It is often said the best way to measure population health is by assessing a community’s infant and maternal health outcomes. For this reason, The Center for Community Solutions has spent decades immersed in this space as the United States continues to grapple with a largely preventable maternal and infant health crisis and data reveals Ohio’s families continue to feel the impact of this multifaceted public health issue at alarming rates.

The best way to measure population health is by assessing a community’s infant and maternal health outcomes.

During this time, we have collaborated with and learned from local organizations that have taken improving outcomes into their own hands and have identified the best approaches, rooted in evidence, to ensure the success of new families. Because of these partnerships and our own research and analysis, we have developed several policy recommendations and testified to those recommendations to local and state agencies, including the Ohio General Assembly. We are also one of a handful of advocacy organizations selected to serve and offer our expertise on several statewide taskforces and coalitions including the Ohio Collaborative to Prevent Infant Mortality and the Ohio Council to Advance Maternal Health.While our advocacy this biennium focused primarily on previous recommendations we have made in this space, including Medicaid reimbursement for doula services, data transparency and implicit bias education requirements for providers, we are thankful for the ongoing engagement from lawmakers and the administration who are eager to maintain the momentum on this issue.

Improvements and Limitations on Ohio Maternal Health Policy

In any given year, Medicaid is the largest single payer of maternity care, covering approximately half of all births in Ohio (and in the United States) and thus plays a critical role in improving maternal and infant health outcomes. As we have previously reported, for example, deliveries covered by Medicaid have disproportionally higher rates of severe maternal morbidity (SMM) compared to private insurance or self-pay. Parents whose births are covered by Medicaid experience SMM rates of 85 per 100,000 deliveries compared to 58.7 for private insurance and 56.8 for self-pay. ^[1]

In any given year, Medicaid is the largest single payer of maternity care, covering approximately half of all births in Ohio (and in the United States).

While general guidelines for Medicaid are set by the Federal government, (such as income, household size, disability, family status and other factors), each state has flexibility on certain requirements and thus some eligibility criteria differ between states. All states, however, are required to include certain individuals or groups of people in their Medicaid plan to remain eligible for federal funds. While there are over 25 different eligibility categories for which federal funding is available, they are often classified into four broad groups in Ohio:

Covered families and children
Aged, blind and disabled population
Medicaid Expansion or Group 8
Individuals with low-income.

Since Ohio has expanded Medicaid, pregnant people whose income level is at or below 138 percent of the Federal Poverty Level (FPL) can receive Pregnancy-Related Medicaid coverage through traditional Medicaid Expansion. Pregnant people who earn too much (up to 205 percent of the FPL) to qualify for the program under normal circumstances, and don’t have access to private insurance, can qualify for coverage through Ohio Medicaid’s Healthy Start program. While Federal law requires this coverage last through 60 days postpartum, many people experience pregnancy and birth complications well beyond 60 days postpartum.To help states improve their maternal health outcomes, coverage stability, and address racial disparities in maternal health, the American Rescue Plan Act of 2021 provides a framework for states to extend Medicaid postpartum coverage for 10 additional months bringing the total coverage to 12 months via a state plan amendment (SPA). The final budget included a provision that the Ohio Department of Medicaid (ODM) must seek approval to provide this coverage through a SPA or an 1115 waiver. While approximately 70,000 births a year are covered by Medicaid, ODM estimates that this enhanced coverage will benefit the roughly 14,000 Ohio birthing people who would not continue receiving coverage beyond 60 days because of their income. The budget appropriates funding of $15 million all funds ($4 million state share) in each fiscal year (FY) for this extended coverage.While this additional coverage is sure to have a positive impact for Ohio’s families, it’s important to keep in mind that as of now the coverage is:

Not permanent – the new option has a 5-year sunset
Not mandatory for states
Available at a state’s regular Federal Medical Assistance Percentage (FMAP) rate

Though this may change as several maternal health provisions are under consideration in the Biden Administration’s Build Back Better legislation.

Currently, uninsured children up to age 19 in families with income up to 206 percent of the FPL can receive insurance coverage through the Children’s Health Insurance Program (CHIP)

Beyond improving outcomes for new birth parents, this extended coverage is also imperative for maintaining coverage for children. Currently, uninsured children up to age 19 in families with income up to 206 percent of the FPL can receive insurance coverage through the Children’s Health Insurance Program (CHIP), however, evidence shows families are much less likely to maintain this coverage if the adults in the household are ineligible. Data also continues to show that Medicaid coverage produces significant returns in regards to children. Outside of simply producing better health outcomes, insurance coverage has been linked to lower costs inside and outside of healthcare, and increasing economic mobility.

