Can MMRCs Do More to Inform State Medicaid Maternal Health Efforts?

As rates of maternal mortality have risen in the United States, maternal mortality review committees (MMRCs) have been an important tool to understand why these maternal deaths occur. State MMRCs consist of multidisciplinary representatives to review deaths that occur during or within a year of pregnancy. In our recent 12-state scan of Medicaid MCO performance and maternal health, we sought to explore how MMRCs interface with state Medicaid agencies and MCOs to advance maternal health outcomes. We reviewed the state MMRC reports for Georgia, Illinois, Iowa, Kansas, Kentucky, Michigan, Mississippi, Nevada, New Jersey, New Mexico, Tennessee, and Washington. The MMRC reports we reviewed varied significantly in length and depth of analysis. Here are a few key findings:

  • All 12 states that we reviewed had an active MMRC, but data was often outdated. The latest MMRC reports from New Jersey and New Mexico contain five-year old data from 2018. Illinois previously reported data through 2017 until its recent report released last month with updated 2018-2020 data.
  • State Medicaid agencies were not represented on MMRCs in five of the 12 states that we reviewed– Iowa, Mississippi, Nevada, New Mexico and Tennessee. Lack of active Medicaid representation on MMRCs is a missed opportunity to pinpoint the best ways to improve the delivery of care that MCOs are providing to patients. In Mississippi, 5% of the 40 pregnancy-related deaths between 2017-2019 were Medicaid beneficiaries. (Medicaid covered about 68 percent of all births in Mississippi.) From 2017-2018, Tennesseans enrolled in Medicaid (TennCare) accounted for half of the 36 pregnancy-related deaths in the state. Yet the Medicaid agency was not represented on the MMRC in either state.

  • None of the 12 MMRC reports reviewed included data that was specific to enrollment in individual Medicaid MCOs among women who died during pregnancy or within a year after birth.

To read more details on our findings from the MMRC Reports, click here.

The United States has the highest maternal mortality rate among high-income countries. We spend the most money on health care, yet health outcomes do not always match the investment– more than 80% of maternal deaths are preventable. Every maternal death is a devastation for families and communities that are left to mourn the life that was lost.

As MCOs receive funds from state Medicaid contracts, it is important to have additional levels of Medicaid representation and transparency on MMRCs so that MCO performance in maternal health can be better understood and measured. States can’t fix a problem without knowing whether MCOs are meeting their responsibilities to deliver optimal care for pregnant and postpartum persons. And maternal and health leaders can’t identify and develop successful strategies to address the maternal and infant health crises without transparent and detailed data.

Medicaid is the single largest payer of births in the United States. More transparency and accountability about the performance of individual Medicaid MCOs on maternal health would allow the public to obtain the information they need to decide which MCO to entrust with their care.

MMRCs make many recommendations on how to improve maternal mortality in their states. State Medicaid agencies should seek to learn from MMRCs and incorporate the lessons learned into the purchasing frameworks reflected in their risk contracts with MCOs.  MMRCs have the potential to help improve state purchasing of Medicaid managed care for pregnant women as well as the performance of individual MCOs.

We recently hosted a webinar where we presented the results of our scan and were joined by two wonderful colleagues as responders – Sara Rosenbaum, Professor Emerita at the George Washington University School of Public Health and Jacy Montoya Price, Senior Director of Advocacy and Issue Campaigns with the Alliance for Early Success. This webinar concluded our joint webinar series on Medicaid MCO contracts and maternal health.

​​Editor’s note: To maintain accuracy, Georgetown CCF uses the term “women” when referencing statute, regulations, research, or other data sources that use the term “women” to define or count people who are pregnant or give birth. Where possible, we use more inclusive terms in recognition that not all individuals who become pregnant and give birth identify as women.

Tanesha Mondestin is a Research Associate at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.