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African American mom with infant

Bridging the Gaps Behind Maternal Health Disparities

Being low-income and pregnant in Texas can come at a deadly cost.

At 18.5%, the state's maternal mortality rate is one of nation's highest. Yet, almost 90% of these pregnancy-related deaths are preventable, the Texas Maternal Mortality and Morbidity Review Committee found in a 2020 report.

However, with one in four women of reproductive age in Texas uninsured, tens of thousands may not receive critical health care services needed to diagnose and treat potentially life-threatening conditions before, during and after pregnancy. In 2019, Texas had the third-lowest proportion of women receiving first trimester care compared with other states.

Medicaid can bridge gaps in prenatal care by providing qualified, low-income pregnant women with health care, support services, counseling and two months of postpartum care.

Responding to its high maternal mortality rate, the state is taking steps to extend postpartum Medicaid coverage. This spring, Gov. Greg Abbott signed a law allowing Texas mothers on Medicaid to keep their health coverage for half a year after giving birth, instead of just two months.

“This is really big news for Texas and means our STAR members could have six months postpartum coverage,” says Sara Daugherty, Texas Medicaid executive director for Blue Cross and Blue Shield of Texas (BCBSTX).

To help mothers get the care and services they need, BCBSTX identifies and tries to contact its Medicaid members at risk of having pregnancy complications.

“We reach out to members as soon as possible and continue to support them throughout their pregnancy,” says Lauretta Dozier, a BCBSTX clinical operations unit manager. “We educate members on all the resources available to them as part of their Medicaid benefit and additional services that BCBSTX provides to pregnant members.”

She and her team try contacting members with conditions, including obesity, hypertension, preeclampsia, depression or diabetes, putting them at higher risk for complications and preterm births. Medical managers and care coordinators assist members in accessing care and finding resources such as healthy food and transportation to help them reach full-term pregnancy.

After a baby’s birth, they offer support for newborns up to one year and currently continue postpartum follow-up with mothers as many as eight weeks, although many deaths have happened more than 60 days postpartum in Texas.

Helping members overcome obstacles

The United States has the highest rate of maternal deaths in the industrialized world, with about 700 women dying every year because of pregnancy-related problems, according to the Centers for Disease Control and Prevention. Receiving prenatal care late in a pregnancy or not at all increases risk of pregnancy complications and maternal deaths.

Dozier and her team offer services to maintain engagement, build relationships and keep Medicaid members on track with their prenatal care plans. As examples, members who attend approved prenatal classes and get frequent care receive incentives, including diaper bags filled with baby items and car seats, for meeting goals.

“Early prenatal care is so important,” Dozier says. “The incentives encourage our members to complete appointments early in their pregnancies and follow up with their postpartum care. Sometimes they need a little push because they don’t understand the importance of prenatal visits.”

Still, the team sometimes doesn’t reach members until after they’ve given birth. Jennifer Flores, a BCBSTX Medicaid nurse, spent a year assisting a member who the team had tried to engage before she gave birth to triplets. The babies required weeks of neonatal intensive care before discharge.

“We kept talking almost every day, even after the babies got home,” says Flores, who helped the mother get car seats, a portable crib and numerous supplies and services she needed.

Every day, she encourages mothers to take vitamins and go to appointments, while listening for clues that will help her understand their struggles and find ways to assist them.

“I’m trying to find solutions for everyone,” Flores says. “It’s different every day. I’m so blessed I can help people who need it.”

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