The Maternal Child Health Block Grant

Another federal-state collaboration to improve maternal and infant health featured in the state budget is the ongoing Maternal Child Health Block Grant. This block grant from the federal government helps to fund a multitude of programming at the Ohio Department of Health (ODH) aimed at improving access to maternal and child health services to reduce infant mortality, preventable diseases, and handicapping conditions among children. Among the programs that receive funding from the Block Grant is the Maternal and Infant Wellness Program that aims to eliminate health disparities and birth outcomes through activities such as decreasing maternal smoking and reducing food insecurity. Because of the nature of the Block Grant, the funds are appropriated to the programs every biennium.

We are hopeful that as the COVID-19 pandemic improves, ODH will have the capacity to be able to spend all the funds allocated to our state in the block grant as we know there are several organizations that could use additional funds to enhance their already successful programming.

We are hopeful that as the COVID-19 pandemic improves, ODH will have the capacity to be able to spend all the funds allocated to our state in the block grant as we know there are several organizations that could use additional funds to enhance their already successful programming.

Help Me Grow Promotes Prenatal Care, Infant Care, and Parenting Education

In the recently passed state budget, there was an investment to provide more funds to infant and maternal health programs. One of the programs, Help Me Grow, is an evidence-based home visiting program that promotes prenatal care, baby care and parenting education for the health and development of children. Established by the passage of Senate Bill 332 in January 2017, the program goals are to:

Encourage positive parenting
Prevent child abuse and neglect
Improve maternal and child health
Promote child development and school readiness

Over 8,200 families participate in the program. Home visitors are social workers, nurses or child development specialists who meet with families about creating a strong parent-child relationship, promoting prenatal care, discussing learning activities for children and encouraging parents to be “their child’s first and most important teacher.” Another crucial role that home visitors do is to help screen and find probable health and developmental issues. Research has shown the advantages of home visiting programs such as a rise in high school graduation rates for mothers and positive birth outcomes (a reduction in low–birth weight infants and preterm births). In fact, women who participated in home visiting were less likely to have a low-birth weight baby by 48 percent. To be eligible for the program, expectant parents or caregivers must have a child under two years old and have a family income below 200 percent of the FPL. Additionally, families and caregivers must experience one or more risk factors (i.e. a previous preterm birth, a pregnancy under 21 years old, and a family history of child abuse, neglect or substance abuse) to be qualified for the program. The budget also extends the maximum age for children to partake in the program from three to five years of age. Increasing more funds for this program will help birth parents and children live healthier lives.[table id=168 /]

Infant Vitality Supported Through Local Faith-Based Providers and Universal Needs Assessment

ODH is receiving an increase in appropriated funds to improve infant vitality efforts. For FY 2022, they will obtain $17.6 million, a 177.8 percent increase from FY 2021. Out of the $17.6 million, $5 million will be used to support maternal health programming led by community and local faith-based service providers. Likewise, $500,000 of the $17.6 million will be allocated for creating a universal needs assessment which will point out and offer health and wraparound services. Both of the programs are one-year initiatives, which is why the funds will decrease to $12.1 million in FY 2023. The remainder of the line item is allocated for a multi-pronged population health approach to help combat the infant mortality crisis. The programming includes enhancing awareness (including respiratory syncytial virus), supporting data collection, selecting resources for the greatest needs, and establishing quality improvement science and programming for evidence-based practices (e.g. safe sleep, Centering Pregnancy, smoking cessation and breastfeeding).

Although much progress has been done to reduce the rates of infant and maternal mortality across Ohio, the work is not over.

Racial Disparities and Geographic Challenges Limit Maternal and Infant Health Improvements

The state budget has shown significant investments for the infant and maternal health space in Ohio. The extra funds will enhance the various programs that women and families rely on and creates opportunity for new resources. Thanks to the American Rescue Plan Act of 2021, ODM can possibly expand postpartum services providing the necessary help if health problems arise after childbirth. Although much progress has been done to reduce the rates of infant and maternal mortality across Ohio, the work is not over. The racial disparity gap in both infant and maternal mortality rates between white and Black individuals are still present. Women in rural communities face hardships accessing maternal health services due to location. Therefore, we hope that the new changes implemented from the state budget will narrow such disparities.