State bolsters coverage for pregnant Medicaid patients

As the national maternal mortality rate continues to rise, the state is ramping up its Medicaid program to protect and care for its pregnant patients.

In one program that will debut next summer, pregnant individuals under HUSKY, Connecticut's Medicaid program, will be able to get covered help from doulas and breast feeding specialists, according to the state Department of Social Services.

Coverage has already opened up some for pregnant patients. In April, those who are pregnant and meet the income requirements began to qualify for prenatal care regardless of their immigration status, opening up care for an estimated 1,400 patients a year. Nearly 600 people have already enrolled, Commissioner Deidre Gifford said in a press conference earlier this month.

“As an obstetrician gynecologist, I know firsthand the critical importance of early and regular prenatal care to a healthy pregnancy outcome,” Gifford said.

Eligible HUSKY members also started to get more postpartum coverage. Originally just two months, the program extended to 12 months starting in April.

Officials are adding these services to help new mothers and try to prevent pregnancy-associated deaths. Though rare, these deaths do happen and disproportionately to Black patients or patients with Medicaid, according to data from the Connecticut Maternal Mortality Review Committee.

“This is a situation that urgently needs to be addressed,” Gifford said.

Of the roughly 35,000 births Connecticut sees a year, HUSKY Health covers about 14,000 each year, according to DSS spokesperson David Dearborn.

The Connecticut Maternal Mortality Review Committee reported 62 pregnancy-associated deaths from 2015 to 2019, or deaths which occurred during a pregnancy or within a year of the end of the pregnancy, regardless of the cause. This could mean complications during pregnancy, or an unrelated car crash.

The state Department of Public Health said data on maternity deaths in 2020 and 2021 is not ready for release yet.

Black patients and patients who had Medicaid for insurance were over- represented in these deaths. Despite only making up 13.1 percent of live births, Black patients made up 27 percent of the pregnancy-associated deaths, according to the report. Medicaid patients made up 37 percent of live births but accounted for 68 percent of the deaths.

Of those 62 deaths, 25, or about 40 percent, were directly related to pregnancy, or “causally related to pregnancy or its management,” the committee said in a report. This means the deaths were caused either from complications, postpartum depression ending in a suicide, or unrelated conditions aggravated by pregnancy such as cancer or other related conditions.

Some 33 of those were not pregnancy related, but occurred either during pregnancy or within a year after the end of the pregnancy, Four cases were undetermined.

The committee determined that 45 of the 62 deaths were preventable — 22 of which were related to the pregnancy.

Nationally, the Centers for Disease Control and Prevention reported more than 2,200 maternal deaths from 2018 to 2020. And Black, American Indian and Alaska Native people are two to three times more likely to die from a pregnancy-related causes than white people.

The maternal mortality rate has also gone up nationally in recent years; from 17.4 maternal deaths per 100,000 births to 23.8 per 100,000 in 2020. It rose from 658 in 2018, to 754 in 2019 to 861 in 2020.

By the summer of 2023, the Department of Social Services is introducing a maternity bundle which will integrate doulas and breastfeeding support. With the bundle, Gifford hopes to address “disparities and birth outcomes, particularly focusing on women of color and those with substance use disorders.”

Cynthia Hayes, a practicing doula and breastfeeding consultant, said doulas are birthing professionals. Though not medical professionals, “we are there simply to support the birthing parent before birth, during birth and also postpartum,” she said during a press conference.

Doulas will be able to help lower the C-section rate, and help new mothers breastfeed and support families in whatever way they need, Hayes added.

The maternity bundle will be similar to what state employees receive, but with doulas, Dearborn said.

The Department of Public Health is also working toward getting doulas certified as independent providers in the state. However, DSS does not need the certification to use doulas in the bundle, Dearborn said.