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

By Dr. Kimá Taylor, Mental Health Advisory Board, and Isha Weerasinghe, Senior Policy Analyst, Center for Law and Social Policy (CLASP) 

The United States is facing tumultuous times amid the coronavirus pandemic, its related economic impact, and racial justice protests. The country is finally reckoning with internal and external anger toward systems that promote and allow racial inequities to persist, even foment. Some of these systems help to perpetuate those racial inequities in maternal and child health, one of many sectors within our health care system rife with deeply rooted issues. The United States’ maternal mortality rate has steadily increased over the past few decades; hidden in the U.S. Centers for Disease Control and Prevention’s (CDC) aggregate data are enormous racial disparities, especially among Black and Native American women. One example is when Serena Williams, the famous tennis player, had post-birth complications that illustrated the profound biases that lead to poorer outcomes for Black women. 

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.