The rapid state adoption of extended postpartum Medicaid coverage from 60 days to 12 months offers an important opportunity to help ensure new parents and their infants get the health care they need during a critical period of family change following a birth. Last month, CMS released a timely resource for states seeking to help ensure they are taking full advantage of opportunities to address maternal health during the postpartum period through Medicaid and CHIP.
The toolkit is “intended to support Medicaid and CHIP programs in their efforts to improve the delivery of postpartum care to reduce rates of morbidity, mortality, and disparities.” For each section, relevant federal requirements or guidance is included. Among its highlights are specific strategies related to:
- Coverage continuity, including reminders on required federal renewal procedures once the postpartum period is complete (p. 8)
- Opportunities to support home visiting programs that support the new parent and infant together (p. 11)
- Postpartum care quality improvement approaches and models, including in managed care (p. 14)
- Strategies to address disparities in care (p. 28), including possible managed care strategies, opportunities to use community-based workforce strategies focused in maternal health (e.g. doulas and community health workers), and translation and interpretation guidance.
- Overall quality measurement and improvement.
Within the toolkit’s strategies is a section on postpartum depression screening, referral and treatment, an important priority given the link between maternal mood and anxiety disorders with morbidity and mortality during this time-sensitive period. CMS notes that postpartum individuals covered by Medicaid are more likely to screen positive for postpartum depression than other postpartum individuals. However, fewer than half of low-income postpartum individuals who have major depressive episodes receive any treatment.
The toolkit outlines state opportunities to support postpartum screening, referral, and treatment, including:
- Proactively identifying resources for individuals who lose Medicaid eligibility 60 days after delivery by coordinating with community mental health programs, health centers, or other community programs.
- Providing guidance to pediatric providers on screening for postpartum depression during well-child visits under the child’s Medicaid coverage as part of the EPSDT benefit or under an appropriate state plan benefit for Medicaid-eligible postpartum individuals.
- Developing a mechanism to reimburse pediatric providers for postpartum depression screening during well-child visits. Our recent survey with NCCP and Johnson Policy Consulting found that more than half of states also use a supplemental payment for such screenings.
CMS also raised ways that new parents can be served alongside their newborns with care designed to support the health needs of the parent-child relationship. The toolkit reminds states that in some cases, postpartum depression treatment could be covered under the child’s insurance l if the service is for the direct benefit of the Medicaid-eligible child and is delivered to the child and postpartum individual together (as specified in CMS 2016 guidance). For example, CMS notes that states could cover family therapy to reduce the effects of postpartum depression on the child as a direct service for the child if such conditions are met. At least 8 states report that they do not reimburse for such treatment in Medicaid, according to CCF’s survey with NCCP and Johnson Policy Consulting.
CMS outlines a range of strategies by providing examples and relevant CMS guidance for each topic. Its handy Postpartum Care Strategy Checklist (Exhibit 1, p. 5 in the toolkit) summarizes each of the options detailed throughout the toolkit. Every state should employ these strategies to improve postpartum outcomes and improve equitable access to quality postpartum care. The persistent maternal health crisis – which has only worsened since it was publicly identified – should compel policy leaders to act now.