Groundbreaking Legislation Introduced to Improve Maternal Health Outcomes in the U.S.
By: Melissa Gradilla
Senators Cory Booker (D-NJ), Kirsten Gillibrand (D-NY), Tammy Baldwin (D-WI), Ben Cardin (D-MD), Richard Blumenthal (D-CT) and Kamala Harris (D-CA) have announced groundbreaking new legislation to improve health outcomes, access to care, and health equity for women and infants in the United States. The Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act– the “MOMMIES Act” — takes a comprehensive approach to fixing a system that too often isn’t meeting the needs of childbearing women in the U.S. Despite spending more on health care than any other country, women in the U.S. are more likely to die from pregnancy and childbirth than in any other developed nation.
The MOMMIES Act is part of a renewed focus on maternal health in the U.S. Senate and House of Representatives and is one of the most far-reaching bills to address this issue. The legislation proposes extending postpartum coverage, expanding on models that work, and improving reimbursement rates, which would have a powerful impact on the health of families at a critical time. By focusing on improving Medicaid services, this bill takes an effective strategy to overhaul the maternity care system, given that Medicaid covers about half of all births in the U.S.
A close look at poor maternal health outcomes in the U.S. has demonstrated dramatic disparities — most notably by race, but also by socioeconomic status and geographic location. Not only are non-Hispanic Black women three to four times more likely to die from pregnancy and childbirth than non-Hispanic Whites, but women living in poverty and in certain states also have much higher rates of maternal deaths than the national average. While issues of race, socioeconomic status, and geographic location are invariably intertwined, Medicaid provides a valuable avenue to close gaps in provision and experience of maternity care.
Extending Medicaid Coverage
The MOMMIES Act would extend Medicaid from the current 60 days postpartum to 365 days, recognizing that the postpartum period is a critical window for preventing maternal deaths and reducing complications.
Nearly half of all births in the U.S. are covered by Medicaid — with some states surpassing fifty percent. Medicaid for pregnant women is required to cover, at a minimum, all care related to pregnancy, delivery, and any complications that may occur during pregnancy and up to 60 days of the postpartum period. Reports from state maternal mortality review committees, however, have consistently indicated that 60 days of postpartum care is not enough. Nearly one in five maternal deaths occur between 6 weeks and a year following childbirth. Of these deaths, 58% are considered preventable.
Additionally, the MOMMIES Act would expand full scope Medicaid coverage to all pregnant and postpartum women, rather than coverage that can be limited to pregnancy-related services. This is particularly critical for reducing disparities as benefits for pregnant women covered by Medicaid vary depending on their eligibility group and also vary across states.
Maternity Care Home Pilot Project
The MOMMIES Act would establish, implement, and evaluate a Maternity Care Demonstration Project in 15 states to serve as a maternity care home model aimed at Medicaid. Similar to pilot programs in other states, such as North Carolina, maternity care home models provide care coordination and support services with the goal of improving quality of care, improving birth outcomes, and providing continuity of care. With a focus on identifying and treating high-risk pregnancies, maternity home programs facilitate access to personalized, comprehensive and integrated care and have shown early successes in reducing health care costs, increasing the number of prenatal visits, and a reduction in low birthweight infants. This is critical because for many pregnant Medicaid recipients, coverage and access does not equal quality. Beyond ensuring that pregnant women on Medicaid are receiving care, maternity care home models have the potential to ensure that this care is timely, tailored, and holistic.
Expanded Access to Doula Care through Medicaid
The Mommies Act would also increase access to doula care for pregnant women on Medicaid. In the U.S., fewer than a handful of states report having Medicaid coverage for doula assistance for women. The benefits of doula support are numerous and have consistently been documented across settings. Doulas not only help improve a woman’s childbirth experience, but also help reduce C-sections, the length of labor, and decrease the use of pain relief medications, which can lead to added interventions or complications. This bill directs the Medicaid and CHIP Payment and Access Commission (MACPAC) to generate a report on the coverage of doula care under state Medicaid programs, the barriers to coverage, strategies and recommendations to increase the utilization of doulas. Following this report, the Centers for Medicare & Medicaid Service (CMS) will issue guidance to states on how to increase access to doula care for Medicaid recipients. The implementation of doula services for Medicaid recipients is a tremendous step toward ensuring that everyone, regardless of socioeconomic status, has the emotional and physical support they need for a healthy pregnancy and childbirth.
Finally, Sen. Booker’s legislation proposes two additional components — 1) for state Medicaid programs to increase access to maternity care through telemedicine, and 2) to require Medicaid to adopt mandatory minimum reimbursement levels for pregnancy and childbirth care.
Every Mother Counts supports the MOMMIES Act, which, true to its name, would maximize outcomes for moms.