This post suggests that in order to improve care for pregnant and postpartum women in light of the COVID-19 Pandemic, state Medicaid programs should implement presumptive eligibility for pregnant women, increase the income limits for pregnancy-related Medicaid, expand Medicaid under the Affordable Care Act, broaden telehealth coverage and reimbursement, and increase access to Medicaid family planning programs.
Two senior health policy analysts for the American College of Obstetrics and Gynecology (ACOG), Emily Eckert and Meredith Yinger, wrote a Health Affairs blogpost entitled “Five Things State Medicaid Agencies Should Do Now To Improve Care For Pregnant And Postpartum Women Amid the COVID-19 Pandemic.” The Medicaid program deems pregnancy a critical event that requires immediate access to care to ensure positive infant and maternal health outcomes. There is a need to facilitate this access during the COVID-19 Pandemic. According to ACOG, pregnant women are to be considered an at-risk population for COVID-19. In 2018, Medicaid paid for 43 percent of all US births, including 50 percent of all births in rural areas, 60 percent of all births to Latinas, and 66 percent of all births to black women. As a primary payer of prenatal, pregnancy, and postpartum care in the US, Medicaid has a crucial role to play in improving the health of mothers and reducing preventable maternal deaths.
Many of the suggested changes can be implemented under a streamlined state plan amendment template released by the Centers for Medicare and Medicaid Services (CMS) in March 2020.
Suggested interventions:
- Implement Presumptive Eligibility For Pregnant Women
This policy intervention may be particularly important amid public health emergencies such as COVID-19, as it provides an easier on-ramp to enrollment and helps guarantee that pregnant women are able to access care in a timely manner.
- Increase The Income Limits For Pregnancy-Related Medicaid
To guarantee access to coverage for more women during the COVID-19 pandemic, states with pregnancy-related Medicaid income limits below 185 percent of poverty should act swiftly to increase these limits. Indiana’s limit is 218%.
- Expand Medicaid Under The Affordable Care Act
To further ensure comprehensive coverage of health services, states can elect to expand Medicaid. This can be done through a state plan amendment and without request to implement policies that create barriers to access, such as premiums and work and community engagement requirements.
- Broaden Telehealth Coverage And Reimbursement
CMS released broadened guidance for Medicare telehealth services in response to COVID-19 that can be adopted by states. Specifically, the guidance should be used as a model for states to eliminate coverage restrictions, waive enforcement discretion for licensure, and reimburse telehealth visits at the same rate as face-to-face visits. Several states have begun expanding telehealth services for Medicaid enrollees by removing originating site and device requirements. Other states should pursue this as soon as possible, as it is particularly important for expanding access to telehealth for pregnant and postpartum women living in rural areas or those who otherwise do not have reliable internet access. Given the importance of blood pressure and glucose monitoring throughout the perinatal period, coverage of remote patient monitoring and store and forward modalities is also essential for ensuring access to comprehensive care. While many state Medicaid programs have reimbursement policies for these modalities, pregnant and postpartum women are often not included in the eligible populations.
- Increase Access To Medicaid Family Planning Programs
While we do not currently know if pregnant women have a greater chance of getting sick from COVID-19 than the general public nor whether they are more likely to have serious illness as a result of contracting the virus, pregnancy prevention is vital during any infectious disease outbreak or other public health emergency.
States may also consider other policies to improve care for pregnant and postpartum women, such as expanding eligibility for coverage to lawfully residing immigrant pregnant women before they meet the five-year residency requirement or adopting the “unborn child” option to extend coverage for immigrant women who are not otherwise eligible for Medicaid and for women with a Medicaid-covered birth beyond the statutorily mandated 60 days postpartum. States may also consider adding additional benefits for pregnant and postpartum beneficiaries, including targeted case management services or home visiting.
