Eligibility Levels for Pregnancy-Related Coverage in Medicaid and CHIP
Eligibility Levels for Pregnancy-Related Coverage in Medicaid and CHIP
Eight States Join NASHP’s Maternal and Child Health Policy Innovation Program Policy Academy to Address Maternal Mortality
The National Academy for State Health Policy (NASHP) has announced a new, two-year policy academy kicking off in April for state health officials interested in building state capacity to address maternal mortality for Medicaid-eligible pregnant and parenting women, with the goal of improving access to quality care.
Through the Maternal and Child Health Policy Innovation Program (MCH PIP), funded by the Maternal and Child Health Bureau within the Health Resources and Services Administration, NASHP’s Maternal and Child Health Policy Innovation Program Policy Academy will engage eight state teams (GA, ID, IL, IA, LA, PA, SD, and VA). The teams include representatives from state 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, and others.)
Through this policy academy, states will identify, develop, and implement policy changes or develop specific plans for policy changes to improve maternal health outcomes, with a specific focus on improving racial disparities in maternal mortality.
The United States has seen a steady rise in maternal mortality over the past few years and has the worst maternal mortality rate among developed nations. Additionally, there are stark racial disparities in pregnancy-related deaths. American Indian/Alaska Native and Black women are two- to three- times more likely to die from pregnancy-related causes than non-Latinx (non-Hispanic) White women. 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.
Over the course of the two-year project, NASHP will provide technical assistance to states, identify barriers, and share promising practices for improving maternal health outcomes to help states achieve their policy goals.
State Health Policy Resources to Promote Black Maternal Health and Equity
Each year approximately 700 women die in the United States as a result of pregnancy or related complications, and Black women are three- to five-times more likely to die in childbirth than White women. In honor of the fourth Black Maternal Health week, April 11-17, 2021, sponsored by the Black Mamas Matter Alliance, the National Academy for State Health Policy (NASHP), is showcasing recent state health policy resources to help improve Black maternal health.
NASHP Blogs
- New Jersey Medicaid Implements New Policies to Improve Maternal Health, March 2021
- How New York Is Safeguarding Pregnant Women during the COVID-19 Pandemic, November 2020
- State Strategies to Address the Black Maternal Health Crisis, October 2020
- Eight States Join NASHP’s Maternal and Child Health Policy Innovation Program Policy Academy to Address Maternal Mortality, April 2021
NASHP Report
- Four State Strategies to Employ Doulas to Improve Maternal Health and Birth Outcomes in Medicaid, July 2020
Interactive Maps and Charts
- State Maternal Mortality Review Committee Membership and Recommendations, February 2021
- State Medicaid Policies for Maternal Depression Screening During Well-Child Visits, April 2020
- View Each State’s Efforts to Extend Medicaid Coverage to Postpartum Women, March 2020
Infographic
State Team-Based Care Strategies for Medicaid-Eligible Women, December 2019
New Jersey Medicaid Implements New Policies to Improve Maternal Health
New Jersey, like many states, faces rising maternal mortality rates and racial disparities. A recent review of pregnancy-related deaths in the state from 2009 to 2013 found 46.2 percent of deaths occurred in Black women, compared to 26.9 percent in White women. With approximately 40 percent of New Jersey’s births covered by Medicaid, the governor’s office recently announced the following Medicaid initiatives to improve maternal health and reduce overall health care costs.
Medicaid Coverage of Doula Care: Legislation passed in 2019 enabled Medicaid coverage of doula services in the state. A doula is a trained professional who provides continuous physical, emotional, and informational support to the birthing parent throughout the perinatal period. Doula care has been shown to reduce cesarean rates, improve birth experiences, and improve birth outcomes. Once doulas receive the community-based doula training from an approved program, they are able to enroll as fee-for-service providers and with Medicaid managed care organizations.
New Jersey has designated two levels of doula care eligible for reimbursement, standard and enhanced care.
- Services for standard care include up to eight perinatal visits and attendance during labor and delivery with a reimbursement rate of $800.08.
- Enhanced care is for members age 19 or younger and services include 12 perinatal visits and attendance during labor and delivery with a reimbursement of $1,066.
- Additionally, for both levels of care there is an $100 incentive for postpartum, follow-up visits.
