At the crux of this bill is the creation of “maternity health homes,” designed to ensure that pregnant women enrolled under Medicaid receive comprehensive, coordinated care through a designated provider or a team of healthcare professionals. This amendment allows states flexibility in organizing care, bypassing restrictions that usually require uniform benefits statewide and consistent standards of care for all enrollees.
The key motivation behind this legislation is straightforward: to reduce severe maternal morbidity and maternal mortality by ensuring consistent, high-quality care for pregnant and postpartum women covered by Medicaid. By establishing these medical homes, states hope to offer a robust, cohesive network of services that extends from prenatal care through the postpartum period, effectively attending to the multifaceted health needs of mothers.
Eligible women, those enrolled in Medicaid with full benefits who are pregnant, can either choose to enroll in these specialized health homes or continue to receive coordinated care from a designated provider or team. Care extends through the full term of the pregnancy and up to one year postpartum. The bill explicitly excludes women who only have limited pregnancy-related benefits from this coordinated care.
Significantly, the bill entrusts the states and relevant healthcare providers the responsibility to establish criteria ensuring these maternity health homes meet extensive requirements. These criteria encompass: 1. Prompt coordination and access to a wide array of maternity and postpartum services. 2. Development of personalized, comprehensive care plans incorporating patient preferences, which also consider changes in Medicaid eligibility. 3. Integration of continuous home care, primary and inpatient care, behavioral health services, and necessary social support services in a culturally and linguistically appropriate manner. 4. Collaboration with a broad spectrum of care providers to execute the care plans effectively.
Financial support from the federal government is a crucial part of the proposal, with states receiving higher Federal matching funds—an additional 15 percentage points for the first year, not surpassing 90%. States must articulate their payment methodology, which could range from per-month per-enrollee rates to prospective payment models for health centers.
Moreover, the bill mandates each state to develop comprehensive tracking systems to monitor reductions in hospital stays, overall cost savings due to improved care coordination, and timely access to medically needed services rendered within or outside the state.
Hospitals are also called to adapt, needing to establish protocols to educate pregnant women about these maternity health homes upon seeking emergency care and informing the respective maternity health home of a patient’s ER visit, ensuring continuity of care.
States would also be required to engage in educating Medicaid providers and eligible women about the maternity health homes, ensuring culturally appropriate information dissemination. Key stakeholders would be expected to assist in outreach efforts pivoted around educating families on available health services.
Additionally, the bill pays particular attention to mental health and social support systems, requiring states, in coordination with the Secretary of Health and Human Services, to develop strategies for mental health and substance use disorders, and connect women to necessary societal support services.
On the data collection front, providers are to report significant details regarding their services, quality metrics, and healthcare outcomes, while states must periodically report data to federal agencies, ensuring the program’s transparency and efficacy.
Finally, the bill provides for planning grants starting October 2024, with a total of $50,000,000 earmarked over two years to aid states in developing and implementing these amendments.
This legislation, underlying the broader effort to reform maternal care on Medicaid, aligns with the heightened awareness around maternal health disparities. It proposes a model that sees to the health needs of pregnant and postpartum women comprehensively, from mental health support services to continuous care and customized health plans, aiming at curbing the alarming rates of maternal morbidity and mortality.
The HEALTH for MOM Act seeks to forge a more supportive, integrated healthcare landscape for high-risk pregnant women, promising significant, long-lasting impacts if enacted. The next steps involve deliberation and approval by the Energy and Commerce Committee, followed by potential endorsements from other legislative bodies, ultimately seeking executive approval. Whether this bill gets signed into law will determine if its intended benefits reach the women who need it the most, shaping the future of maternal healthcare in the United States.
