Introduction
A new report from the Department of Health and Human Services Office of Inspector General (HHS OIG) sheds light on a critical issue facing Medicaid insurers. According to the report, many states are missing key opportunities to require Medicaid managed care organizations (MCOs) to expand access to maternal health services. This gap in coverage could be contributing to the United States’ disturbingly high rates of maternal mortality, particularly for Black, American Indian, Alaska Native women, and women in rural areas.
Overview of Medicaid Insurers and Maternal Health Access
Medicaid is the primary payer for pregnant women in the United States, covering 40% of all births. Despite this, access to maternal health services remains uneven across states, with MCOs often failing to provide coverage for essential maternal health providers such as midwives, maternal-fetal medicine specialists, and doulas. This lack of coverage limits the options available to pregnant women and may lead to poorer health outcomes.
The HHS OIG report analyzed 41 states and found that while all states require MCOs to cover access to OB-GYN physicians and hospital births, many do not extend coverage to other critical providers. This gap in coverage disproportionately affects vulnerable populations and may exacerbate existing health disparities.
Gaps in Coverage for Maternal Health Providers
Midwives
One of the most glaring issues highlighted by the HHS OIG report is the lack of coverage for midwives. Although midwives play a crucial role in maternal healthcare, one in five states does not require MCOs to cover their services. This is a missed opportunity to improve maternal outcomes, especially in communities where access to OB-GYNs is limited.
Maternal-Fetal Medicine Specialists
Maternal-fetal medicine specialists provide care for high-risk pregnancies, yet over half of the states analyzed do not require MCOs to cover these specialists. Pregnant women facing complications may be left without access to the specialized care they need, increasing the risk of adverse outcomes for both mother and child.
Doulas and Lactation Consultants
Coverage for doulas and lactation consultants is even less common, despite evidence suggesting their involvement can lead to better maternal health outcomes. Doulas, who provide emotional and physical support during childbirth, and lactation consultants, who assist with breastfeeding, are vital to ensuring the well-being of both mother and baby.
Federal Regulations and State Flexibility
Federal regulations require states to cover certain services for maternal health, but states have significant flexibility in determining which providers are included in their Medicaid programs. This flexibility allows states to tailor their programs to meet local needs but also means that many states are not fully utilizing the tools at their disposal to improve maternal health access.
According to the HHS OIG report, some states have missed opportunities to expand coverage for maternal health providers. Regional Inspector General Laura Kordish emphasized that while states have flexibility, they could be doing more to ensure better access to maternal care.
Impact of Insufficient Coverage on Maternal Health
The lack of comprehensive coverage for maternal health providers has significant consequences. The United States has the highest maternal mortality rate among high-income countries, and the situation is even worse for marginalized populations. For instance, Black women are three to four times more likely to die from pregnancy-related causes than white women.
The Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) have found that infants who do not receive prenatal care are five times more likely to die. Additionally, women without access to postpartum care are more likely to suffer from postpartum depression, further compounding the challenges they face.
Addressing Maternal Health Inequities
The disparities in maternal health outcomes are stark, with Black, American Indian, and Alaska Native women, as well as women in rural areas, being the most affected. These populations could benefit greatly from expanded access to midwives, maternal-fetal medicine specialists, doulas, and community health workers.
The HHS OIG report calls on states to do more to ensure that all pregnant women have access to the care they need, regardless of their location or socioeconomic status.
Recommendations from the HHS Report
The HHS OIG report recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to ensure that states cover required services from maternal care providers. Additionally, the report suggests that CMS provide states with technical assistance to improve access to care and adjust network adequacy standards to better meet the needs of Medicaid enrollees.
Network adequacy standards, which are meant to ensure that MCO networks have enough providers to meet patient needs, are not consistently enforced across states. Only 14 states have specific network adequacy standards for maternal care, and 36 states reported that they had not observed any changes in access to maternal health services since implementing these standards.
Moving Forward: CMS Response and Future Actions
CMS has responded positively to the HHS OIG report and has committed to taking action within the next six months. The agency plans to work with states to ensure that Medicaid enrollees have access to all required maternal health services. Additionally, CMS will provide guidance to states on improving network adequacy standards, ensuring that maternal care providers are available to meet the needs of pregnant women across the country.
Conclusion
The HHS OIG report highlights the urgent need for states to do more to improve access to maternal health services through Medicaid MCOs. By expanding coverage to include midwives, maternal-fetal medicine specialists, doulas, and other providers, states can help reduce maternal mortality rates and improve outcomes for both mothers and babies. The actions taken by CMS in response to this report could play a significant role in addressing the disparities in maternal healthcare and ensuring that all women receive the care they need during pregnancy and postpartum.
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FAQs
1. Why is Medicaid coverage for maternal health important?
A. Medicaid covers 40% of all births in the U.S., making it a crucial payer for maternal health services. Expanding coverage can improve maternal and infant outcomes.
2. What are the gaps in maternal health coverage?
A. Many states do not require Medicaid MCOs to cover services provided by midwives, maternal-fetal medicine specialists, doulas, and lactation consultants.
3. How can states improve maternal health access?
A. States can require MCOs to cover more types of maternal health providers and implement stricter network adequacy standards to ensure access to care.
