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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

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

    • Medicaid Outreach and Enrollment THE URBAN INSTITUTE 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
    • 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 THE URBAN INSTITUTE
    • 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 THE URBAN INSTITUTE
    • 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 THE URBAN INSTITUTE
    • 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 THE URBAN INSTITUTE
    • 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 THE URBAN INSTITUTE
    • March of Dimes Highlights: State Enrollment Strategies 51* 50 44 36* Number of States 40 30* 30 20 14 10 0 No Assets Continuous Eligibity at Presumptive Eligibility Expedited Eligibility 185% or Eligibility Higher Test *State total is higher than in 1991. THE URBAN INSTITUTE
    • Number of States 0 10 20 30 40 50 Shortened Application 25 Form THE URBAN INSTITUTE Self- Declaration 8* of Income Mail-in *State total is higher than in 1991. Application 22* Outstationed Eligibility Workers 35* Online Application Availability 19* Online March of Dimes Highlights: Application Submission 14* State Enrollment Strategies (cont.)
    • Number of States 0 10 20 30 40 50 Dedicated Medicaid 13 Funding THE URBAN INSTITUTE Media Campaigns 10 Community- Based 22 Outreach Targeted Outreach 18 Incentive Programs 19 Print Materials 26 Multiple State Outreach Strategies Languages 30 March of Dimes Highlights: Hotline 36
    • Number of States 0 10 20 30 40 50 Targeted Case 32 Management Prenatal Risk THE URBAN INSTITUTE Assessment 35 Preconception Counseling 19 Nutrition Counseling 27 Psycho-social Counseling 30 Health Education 28 Smoking Cessation 32 Home Visiting March of Dimes Highlights: 30 Substance State Enhanced Prenatal Benefits Abuse 32 Treatment
    • States Receiving Telephone Follow-Up Selected for Follow-Up THE URBAN INSTITUTE
    • 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 THE URBAN INSTITUTE
    • 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 THE URBAN INSTITUTE
    • 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 THE URBAN INSTITUTE