WASHINGTON — Addressing the maternal mortality crisis requires a layered approach that includes extending Medicaid coverage for postpartum persons, expanding home visitation programs, and giving hospitals “gold stars,” government officials said.
But without action from Congress and the states, they stressed during a stakeholder meeting here Tuesday, certain tools to reduce maternal illness and death will fall by the wayside. “Women are dying needlessly during childbirth in the United States of America,” said Ambassador Susan Rice, President Biden’s domestic policy advisor, noting that people of color are among the most vulnerable.
Black, American Indian, and Alaska Native women are dying during and after pregnancy at up to five times higher rates than their white peers, said Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services (CMS). The problem of maternal morbidity and mortality has gotten worse in recent years, she said, adding that four in five pregnancy-related deaths are preventable.
As Rice pointed out, there are a number of reasons for the disparities. “Often their insurance only covers the first few months of postpartum care. Often a good hospital is hours away. Often a headache is dismissed,” Rice said, referring to women who have voiced concerns during a pregnancy only to be ignored by a clinician. “It’s infuriating, it’s unacceptable, and it has to be remedied.”
The Biden administration’s “Blueprint for Addressing the Maternal Health Crisis” includes $470 million for addressing the maternal health crisis, from measures such as investing in rural maternal health to implicit bias training for healthcare providers, Rice said.
CMS has built on the administration’s plan to create its own Maternity Care Action Plan, which aims to improve access to maternity care during and after pregnancy through steps such as extending healthcare coverage to postpartum women, Brooks-LaSure noted. As part of the American Rescue Plan, CMS gave states the option through state plan amendments to provide continued guaranteed access to Medicaid and to the Children’s Health Insurance Plan (CHIP), and 26 states and the District of Columbia have implemented the 12-month extension to date, said HHS Secretary Xavier Becerra. “That means there are 24 states, there are territories, that haven’t done this,” he noted.
Separately, as part of hospital-focused efforts, CMS issued a rule in 2021 requiring all hospitals to report whether they had engaged in perinatal care quality collaboratives and whether they had instituted other best practices, such as initiatives aimed at reducing sepsis.
The agency also put forward the idea of a “birthing-friendly hospital” designation that appears on CMS’s websites alongside a hospital’s name, giving consumers a chance to gather more information about which hospitals are committed to high-quality maternal care, Brooks-LaSure said. The designation is granted to hospitals that attest to participating in perinatal quality collaboratives — which the blueprint defines as “networks of providers working together to implement best clinical practices in hospitals” — and adopting other recommended interventions.
To date, 27 national and statewide health plans, responsible for coverage of more than 150 million Americans, are also sharing their “birthing-friendly” designation in provider directories, she added. One thing she’s learned in her job is “how much people like getting a gold star from CMS,” Brooks-LaSure told reporters later. “And we really intend to make sure it’s meaningful,” she said, noting that CMS plans to update the designation over time with feedback from stakeholders.
Another challenge for hospitals, clinicians, and pregnant people around the country is the Supreme Court’s recent reversal of Roe v. Wade, the 1973 decision that legalized abortion nationwide. “We’re seeing pregnant women denied care despite being at risk of sepsis or other life-threatening conditions,” Rice said. She stressed that the Biden administration will “continue fighting mightily” to defend the right to abortion and reproductive health.
But certain other efforts to improve maternal healthcare are still in flux. For example, although the House passed a measure to reauthorize a Health Resources and Services Administration (HRSA)-funded home visiting program, HRSA Administrator Carole Johnson noted that the Senate has only a matter of days to ensure funding continues for the program.
The program pays nurses, social workers, and other support staff to go into the homes of postpartum people whose children are under 5 years. It has been proven to improve health, economic, and educational outcomes, she said.
Asked what will happen if Congress passes a short-term continuing resolution instead of addressing some of these long-term funding needs, Brooks-LaSure said everyone will continue to work toward these same goals, whether they succeed this time or in the future.
Congress also has not yet passed the “Momnibus,” a $1.1 billion legislative package of about a dozen bills that aim to expand and diversify the perinatal workforce, improve data collection, and invest in social determinants of health. “Everything that’s in the Momnibus is evidence-based,” said Rep. Lauren Underwood (D-Ill.), co-founder of the Black Maternal Health Caucus and the bill’s sponsor. The package includes $100 million in mental health equity grants, she said, because in Illinois and other states, mental health and substance use disorders are the leading cause of maternal mortality.
Postpartum depression is generally accepted as a problem in our culture, but not every community has the specialists to provide care for other behavioral health conditions, including substance use disorders, “so we want those resources to be in every community in this country,” Underwood said. And the stakes are high: if the bill fails, “we’ll continue to see moms die. We’ll continue to see the increase in COVID-related maternal deaths in this country,” and the under-representation of people of color in the maternal health workforce.
Even without these bills and reauthorization, states will continue to expand postpartum coverage for pregnant people through Medicaid and to opt into the overall Medicaid expansion, Johnson said, but “make no mistake, resources matter. And our ability to continue to advance the work that we’re doing depends on resources.”
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