DMAS-contracted managed care plans; and
Organize provider education, training, and recruitment activities.

The Virginia state Medicaid agency has made additional policy changes to improve access to care for pregnant enrollees with SUD. Some of these changes include:

Allowing and encouraging same-day billing of medical and behavioral health services;
Requiring access to medication-assisted treatment (MAT) along the addiction care continuum; and
Removal of prior authorization requirements for up to 24 mg/day of Suboxone film for in-network buprenorphine-waivered practitioners.

Additionally, the Virginia Medicaid MEDALLION 4.0 has an embedded High-Risk Maternity Program that includes comprehensive care management and family planning services to women with SUD. MEDALLION 4.0 is a statewide, fully capitated, risk-based, mandatory managed care program for Medicaid and Family Access to Medical Insurance Security (FAMIS) members that operates under the authority of a §1915(b) waiver. MEDALLION 4.0 covers pregnant women, infants and children and provides acute and primary health care services, prescription drug coverage, and behavioral health services for their members.

Harrell’s presentation spurred much discussion among academy participants, who quickly shared their concerns about access to care, integration of services, health equity, and the long-term health outcomes of women, children, and families affected by SUD.

Over the next two years, NASHP academy participants will continue to learn from each other and from subject matter policy experts as they strive to develop, support, and advance state-level policy innovations for pregnant and parenting women with or at risk for SUD and/or mental health conditions. Understanding state innovations is key to identifying new strategies to leverage change. As one policy academy participant observed during the meeting, “No one [state] has all the answers, but we have a lot of resources in each other.”

For more information on the academy, read NASHP’s blog, New Eight-State Policy Academy Advances Access to Care for Pregnant/Parenting Women with SUD. For more information about the Virginia ARTS program, visit the Virginia DMAS ARTS website or email questions about the ARTS program to sud@dmas.virginia.gov.

Infographic: State Team-Based Care Strategies for Medicaid-Eligible Women

December 2, 2019/in Policy District Of Columbia, Minnesota, Montana Featured News Home Behavioral/Mental Health and SUD, Care Coordination, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health System Costs, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration /by Eddy Fernandez

For more information, please click the program titles and read NASHP’s State Medicaid Quality Measurement Activities for Women’s Health.

Acknowledgement: Thank you to the officials in Washington, DC, Montana, and Minnesota for reviewing their respective highlighted strategies. This infographic is a publication of the National Academy for State Health Policy (NASHP). This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services HHS under the Supporting Maternal and Child Health Innovation in States Grant No. U1XMC31658; $398,953. This information, content, and conclusions are those of the authors’ and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US government.

Posts

State Medicaid Coverage of Dental Services for General Adult and Pregnant Populations

Eligibility Levels for Pregnancy-Related Coverage in Medicaid and CHIP

NASHP Maternal and Child Health Policy Innovations Program Policy Academy – Call for Applications

State Strategies to Address the Black Maternal Health Crisis

Infographic: How State Medicaid Programs Can Use Telehealth to Serve Pregnant Women during COVID-19

States Implement Strategies to Safeguard Pregnant Women during the COVID-19 Pandemic

Virginia Advances Integrated Care for Pregnant and Parenting Women with Substance Use Disorder

Infographic: State Team-Based Care Strategies for Medicaid-Eligible Women

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