In order to receive the incentive payment, doulas must provide a postpartum service visit within six weeks of delivery and use the code 99199 HD U8 for billing. An obstetric clinician follow-up visit must occur within six weeks of delivery to receive the incentive payment but is not required for doulas to receive reimbursement for other services. Doulas serving Medicaid enrollees must be trained to provide culturally competent care that supports the diversity of the members and assist members with community-based services to improve health outcomes. Currently, Minnesota and Oregon cover doula services for all Medicaid recipients and New York has a pilot program running in two counties. Additionally, as directed by their state legislatures, Virginia and Washington State have submitted reports and studies on implementation of Medicaid reimbursement.
Increased Payments to Certified Nurse Midwives: In an effort to increase access to quality maternity services, New Jersey Medicaid has also increased the reimbursement rate of certified nurse midwives (CNMs) to be equivalent to 95 percent of the current rate for physicians who provide prenatal, labor and delivery, and postpartum services. A CNM is an advanced practice registered nurse (with a master’s degree in nursing) who specializes in the care of women throughout their life course, including pregnancy, childbirth, and the postpartum period. According to the most recent Pregnancy Risk Assessment Monitoring System (PRAMS) data, 33.1 percent of Black, non-Hispanic mothers in New Jersey reported receiving late or no prenatal care, compared to 14.6 percent of White, non-Hispanic mothers. The increase in reimbursement rates for CNMs is designed to build a larger network of midwives and increase access to quality pregnancy-related care for mothers and babies in New Jersey. As of 2013, approximately 34 states and Washington, DC, reimburse CNMs at 90 to 100 percent of the rate of earned by practicing physicians.
Medicaid Will Not Pay for Non-Medically Necessary, Early-Elective Deliveries (EED): In 2019, New Jersey passed a law that no provider will be approved for reimbursement by Medicaid for a non-medically indicated, early-elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation. Scheduled cesarean sections or medical inductions performed prior to 39 weeks carry risks for both mother and baby. Overall, New Jersey’s rate of surgical births (cesareans) is 30.3 percent. The benefits of non-surgical birth include shorter hospital stays, reduced infection rates, lower blood clot risk, and fewer infants born with difficulty breathing. Currently, 20 states have reduced or eliminated payment for procedures (EEDs, elective inductions, and non-medically necessary cesarean sections) that do not follow clinical guidelines. The new Medicaid policy in New Jersey supports education campaigns and hospital initiatives that are already in place to lower non-medically necessary EEDs. The new policy will not affect mothers who have medical indications for early delivery.
Providers Required to Complete the Perinatal Risk Assessment (PRA) Forms: In 2019, the state passed a law requiring Medicaid providers to complete PRAs during the first prenatal visit for all Medicaid enrollees. The tool is used to identify demographic, medical, and psychosocial factors that can help determine case management plans for pregnancies. The PRA form has been updated to included assessment of alcohol and drug use and COVID-19-related challenges. The state will use the data collected from the PRAs to analyze and identify risk factors among pregnant Medicaid enrollees in the state.
State Medicaid programs have the opportunity to implement policy changes, similar to New Jersey’s, that support improving maternal and infant health outcomes. Given current budget challenges in states, funding can be challenging, but these policy changes can result in cost savings by lowering cesarean rates, decreasing length of stays in hospitals, and improving overall birth outcomes. The National Academy for State Health Policy (NASHP) will continue to track state maternal and child health policies.
NASHP Maternal and Child Health Policy Innovations Program Policy Academy – Call for Applications
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:
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- 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).
NASHP Roundtable: Georgia and Illinois Work to Improve Maternal Health Outcomes
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.
Despite spending more than other developed nations on hospital-provided maternity care, about 700 US women die each year from pregnancy-related complications.
- Women of color have significantly higher rates of maternal morbidity and mortality, and Black women are approximately four-times more likely than White women to die of pregnancy-related causes.
- In comparison to women covered by private insurance, pregnant women enrolled in Medicaid have increased rates of severe maternal morbidity and mortality and are more likely to have risk factors affecting their pregnancies.
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.
How New York Is Safeguarding Pregnant Women during the COVID-19 Pandemic
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.
States Use CHIP Health Services Initiatives to Support Home Visiting Programs
Maternal and infant mortality rates in the United States have been steadily rising over the past decade, with stark racial disparities between White and Black mothers and their babies. Black infants are twice as likely to die than White infants, and Black mothers are four-times more likely to die from pregnancy-related causes than White women.
