[E Medicaid Outreach and Enrollment
for Pregnant Women: 
What is the State of the Art? 

Prepared by: 
Ian Hill and Briget...
Outline of Presentation

* Background on our study
* Refocusing on early access to prenatal care

* History of Medicaid ou...
Project Background

° Goal:  To determine the current “state of the art” of

Medicaid outreach and enrollment for pregnant...
Why Renew our Focus on
Prenatal Care? 

Divergent Trends: 

* Infant mortality continues to drop

* Early entry into prena...
History:  Medicaid Expansions for
Pregnant Women

° OBRA-86, -87, and -89 dramatically expanded
financial access to Medicai...
By the early 1990s.  .. 

* Almost half the states set upper income thresholds
at 185% FPL or above

* Almost every state ...
March of Dimes Highlights: 
State Enrollment Strategies

 

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Selected for Follow-Up
Examples of Innovative Practices

* Online application submission in 14 states

* Premium assistance in NM

* Community he...
Next Steps: 

* Select four states for case studies

* Conduct multi-day site visits to obtain
detailed information on “be...
Conclusions

Preliminary results suggest: 

* States continue to place high priority on pregnant
women

* Tremendous varia...
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Medicaid Outreach and Enrollment for Pregnant Women: What is the State of the Art?

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Ian Hill

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Medicaid Outreach and Enrollment for Pregnant Women: What is the State of the Art?

  1. 1. [E Medicaid Outreach and Enrollment for Pregnant Women: What is the State of the Art? Prepared by: Ian Hill and Brigette Courtot The Urban Institute and Shelly Gehshan, Andrew Snyder, Dan Belnap and Mary Takach National Academy for State Health Policy for The March of Dimes Presented to: NASHP Annual Meeting, Denver, CO 15 October 2007
  2. 2. Outline of Presentation * Background on our study * Refocusing on early access to prenatal care * History of Medicaid outreach and enrollment for pregnant women * Preliminary findings * Next Steps [B THE URB. -N INSTITUTE
  3. 3. Project Background ° Goal: To determine the current “state of the art” of Medicaid outreach and enrollment for pregnant women; provide March of Dimes chapters with insights into “best practices” to advocate for ° Team: Urban Institute and NASHP ' Scope of work: - Literature review - 50-state email survey - Site visits/ case studies of four states I THE URBAN INSTITUTE
  4. 4. Why Renew our Focus on Prenatal Care? Divergent Trends: * Infant mortality continues to drop * Early entry into prenatal care has improved However: * Rate of pre-term births has increased * Rate of LBW and VLBW has increased ' Serious racial disparities persist Timely Prenatal Care Remains a Wise Investment [B THE URBAN INSTITUTE
  5. 5. History: Medicaid Expansions for Pregnant Women ° OBRA-86, -87, and -89 dramatically expanded financial access to Medicaid perinatal coverage ° Tools in law triggered unprecedented efforts to simplify enrollment procedures ° Eligibility simplification was coupled with multi-faceted outreach efforts ° Enhanced prenatal benefits improved content of care I THE URBAN INSTITUTE
  6. 6. By the early 1990s. .. * Almost half the states set upper income thresholds at 185% FPL or above * Almost every state dropped assets from eligibility determination and provided “continuous eligibility” through 60 days postpartum ' Roughly half the states had large-scale outreach campaigns, presumptive eligibility, and shortened forms “ Vast majority of states provided “enhanced prenatal care” for pregnant women [B THE URBAN INSTITUTE
  7. 7. March of Dimes Highlights: State Enrollment Strategies magnum 50 .3532 a___%__m _§_u&xm . £__£m__m o>uaE: mo. m >= _3_m__m maosczcoo «mu. .. 3$m< 02 .2_m__. _ 3 . .. m8 E a_%__m ‘State total is higher than in 1991. [B THE L'RBA' lI'STlTU']‘E
  8. 8. :o_mw_En: m coauo= aa< 2.__. .o a___£__. ;< _. .o_.8._&< 0:= :O _m E. .ou_ : o=ao. _._n< II usocofi Nlilul 0 0 0 0 3 2 1 m. .3_. _o>> >. ___a_m. _m uocozssso . _o_. _3__&< : _.__2z oEoo: _ ho : o_. Eu. oco saw March of Dimes Highlights: State Enrollment Strategies (cont. ) 0 0 5 4 moamam v0 5&3 E32 ‘State total is higher than in 1991. i THE URBAN INSTITUTE
  9. 9. March of Dimes Highlights State Outreach Strategies Hl| |l| 0 5 o. .._= o: mouuamcaa o_. .=_= : m_n_. .2a.2 Eta mEEmo. _m o>= :oo: _ gouozao .5393 __ou2.: o venom N . >._: :EEoo 2.m_a. .E3 «Go: 9___. .:: _ _. _3_uos_ I .8.8_u3 0 4 0 0 0 0 3 2 AI magnum «O . _On= =._ 2 i THE URBAN INSTITUTE
  10. 10. «c¢E«a2._. wm: n< oocwamnam 9.= .2> GEO. .. cozunnoo m: .._oEm . _o=8=um 5.52.. u: __on: :oU _u_oo. o.. o.. _o>. o.m u: _.oa: :oU . .o_. _== z u: __oa: :oo coznoocoofin. . :oEnmonu< . .nE .332; March of Dimes Highlights State Enhanced Prenatal Benefits 2 3 0 3 2 3 8 2 0 3 7 2 5 3 2 3 0 4 Eofioaocaz oaao ueawmih IIIIII 0 0 0 0 0 5 3 2 1 moawum uo . _onE: z i THE URBAN INSTITUTE
  11. 11. States lTe»2efvi,1i, g Tel. epii»31i-«e F0 ll-ow-U11 Selected for Follow-Up
  12. 12. Examples of Innovative Practices * Online application submission in 14 states * Premium assistance in NM * Community health Workers/ Home visitors in NY * Coordination between Family Planning Waivers and Medicaid Pregnancy Coverage [B THE URBAN INSTITUTE
  13. 13. Next Steps: * Select four states for case studies * Conduct multi-day site visits to obtain detailed information on “best practices” * Report on 50-state results and 4 case studies, Spring 2008 [B THE URBAN INSTITUTE
  14. 14. Conclusions Preliminary results suggest: * States continue to place high priority on pregnant women * Tremendous variation across states * Enrollment simplification has advanced since early- 1990s * Outreach appears to have been scaled back * Enhanced prenatal care benefits have also been scaled back * Considerable room for improvement remains Ea THE URBAN INSTITUTE

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