In Pennsylvania, Medicaid covers 3 in 10 births; far more than the national average. The Medicaid program is critical to addressing maternal and child health, especially among vulnerable populations that traditionally lack access to quality prenatal and postpartum care. In recognition of this, Pennsylvania recently announced several new initiatives aimed at protecting and expanding prenatal and postpartum services for mothers and children: Beginning February 2024, Pennsylvania’s Medicaid program will offer coverage of Doula services; in July 2023, Governor Shapiro signed a bill into law focused on collecting data around maternal mortality; and just last week, the Pennsylvania House and Senate each unanimously passed a bill that, if signed by the Governor, will allow babies on Medicaid to access donated breast milk in the NICU. These initiatives will no doubt have a positive impact on birthing people and babies receiving Medicaid in Pennsylvania.
Earlier this year, the Department of Human Services (DHS) announced that doula coverage will be a required component of maternity bundles in value-based purchasing (VBP) arrangements beginning in 2024. VBP is a managed care delivery strategy aimed at improving the quality and value of healthcare services a person receives. This comes following a report earlier this year by the managed care plans’ Community Based Care Management initiative identifying doula programs as critical to improving racial disparities in maternal mortality.
In order to deliver care to Medicaid patients, a doula provider must be state-certified and enrolled in Pennsylvania’s Medicaid program. As of now, fewer than 40 doulas are enrolled statewide. However, the state is working with the Pennsylvania Doula Commission to identify barriers to provider enrollment and assist doulas in becoming Medicaid-enrolled.
Doulas are advocates that help expectant parents with informational, emotional, and physical support. This includes assisting with labor preparation, decision-making during labor, working with other providers, and connecting the parent(s) with any other service that may be needed related to the birthing process. With this expansion of doula coverage, Medicaid recipients will now have access to a critical service that has been shown to reduce maternal mortality rates, especially in black and brown individuals.
Last year, Pennsylvania expanded postpartum Medicaid coverage to twelve months, a move similarly aimed at addressing national trends in maternal mortality. In July 2023, Governor Shapiro signed a bill into law that builds on the Maternal Morality Review Act of 2018 by requiring more and better data collection around maternal health and mortality. Under the new law, the Pennsylvania Department of Health must collect and report data on maternal morbidity, which is any short or long-term health problem that results from being pregnant or giving birth, as well as data on demographics and underlying conditions. Previously, the state was only required to report maternal mortality. This new law is one more piece in the puzzle of preventing unnecessary deaths in birthing people and promoting healthy pregnancies and babies.
In addition to expanding prenatal Medicaid Services to include doula services and collecting more data on maternal health and morbidity, the Pennsylvania House and Senate both unanimously passed a bill that, if signed by Governor Shapiro, would require the Medicaid program to cover donated breast for infants in the NICU. Often, these babies are prescribed donated human breast milk to help with their treatment, but without insurance it can cost families around $100 a day to feed their baby. This is not only a financial burden but can lead some families to choose formula instead of the prescribed breast milk, even if the baby’s body may not be ready for it.
PHLP applauds the state for taking these important steps towards improving maternal and child health and will continue to monitor the implementation of these initiatives as well as keep readers updated about future developments in these areas.