The report urges states to leverage managed care provider coverage requirements and network adequacy standards to boost access to maternal health care services to improve both maternal and infant health outcomes.
As maternal mortality rates in the United States remain highest among high-income nations, the Department of Health and Human Services Office of Inspector General (HHS OIG) is urging states to play a bigger role in combatting the maternal health crisis.
Given the severe racial and geographic disparities that have been longstanding in maternal deaths and complications, better access to maternal health care is critical to improve health outcomes.
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According to the report, which surveyed 41 states about their provider coverage rules and network adequacy standards, states are not leveraging managed care provider coverage requirements and network adequacy standards to improve access to maternal health care services. While all states require their managed care organizations (MCOs) to cover OB/GYN physicians and hospitals, many states do not require their MCOs to cover other important maternal health providers and professionals.
For example, for provider types that offer federally required services, only 32 states require their MCOs to cover certified nurse-midwives, 28 require coverage of birth centers, and 20 require coverage of maternal-fetal medicine specialists.
Even fewer states require their MCOs to cover health professionals that provide optional services, such as lactation consultants (14 states), other types of midwives (12 states), doulas (10 states), and community health workers (eight states).
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OIG also found that some states are not using network adequacy standards to promote maternal health care access, such as time and/or distance standards, appointment wait time standards, and provider-enrollee ration standards.
While all states monitor MCOs’ compliance with network adequacy standards, they may lack data on the standards’ impact on enrollees’ access to maternal health care, explained OIG. Further, 38 states have time and/or distance standard for maternal health care, however, standards for appointment wait time was significantly less common, with only 24 states monitoring, as well as provider-enrollee ration standards, with only 11 states monitoring.
To ensure states do more to improve access to maternal health care in Medicaid managed care, OIG made several recommendations to the Centers for Medicare & Medicaid Services (CMS).
“While CMS has recently finalized new regulatory requirements for states’ network adequacy standards to help improve enrollees’ access to timely maternal health care, our findings demonstrate that there are additional steps states can take to help ensure access to pregnancy and postpartum care in Medicaid managed care,” wrote OIG. “CMS has opportunities to help ensure that states’ requirements function most effectively to promote maternal health care access, which could particularly benefit Medicaid enrollees experiencing the worst maternal and infant health outcomes.”
OIG recommends CMS:
- Confirm that all states cover required services from maternal health care providers for Medicaid managed care enrollees.
- Clarify the requirement that states have a provider-specific OB/GYN network adequacy standard.
- Support states in tailoring their network adequacy standards to better address maternal health care needs.
CMS agreed with all three recommendations.