Evidence-based home visiting programs, such as those funded by the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), play an important role in improving the health and well-being of the maternal and child health (MCH) population, especially during stressful periods of economic downturns and the COVID-19 pandemic. In addition to MIECHV funding, the Children’s Health Insurance Program’s (CHIP) Health Services Initiatives (HSIs) are a funding opportunity available to states to support home visiting programs.
Research shows home visiting programs improve overall maternal and infant health outcomes, increase maternal depression screenings, reduce child abuse and neglect, promote child development and school readiness, and improve coordination and referrals for community resources.
To support these programs, states use an array of private and public funds, including Medicaid and the CHIP funding, to support home visiting services. Specifically, CHIP HSIs are available to states to support a range of child health services, including home visiting since CHIP’s inception in 1997. Recently, there has been an uptick in the number of states using HSIs with 45 federally approved HSIs established between 2016 to 2019.
The Centers for Medicare & Medicaid Services (CMS) approve state HSIs through a state plan amendment that includes performance metrics to measure impact and outcomes of the programs. CHIP HSIs are designed to serve children under age 19 who are eligible for Medicaid or CHIP, but they can be designed to improve the health of a broader population of children beyond those eligible for Medicaid or CHIP.
HSIs can focus on direct services, public health initiatives, or ongoing social, behavioral health needs. Funding for HSIs comes from a combination of state and federal funds. A state draws federal funds from its CHIP administrative allocation, which is 10 percent of its CHIP block grant spending, to help fund an HSI. These funds are provided at the state’s CHIP match rate. States must consider all of their administrative expenditures, including those required to operate their CHIP programs, such as staff, managed care fees, systems upgrades, etc. to ensure there are remaining funds, within a 10 percent cap, before committing funds to an HSI project.
As of 2019, there are 71 approved HSIs in 24 states. At least three states currently have HSIs that include home visiting services and one state recently received CMS approval to start an HSI that includes home visiting services.
- Alabama’s State Plan Amendment was approved in September 2019 to implement an HSI to provide case management and care coordination to low-income, high-risk pregnant women and their infants in three counties to improve pregnancy outcomes and infant health for up to one year postpartum. The case management services include home visits.
- The Arkansas SafeCare program is a structured, evidence-based and in-home parenting program that has a home visitor and parent work together to create a safe home environment. The home visitor assists the parent in providing structure and routines, while encouraging systematic health decision-making to keep children safe in their homes. Parents are provided with useful tools, such as books, thermometers, childproof safety locks, and other learning materials to use in their family environment to keep children safe. The home visitor delivers weekly or biweekly home visits for approximately 18 to 22 weeks. More information can be found about the state plan amendment here.
- Massachusetts has two CHIP HSIs that include home visiting services. The first, Healthy Families, is a newborn home visiting program that provides home visits, a six-week neonatal and postnatal parenting education support group series, and parent-child interaction groups to support positive parent-child relationships. The HSI is designed to serve families with at-risk newborns. The Young Parent Support program is another CHIP HSI that provides funding for community-based organizations that provide outreach, home visits, mentoring, and parent groups to strengthen the skills of young parents.
- Missouri’s newborn home visiting program serves at-risk, low-income pregnant and postpartum women and their children up to five years of age. Clinical staff and other trained professionals provide a range of services to families, including group training sessions and connection to needed resources. The CHIP HSI’s goal is to increase healthy pregnancies and positive birth outcomes, as well as decrease child abuse and neglect through its home-based services.
States are implementing evidence-based home visiting programs to improve health outcomes for women, children, and their families. CHIP HSIs are one of many funding mechanisms states can use to help expand their home visiting services and continue to improve the lives of children and their families, especially at a time when the COVID-19 pandemic has brought new challenges for states and families. In spite of these challenges home visiting remains an important service for women, children, and families.
States will soon be faced with critical budget challenges brought on by the COVID-19 pandemic and will have to make tough decisions about funding for home visiting services. CHIP HSIs provide one funding source states may want to use to help support home visiting services.
- For more information on financing home visiting, read the NASHP report, Medicaid Financing of Home Visiting Services for Women, Children, and Their Families.
- And for additional information on CHIP HSIs, explore NASHP’s report, Leveraging CHIP to Improve Children’s Health: An Overview of Stare Health Services Initiatives.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
