Maternal health continues to face a crisis in the United States, and there is much to be done to combat it. Inequities in maternal health continue to persist, especially across racial and ethnic groups. For example, Black women have a 2.5 to 3 times higher maternal mortality ratio compared to white women and hemorrhaging accounted for twice the proportion of pregnancy-related deaths among American Indian and Alaska Natives compared to white and Black people. Disparities like these highlight the need for a more holistic approach to maternal health coverage, specifically with Medicaid.
Given that Medicaid covers more than 40% of all births in the US, it is extremely important to ensure that those who receive coverage from Medicaid can receive the maternal healthcare they need in a manner that is holistic, consistent, and adequate. Centers for Medicare and Medicaid Services (CMS) has announced their Transforming Maternal Health (TMaH) model that aims to improve maternal health coverage for those enrolled in Medicaid and CHIP programs over the course of 10 years. TMaH will support state Medicaid agencies in increasing access to care and infrastructure (including access to doulas, midwives, and community health workers), implementing protocols to ensure the safety of the mother and the baby during childbirth, and enact a holistic care delivery plan through making sure the mother feels supported in developing her own unique birth plan. This model will provide direct support to state Medicaid agencies, enabling them to not only target the poor health outcomes and disparities facing maternal health, but as well as enabling the delivery of community-based services.
Another potential route to improve maternal health through Medicaid is with 1115 waivers. CMS has made efforts through Section 1115 demonstration waiver opportunities to address health-related social needs (HRSN) of Medicaid enrollees. HRSN is defined by CMS as “unmet, adverse social conditions that contribute to poor health”, with larger relation to social determinants of health. In broadening access to HRSN services, improved access to care and health outcomes are expected to be a result. These waivers could allow for a holistic and standard continuum of care in regards to maternal health to be established. Past 1115 demonstrations, like that with substance-use disorders, have created guidelines for holistic care. If CMS can look at such past demonstrations for guidance, 1115 waivers have the potential to create new guidelines for maternal health for states that emphasize the ability of managed care contracting to improve maternal health. Considering the benefits of improving maternal health coverage with Medicaid, states should examine policy that both broadens access and improves the quality of Medicaid coverage.
