Could Medicaid plan help fix what’s wrong with pregnancy care in NY?

States are competing for millions of dollars in new federal funding aimed at improving maternal health in the U.S. by focusing on Medicaid-eligible women at heightened risk of pregnancy related deaths.

New York could be among the 15 states granted up to $17 million each under the project. The effort seeks, in part, to fund patient safety bundles that limit key childbirth risks, improve access to doulas and midwives and address health-related social needs, such as housing and transportation issues that hinder maternal care.

Requests for the program are due in September, with the one-time award expected to provide funding over the next 10 years.

USA TODAY Network New York reporter David Robinson took a closer look at the possible impact of this effort.

Addressing the most in-need birthing parents in U.S. NY

Much of the Centers for Medicare and Medicaid Services’ new $255 million plan for improving maternal health — called the Transforming Maternal Health Model — hinges on states taking advantage of reforms to Medicaid, the government health program for low-income and disabled Americans.

• How New York ranks in U.S. racial health disparities

Central to the effort are proposals to offer added federal funds to states as an incentive to create “a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy.”

The stakes are reflected in the fact that Medicaid covers about 41% of births nationally. In New York, that metric stood at nearly 48% in 2022, according to the March of Dimes. Yet there are gaps in how the billions of taxpayer-supported funding for Medicaid programs in New York addresses maternal health needs.

Further, Medicaid — which is jointly funded by federal, state and local governments — has historically struggled to address health-related social needs, such as housing, transportation and environmental issues that fuel health disparities.

Pregnant women on Medicaid are also much more likely to experience adverse pregnancy and birth outcomes than those on private pay insurance, on several fronts.

For example, nationally, women with Medicaid or other government insurance faced nearly two times higher risk of suffering severe injuries during childbirth than women on private payer health insurance in 2021, a federal report in May revealed.

Those same women with Medicaid also reported pregnancy-related depression — a key risk factor — at rates more than twice as high as private payer women.

What’s already being done on pregnancy outcomes in NY, across U.S.? 

Among our findings regarding ongoing maternal health efforts across the U.S.:

• Some states have recently launched sweeping Medicaid waiver programs that included plans that focused on better treating social determinants of health. That includes the $7.5 billion effort approved this year in New York, where health officials will be approving a range of proposals for addressing how Medicaid reduces health disparities and improves quality of life.
• California’s path to nation-leading maternal health initiatives traced to the launch of its maternal quality care collaborative in 2006. Since then, its maternal mortality rate has dropped about 41% to 10 deaths per 100,000 live births between 2018 and 2022, the latest federal data show.
• By contrast, New York launched its perinatal quality collaborative in 2010. Since then, its maternal mortality rate declined about 8% to 22 deaths per 100,000 live births between 2018 and 2022.

Medicaid’s current pregnancy care: Can it fix what’s broken?

Medicaid is working with states to continue improving outcomes for those using government healthcare. But there is still much to be done.

Research identified behavioral health conditions, including substance use disorder, as the leading underlying cause of pregnancy-related deaths nationally, at about 23%, the federal report added. It topped the next-highest causes, hemorrhage (14%) and cardiac (13%).

But efforts to improve behavioral health access have fallen short. About 17% of women ages 18 to 49 on Medicaid who needed treatment for drug or alcohol use failed to receive it in 2021, the report added. In that same group, 14% of women did not receive needed mental health care or counseling.

Another example of Medicaid’s inability to address all aspects of maternal mortality disparities is the push to reduce low-risk cesarean deliveries. The federal Healthy People 2030 project aims to reduce that rate to about 24% of all births to new mothers across the country.

California decreased its statewide low-risk C-section rate from 26% in 2015 to about 23% in 2019, surpassing the federal goal, a July state report revealed. But that progress missed most hospitals handling a lot of Black births, suggesting other factors — such as implicit bias, discrimination and racism in medicine — contributed to the inequality.

By contrast, New York’s low-risk C-section rate was 28% in 2019, according to the March of Dimes, which noted the rates in many states, including New York and California, increased during the pandemic.

Those findings underscored the fact that Black mothers and their infants in the highest income families fared worse during childbirth than the poorest white mothers and infants in California, a 2023 study found.

At the same time, the evidence-based solutions targeting many maternal health failures, in some ways, stemmed from California’s unique maternal data center, which launched in 2012 and involves a partnership with Stanford University.

A mix of state, federal and nonprofit funding supports California’s maternal data center, which also charges hospitals membership fees ranging from $2,000 to $10,000 per year, depending on the health system size and Medicaid population at hospitals.

Hospitals in New York — many of which rely upon the state Health Department for maternal health data analysis — lack the granular understanding of the issue unfolding in California, said Dr. Peter Bernstein, co-chair of the American College of Obstetricians and Gynecologists, or ACOG, Safe Motherhood Initiative in the New York region.

But recent measures in New York, including the launch of its maternal mortality review board in 2019, have resulted in new insights into preventable causes of maternal deaths. And new health equity surveying of New Yorkers offered key findings about unmet social needs fueling maternal health disparity.

“Now it’s up to us to get to those patients who are at high risk and not lose them,” Bernstein said.

David Robinson is a veteran health reporter for the USA Today Network’s New York State Team. Reach him at Drobinson@lohud.com.