Tuesday, December 5th, 2023

Establishment of presumptive eligibility for pregnant women (PEPW) in Mississippi

Written by Prachi Prajapati

Executive summary

The recent expansion of postpartum care coverage in Mississippi is the first step towards improvement of maternal and infant health outcomes. The focus should now move to provision of appropriate and necessary prenatal care for pregnant women. As hospitals and clinics in rural areas are collapsing[i], pregnant women delay seeking prenatal care which pose challenges for both the mother and the fetus during pregnancy. Our recommendation to improve access and utilization of affordable prenatal care is to establish presumptive eligibility for pregnant women (PEPW) in Mississippi. PEPW allows providers to assume that pregnant women are on Medicaid, in turn encouraging receipt of care without any delays. It takes about a month for Mississippi Medicaid to approve applications for pregnancy-related coverage[ii], forcing uninsured women to pay out-of-pocket during their first trimester of pregnancy. Since Mississippi Medicaid is responsible for funding more than two-third births[iii], presumptive eligibility is needed to encourage women to seek prenatal care as early as possible during their pregnancy to safeguard Mississippi’s women and infants from pregnancy-related morbidities.

Background

According to the Mississippi maternal mortality report published in January 2023, the mortality rate ratio in the State was 36 maternal deaths per 100,000 live births. Moreover, about 58% of these deaths occurred during pregnancy or sixty days after delivery.[iv] Mississippi is also one of the states in the country with the poorest infant outcomes with an infant mortality ratio of 8.5 per 1000 live births in 2020, well above the national rate of 5.5 infant deaths per 1000 live births.[v] Mississippi is also leading in the nation with respect to premature deliveries owing to the high prevalence of chronic conditions like high blood pressure and obesity among pregnant women. The presence of such conditions can cause problems during pregnancy for the mother and the baby, requiring appropriate management and engagement with the healthcare system.

To avoid such adverse maternal and infant health outcomes, postpartum and prenatal care are of utmost importance. According to the Agency for Healthcare Research and Quality, postpartum care is essential for families to recover from birth, move to parenthood, promote healthy behaviors, and prevent short-term and long-term health risks due to pregnancy-associated chronic physical and mental health conditions.[vi] However, prenatal care is equally important as postpartum care. Women who do not receive prenatal care are three times more likely to give birth to low birth weight infants and their infants are five times more likely to die than women who receive prenatal care.[vii] Engaging in early prenatal care is beneficial for the women and her baby as it increases access to and interaction with the healthcare system. Such opportunities allow healthcare professional to screen and treat preventable conditions and manage chronic conditions that could potentially harm the woman and the unborn baby during pregnancy.

Due to the rural and low-income population in Mississippi, a significant portion of the state is uninsured. Out of those who are insured, a large proportion of people depend on Medicaid. Around two-thirds of births in the state are funded by Medicaid. Thus, Medicaid and its policies play a crucial role in improving access to and promotion of postpartum and prenatal care for pregnant women. The expansion of postpartum coverage came after the state department of health made a strong recommendation in their recent report. However, as demonstrated previously, early receipt of prenatal care protects the mother and the infant from both immediate and far health risks differently from postpartum care. Thus, the next challenge for the policymakers and state leaders is focusing on policies to improve prenatal care coverage.

Key findings

Presumptive eligibility for pregnant women (PEPW) is a provision offered by states by which an uninsured or low-income pregnant woman can be presumed to be Medicaid, can avail prenatal care outside hospitals and be reimbursed by Medicaid. This provision bridges the gap between processing of pregnancy-related Medicaid coverage delays and prenatal care. According to a study by the University of Mississippi Center for Population Studies, low-income women who live in a state with expanded Medicaid and PEPW are less likely to have preterm deliveries. Mississippi is one of the three states in the nation that has neither expanded Medicaid nor allowed PEPW.[viii] It takes close to a month for Mississippi Medicaid to process applications for pregnancy-related coverage leaving this vulnerable population to either pay out-of-pocket during early months of pregnancy or delay getting care till they get coverage. Mississippi allows hospital PEPW. However, with a third of the Mississippi’s rural hospitals on the verge of closure and diminishing medical workforce, there is a need to expand PEPW beyond hospitals. Adoption of PEPW will ensure uninsured and low-income pregnant women have access to prenatal care at any doctor’s office and that providers will be paid for their services immediately by Medicaid.

Recommendation

Adoption of PEPW women in Mississippi to encourage early receipt of prenatal care leading to improvement of maternal and infant health outcomes.

Conclusion

Mississippi ranks one of the lowest in terms of health outcomes in the country. As national efforts are directed towards improving overall maternal and health outcomes, states should contribute to these efforts in every way possible. Allowance of PEPW has proved to be helpful for other states to encourage receipt of prenatal care. Because of the large proportion of uninsured and low-income vulnerable population, Mississippi State leaders should implement PEPW for avoidance of adverse outcomes due to delays in prenatal care among pregnant women.

Endnotes

[i] Rural Hospitals at Risk of Closing. Center for Healthcare Quality and Payment Reform. Accessed October 8, 2023, https://ruralhospitals.chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf.

[ii] Devna Bose, “Mississippi Mothers Are Now Guaranteed Coverage for a Year after Giving Birth. But They May Not Get the Prenatal Care They Need” Mississippi Today. May 3, 2023. Accessed October 8, 2023, at http://mississippitoday.org/2023/05/03/mississippi-mothers-are-now-guaranteed-coverage-for-a-year-after-giving-birth-but-they-may-not-get-the-prenatal-care-they-need/.

[iii] “Medicaid Eligibility and Enrollment in Mississippi”. Healthinsurance.org. March 9, 2023. Accessed October 8, 2023, at https://www.healthinsurance.org/medicaid/mississippi/.

[iv] Mississippi Maternal Mortality report 2017-2019. Mississippi State Department of Health. January 2023. Accessed October 8, 2023, at https://msdh.ms.gov/page/resources/19612.pdf.

[v] 2019 & 2020 Infant Mortality Report. Mississippi State Department of Health. Accessed October 8, 2023, at https://www.supremecourt.gov/opinions/URLs_Cited/OT2021/19-1392/19-1392-19.pdf.

[vi] Postpartum Care for Women Up to One Year After Pregnancy. Agency for Healthcare Research and Quality. Accessed October 8, 2023, at https://effectivehealthcare.ahrq.gov/products/postpartum-care-one-year/protocol.

[vii] Prenatal Care. Office on Women’s Health. Accessed October 8, 2023, at https://www.womenshealth.gov/a-z-topics/prenatal-care.

[viii]  Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020. Kaiser Family Foundation. Accessed October 8, 2023, at https://files.kff.org/attachment/Table-12-Medicaid-and-CHIP-Eligibility-as-of-Jan-2020.pdf.