Advancing Equity in Maternal Mental Health: Strategies for State Medicaid Programs

CLASP reports that over the past few years, stark data and merciless community-based advocacy about U.S. maternal mortality and morbidity rates have led to various local, state and national efforts. These initiatives, laws, programs, and practices include legislation to ensure perinatal providers receive implicit bias training, a focus on perinatal and maternal health quality initiatives, and care bundles. Outcome measures must reflect the reality that other social and societal determinants affect women’s lives and outcomes, such as employment status, housing instability, and access to transportation. System leaders must identify such factors and ways to address them through policy and payment reform. Furthermore, providers have little financial incentive to extensively engage with people enrolled in Medicaid who may face the deepest health disparities, given the program’s historically low payment. But none of these initiatives, laws, and programs, to date, have managed to deliver equitable outcomes across race and ethnicity. For the purpose of this paper, “providers” includes a broad range of people working with birthing persons, including OB/GYNs, doulas, midwives, case managers, community health workers, and others who provide care for the mother during the prenatal period. This paper aims to offer guidance to state Medicaid offices on the steps needed to advance equity in maternal health, particularly as it relates to people of color. We outline a framework that employs three specific areas of action. In addition to recommending key agency strategies, we offer effective state and federal models that leaders can look to when taking each approach. #racialequity

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