Perinatal & Parenting Support
The Department of Human Services has established various
policy priorities under the leadership of Acting Secretary Meg Snead. One of the priorities is focused on maternal health:
To extend Medicaid post-partum benefits from 60 to 365 days by April 1, 2022, to:
American Rescue Plan Act of 2021 shares this priority by giving states a new option to extend Medicaid post-partum coverage through a State Plan Amendment.
Currently, Medicaid covers almost half of births nationally (and similarly in PA), with eligibility levels ranging from 138% to 380% of poverty across states. States must cover pregnant women with incomes up to 138% of the federal poverty level through 60 days postpartum (the end of the month of the 60th postpartum day).
Apply for Medical Assistance
States must cover pregnant women with incomes up to 138% of the federal poverty level through 60 days postpartum (the end of the month of the 60th postpartum day).
Pregnancy & Family Planning
Improving Costs and Outcomes
Integral to extending the length of service is expanding the quality and scope of care and improving the cost and outcomes of care. Each of these factors is considered in a scope of work the department plans to introduce as a public-facing policy agenda in early August.
Work in Progress
Our continuing work includes current, planned and proposed initiatives working collaboratively with other state agencies, including the departments of health and drug and alcohol programs, and stakeholder groups. We are also pleased to have the Pennsylvania Women's Commission and the General Assembly’s Women’s Health Caucus as active partners in this initiative.
This is part of a strategic plan to set achievable, measurable goals that can make a real difference in the health and well-being of those we serve as well as be sustainable for years to come.
Perinatal and parenting support has many facets that when combined present a package of public-facing initiatives to protect and support the people DHS serves with a simple, clear and complete path to a healthier present and future for themselves and their families.
National Academy for State Health Policy Maternal Child Health Policy Academy
DHS, in partnership with DOH, was awarded participation in this policy academy and our collaborative state team planning worksheet was submitted at the end of May. It includes:
Moving on Maternal Depression (MOMD)
Perinatal depression is the most common complication during pregnancy and the postpartum period.
One in seven women experience depression during or following a pregnancy, but too often it goes undiagnosed.
Pennsylvania’s Perinatal Quality Collaborative (PA PQC) was established between DHS and other state agency partners, hospitals and health systems, health care payers, and non-profits as a partnership that works across systems in pursuit of better care and quality of life for perinatal families.
The PQC is a participant in the national Moving on Maternal Depression project, an effort to enhance perinatal depression screenings and increase use of validated screening methods and to develop follow-up models to ensure that these screenings result in proper evaluation and treatment.
Sixteen birthing hospitals in Pennsylvania are participating in this effort, which involves establishing dedicated multi-disciplinary teams focused on identifying and treating perinatal depression, building a quality improvement plan to set and track progress towards goals, and engaging community partners in this work.
Also, the MOMD Coalition formed a sub-group, the Doula Advisory Group, to gain consensus on education requirements and nationally recognized doula certifications to develop a mechanism in the private sector to maintain a registry of certified doulas in PA; and to create recommendations to improve the financing of doula services in Pennsylvania.
The department is working on a proposed expanded role for doulas to provide supportive, care in various ways, including in support of mental health, reproductive plans, scheduling of pregnancy, post-partum and well-child care, among other needs as a trusted support system for the parenting family.
We believe this could go a long way with building trust of the health care system among Black families, increase levels of consistent care, improve outcomes and ultimately lead to lower maternal mortality rates.
Maternal Mortality and the Maternal Mortality Review Committee
Maternal mortality is on the rise in the U.S. as compared to other first-world countries and especially among Black women, so we plan an emphasis on perinatal health as it pertains to reducing maternal mortality rates, in particular among Black women.
Further defining and expanding DHS's role with sibling agencies on shared initiatives such as maternal mortality, doula care, and home visiting can help focus and inform the work of the Maternal Mortality Review Committee, housed at DOH. We hope to accomplish this with more cross-agency collaboration meetings, representation on working groups, and data sharing.
Home Visiting Programs
Each of Pennsylvania's MCOs offers a home visiting program benefit, but another objective of the NASHP policy academy is to encourage Physical Health-MCOs to build their home-visiting capacity by continuing to outreach to evidence-based and evidence-informed home visiting programs that they have not yet partnered with.
Home visiting capacity can be increased through increased training, which is under way; providing updated home visiting program contact information, addressing barriers to working with certain home visiting programs, and increased collaboration among sibling agencies involved in the home visiting initiative.
As well, home visiting or in-house post-partum programs (including doula care) can improve overall outcomes by providing care for physical and psychological well-being; infant care and feeding; sleep and fatigue; sexuality, contraception, birth spacing and parenting planning, including among younger audiences who may be on CHIP; chronic disease management and health maintenance.
Maternal Care Bundle (MCB)
The Maternity Care Bundle – a combination of care for mom and busy that is unique and transformative – was included in PH-MCO contracts beginning in January 2021. While it may be early to determine success of this contract addition, we will review its use as it pertains to our initiatives’ success and if we might add services to the bundle. We hope to have 25% MA births billed through the MCB by the end of 2022.
The bundle structure does not introduce new practice guidelines or concepts, but offers a standardized approach for delivering well-established, evidence-based practices to be implemented with complete consistency, for every patient, every time – resulting in improved patient outcomes.
DHS's data program area, PeopleStats, is working to provide even more data on maternal health and our MA participants, including reviewing and providing post-partum data in 30-day increments so we can develop "packages of episodes" surrounding maternal mortality and strengthen the rationale for for extension of coverage.
We also believe focus groups with MA moms can help us better understand maternal needs, address equity, and strengthen our programs. We will be expanding our collaborative efforts to see if we can work with stakeholders and talk with those with lived experience to ensure our programs use data to create “person-centered” programs.