Proposed Federal Policies Address Nation’s Maternal Health Crisis

A new proposed regulation from the Centers for Medicare & Medicaid Services released on July 10, 2024 aims to reduce the nation’s high maternal mortality rate and increase access to services in Tribal, rural, and other under-resourced communities. The proposed rule addresses health and safety requirements for hospitals providing obstetric care, continuous Medicaid eligibility for children, and flexibilities to deliver Medicaid services outside of clinics.

New Quality Standards for Maternal Care

The notice of proposed rulemaking (NPRM) calls for creation of baseline health and safety requirements for hospitals and critical access hospitals for obstetric services, including new standards for maternal quality care. For too long, the United States has seen maternal mortality rates higher than those in any other developed nation, especially for Black women, Native American/American Indian women, and women living in rural communities. For example, in Missouri, pregnancy-related mortality is highest among Black women and Black women experience pregnancy-related death at a rate three times higher than white women. Aurrera Health Group is currently partnering with Cardea to support the Kansas City, Missouri Health Department to develop a scorecard intended to improve health care delivery and outcomes for Black women and babies. The CMS proposed quality standards could help improve the quality and timeliness of pre-and post-natal care pregnant women receive and advance health equity.

12-Month Continuous Eligibility for Children in Medicaid and CHIP

The proposed rule would also codify the requirement for states to establish 12 months of continuous eligibility for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), even if a family experiences a change in income during the year. According to the Assistant Secretary for Planning and Evaluation (ASPE), this is particularly important for communities of color and those with less education, who typically experience greater income volatility. Continuous eligibility is a critical policy that has been shown to reduce gaps in coverage and uninsurance rates for children, allowing them to have consistent access to important health care services. ASPE estimates that over one million children will become eligible for at least one additional month of Medicaid or CHIP over the course of a year under a federal 12-month continuous eligibility policy.

New Exceptions for Medicaid Services Provided Outside of Clinics

Additionally, the proposed rule would build upon flexibilities implemented during the COVID-19 pandemic by requiring states to create exceptions to what is known as the “four walls requirement.” Current federal regulation allows for Medicaid payment for clinic services furnished outside of the four walls of the clinic only to individuals who are unhoused (at 42 CFR § 440.90(b)). The NPRM would also create mandatory exceptions to this policy for Medicaid payments for services provided outside of Indian Health Service and Tribal clinics, and optional exceptions for services provided outside behavioral health clinics and clinics located in rural areas. This flexibility would allow states to better meet the needs of under-resourced communities through innovative service delivery.Public comments on the rule are due September 9, 2024. The Aurrera Health team will continue to monitor progress on these important issues, and we look forward to helping states and other stakeholders understand and implement any finalized regulations to ensure Medicaid and CHIP beneficiaries receive high quality services. 

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Authors

Liz Stein [Senior Policy Consultant]