7/19/22: Implementing the Medicaid Post-Partum Coverage Expansion: Lessons From California and Illinois

Thank you for participating in this month’s Maternal Health Hub Learning Community session on implementing the Medicaid postpartum coverage extension. We heard from Palav Babaria (Chief Quality Officer, California Department of Health Care Services) and Dawn Wells (Bureau Chief, Bureau of Quality Management, Illinois Department of Healthcare and Family Services).  View the recording here.

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Dr. Babaria shared that the CA Department of Health Care Services (DHCS) recently released a new comprehensive Quality Strategy to transform the Medicaid system from FFS to one that thinks proactively about health care management. As part of this, they released the Bold Goals Initiative, 50 x 2025, that aims to improve equitable care around three high risk areas: child health, maternity care, and mental health. These goals are accompanied by specific measure targets to achieve by 2025.

Dr. Babaria also shared several maternity specific initiatives California is undertaking under the California Advancing and Innovating Medi-Cal (CalAIM):

• Extending postpartum coverage under Medicaid, which also covers all undocumented individuals.
• Adding new benefits to provide access to Community Health Workers (CHWs), doulas, and dyadic services (allowing one provider to provide and bill services for both mother and child during a visit).
• Creating state-wide clinical standards and toolkits specifically focused on the postpartum period and addressing SDOH.
• Using value-based payment to manage children’s health, maternity care, and behavioral health.

As part of CalAIM, California is shifting to a population health management approach, characterized by managed care plans having the ability to follow members through the system, with certain data points triggering a risk-tiering system (which the state is working to standardize) that would alert providers to patients’ urgent needs. For managed care members that meet the ”population of focus” criteria (homelessness, pregnant individuals transitioning from incarceration, pregnant individuals with mental health needs, and children and youth), other clinical and non-clinical supports (social services not typically covered by insurers) will be  available to support care management.

Dr. Babaria shared several resources:

• CA DHCS Population Health Initiative: https://www.dhcs.ca.gov/CalAIM/Pages/PopulationHealthManagement.aspx
• CA DHCS Comprehensive Quality Strategy: https://www.dhcs.ca.gov/services/Documents/Formatted-Combined-CQS-2-4-22.pdf
• CA DHCS Strategic Plan for Children and Families: https://www.dhcs.ca.gov/Documents/DHCS-Medi-Cal%27s-Strategy-to-Support-Health-and-Opportunity-for-Children-and-Families.pdf
• Dyadic Services/CalAIM:
  • https://www.dhcs.ca.gov/CalAIM
  • https://www.dhcs.ca.gov/cybhi
  • Background on Dyadic Care from UCSF: https://first5center.org/blog/dyadic-care-in-action-technical-assistance-to-expand-parent-child-social-emotional-care
• CA CHW information: https://www.dhcs.ca.gov/community-health-workers

Dawn Wells shared initiatives being implemented under Illinois’ Department of Healthcare and Family Services (HFS) for the state’s Medicaid program. Illinois was the first state to extend postpartum coverage under Medicaid for 12 months. However, HFS acknowledged that extending coverage does and will not solve all of the problems in maternity care. The department implemented several other initiatives to address poor maternal health outcomes including:

• Adding a second preventive postpartum visit, so that now new mothers have access to one visit between week 1 and week 4, and one visit between week 4 and week 12.
• Expanding Medicaid presumptive eligibility provider types to organizations such as Planned Parenthood.
• Affirming coverage of abortion services.
• Establishing maternal health and equity as pillars in the HFS quality strategy.

One member asked about the challenges related to implementing the second postpartum care visit. Dawn shared that it is important to get all stakeholders bought in before implementing a second postpartum visit.  Ideally a state would also have a plan for tracking the rate of second visits, which can be challenging. Illinois is currently working on how best to accomplish this.

HFS has five pillars for care improvement, with two of them being maternal health and equity. Each pillar includes pay-for-performance and pay-for-reporting initiatives. Under the pillars, plans collect data to help improve their programs and policies. As an example, under the health equity pillar, one plan found that individuals were not able to come in during the week for breast cancer screening appointments, and therefore the plan was unable to meet this screening measure. With this finding, the plan reached out to clinics to try and improve access for members. One clinic was willing to open on Saturdays, and made education materials available to members on the importance of screening when they came in for their appointment.

Finally, Dawn shared several maternal health initiatives that are in process in Illinois:

• Establishing coverage for doulas, lactation consultants, CHWs, and midwives. This includes developing a state plan amendment to create billing guidance for these services.
• Implementing a Medicaid partial benefit for family planning.
• Increasing prenatal and postpartum rates effective January 2023.
• Building a collaboration between the Illinois Department of Public Health and HFS, that allows for data sharing between the organizations.