Eligibility Levels for Pregnancy-Related Coverage in Medicaid and CHIP
Eligibility Levels for Pregnancy-Related Coverage in Medicaid and CHIP
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 more than three times more likely to die in childbirth than White women. Each year, the Black Mamas Matter Alliance sponsors a Black Maternal Health week (BMHW) on April 11-17.
In 2021, President Biden signed a proclamation recognizing BMHW and “the importance of addressing the crisis of Black maternal mortality and morbidity in this country.” The proclamation states the Biden Administration is committed to pursuing systemic policies, like addressing social determinants of health to reduce maternal mortality.
The National Academy for State Health Policy (NASHP) currently operates a state policy academy to support states in improving maternal health outcomes, with a specific focus on reducing racial disparities in maternal mortality. The following are examples of actions states are taking to reduce maternal mortality among Black women:
- Maternal Mortality Review Committees (MMRC). Review of maternal deaths is vital to inform prevention efforts. Nearly all states have an MMRC, but Committees differ by membership, scope of work and recommendations. Examining deaths by race and ethnicity through a full year postpartum can also help identify drivers of maternal mortality disparities. For example, a review of 14 Maternal Mortality Review Committee reports found that the leading cause of death for non-Hispanic White women was behavioral health conditions (including mental health, substance use disorder and overdose) while the leading cause for non-Hispanic Black women was cardiovascular-related conditions. Understanding the root causes of these deaths can inform recommendations to reduce disparities.
- Postpartum Coverage Extension in Medicaid. Some states are pursuing options to extend coverage to 12 months postpartum for pregnant people. Section 9812 of the American Rescue Plan Act provides states the opportunity for continuous Medicaid coverage through 12 months postpartum. As Medicaid pays for 65 percent of births for Black women, extending Medicaid coverage has the ability to greatly improve health outcomes and reduce racial disparities.
- Medicaid Coverage of Doula Services. Doulas provide culturally congruent physical, psychological and emotional care over the perinatal period and can make important connections to care and social services in communities. Currently four states (Minnesota, New Jersey, Oregon and Virginia) reimburse doulas as an optional Medicaid benefit. Pregnant people who receive doula care are more likely to have a healthy birth outcome and positive birth experience. Community-based doula programs engage trusted community members and can support Black mothers with shared decision making and self-advocacy. Medicaid reimbursement for doula services can increase access and birth outcomes for Black women.
Recently released data by the National Center for Health Statics, shows the number of women who died during pregnancy or 42 days after termination or pregnancy increased 14 percent from 2019 to 2020, with significant increases for non-Hispanic Black and Hispanic women. These data highlight the importance of considering state policy options to reduce racial disparities and promote wellbeing across the perinatal period. NASHP will continue to work with states and track state action to improve maternal health outcomes.
Below are state health policy resources to promote Black maternal health equity.
Doulas
- State Medicaid Approaches to Doula Service Benefits, March 2022
- Virginia Invests in Doulas to Improve Maternal Health Outcomes, February 2022
- Four State Strategies to Employ Doulas to Improve Maternal Health and Birth Outcomes in Medicaid, July 2020
Health Equity
- Virginia Advances Maternal Health Equity Policy, October 2021
- Resources for States to Address Health Equity and Disparities
Home Visiting
Maternal Mortality
- State Maternal Mortality Review Committees Address Substance Use Disorder and Mental Health to Improve Maternal Health, August 2021
- State Maternal Mortality Review Committee Membership and Recommendations, February 2021
Postpartum Coverage
Behavioral Health
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
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. 
