A study released by the March of Dimes finds that a vast majority of states currently have policies in place to facilitate pregnant women’s access to coverage; however, much improvement is needed to improve outreach and enrollment.
The study, “Medicaid Outreach and Enrollment for Pregnant Women: What Is the State of the Art?” was commissioned by the Foundation and conducted by the Urban Institute in conjunction with the National Academy for State Health Policy. Published this spring, its findings are especially relevant with the recent release of the Centers for Medicare and Medicaid Services guidance to states on implementing the new option to cover pregnant women enacted as part of the recently reauthorized Children’s Health Insurance Program (CHIP).
“We found a tremendous variation across the states,” said Ian Hill, lead investigator for the Urban Institute. “But given the unique environment and different challenges every state faces, that is to be expected. The ‘right’ combination of outreach and enrollment policies and procedures may in fact be very different in one state than they are in another. What is critical is that states have the information on the best practices from which to draw to improve coverage and services for pregnant women especially in today’s economy.”
Medicaid officials in all 50 states, and the District of Columbia, were surveyed on policies affecting pregnant women. Following the survey, evaluators conducted follow-up telephone interviews with Medicaid officials in 10 states that appeared to be implementing innovative outreach and enrollment strategies. From these, two states – Louisiana and New York – were chosen for more in-depth study, and multi-day site visits were conducted.
Louisiana Medicaid dropped its requirement for medical verification of pregnancy, and allows eligibility workers to exercise “reasonable certainty” in determining women’s income which is one element in reducing the processing time for eligibility determination from an average of 19 days in 2004 to less than 5 days in 2008. New York’s Medicaid program monitors the quality of care provided through health plans by tracking several key perinatal outcome measures and adjusts payment levels to health plans based on their performance on these measures.
Policy recommendations fall into three categories: facilitating coverage and enrollment of pregnant women, raising public awareness of available coverage and encouraging enrollment, and broadening the scope of prenatal care to include an enhanced benefit package. Suggestions for policymakers include:
Making upper income limits for pregnant women and children uniform within each state:
- Designing application forms that are short, clear, simple, and written at easy-to-read literacy levels;
- Allowing applications to be submitted online;
- Adopting some form of expedited eligibility determination (whether or not that represents formal “presumptive eligibility”);
- Making application assistors widely available at the community level; Using broad-based outreach strategies that include social marketing, both electronic (radio and television) and print (posters, billboards, brochures, newspaper advertisements) media to promote early enrollment;
- Reimbursing for home visits as part of the enhanced benefit package;
- Developing explicit contract language with managed care organizations surrounding the delivery of enhanced care.
“The reauthorization of CHIP enables states to enroll pregnant women without having to obtain a federal waiver,” said Dr. Marina L. Weiss, senior vice president of public policy and government affairs for the March of Dimes. “Our Chapters, located in every state across the country, are taking the lead to work with their state policy makers to implement this option. This long-held March of Dimes priority is critical step forward towards improving birth outcomes.