How to get more low-income moms screened for depression? CMS says, ‘Bill me!’

By Ryan White

In recent years there’s been a surge in awareness of how common and debilitating maternal depression can be. As the research accumulates and media coverage keeps apace, the idea that depression and related disorders can wreak serious havoc on a mother and affect her baby’s development has given fresh urgency to efforts to get moms more help.

Among policymakers, growing recognition of the problem has translated into new programs, with a number of states encouraging screenings and treatment. (New Jersey has required it since 2006.) The Affordable Care Act provided a tailwind as well by requiring insurance coverage and seeding new programs and research. Then, in January, the U.S. Preventative Services Task Force issued new recommendations that called for women to be screened for depression while pregnant and after giving birth. The updated guidelines rested on an extensive review of the research.

And yet many of the mothers who might benefit most from screenings — low-income women, in particular — don’t receive them. “Depression is a particularly serious problem for low-income mothers, since it can create two generations of suffering, for the mother and her children,” the Urban Institute has noted. Depressed mothers can’t stimulate and nurture their child the way they otherwise could, and that can hinder babies’ rapidly developing brains.

But a recent bulletin issued by the Centers for Medicare and Medicaid Services (CMS) earlier this month attempts to improve the situation by making sure states realize that depression screenings for mom can be billed to the child’s Medicaid coverage — whether or not a given state expanded its Medicaid program in the wake of Obamacare.

So why does this move matter?

In states that haven’t expanded Medicaid eligibility levels, many mothers are no longer able to receive benefits after their babies are born. In such cases, even if a mother were to be diagnosed with postpartum depression, she wouldn’t be able to receive mental health treatment under Medicaid, which covers only the child. But CMS is now saying to these states: You may bill Medicaid for mom’s depression screenings, as well as treatment or therapies for her as long as they involve both mother and child — even if mom isn’t otherwise eligible for Medicaid.

This isn’t a totally new practice. Medicaid programs in five states already pay for maternal depression screenings through the child’s coverage, according to Georgetown’s Center for Children and Families.

As Stephanie Schmit and Christina Walker at the Center for Law and Social Policy note in a blog post, states that embrace Medicaid’s explicit willingness to pay for screenings stand to reach many more moms:

The ability to reimburse the screening … may be especially important in states that have not expanded Medicaid because mothers without insurance may not encounter a medical professional other than their child’s pediatrician. In these states, the screening will likely identify many mothers who need treatment for their depression yet are not eligible for Medicaid as a resource to support that treatment.

It’s a crucial group when it comes to combatting maternal depression. Mothers with fewer means are not only less likely to receive a diagnosis and treatment; they’re more likely to suffer depression in the first place. A 2012 report found that 11 percent of infants in families below the federal poverty line have a mother who is suffering from severe depression — that’s compared with 7 percent of infants more broadly.

For reporters who cover the children’s health beat, it’s worth taking a closer look at how your state is responding to the new guidance. In particular, have providers in states that haven’t expanded Medicaid received the go-ahead from their state’s Medicaid program to bill a child’s coverage for a mom’s depression screening and treatment? If not, how and why was the decision made?

With a mounting body of research showing that maternal depression can have serious long-term effects on children’s health, the issue is ripe for sustained reporting.

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