457: Medicaid Strategies for Rural Communities, Pregnancy-Related Mental Health Disorders

ROBERT JOHNSON: 

This is Public Health Review Morning Edition for Tuesday, July 11, 2023. I'm Robert Johnson. Now, today's news from the Association of State and Territorial Health Officials.

LEXA GIRAGOSIAN: 

So, access to insurance is one of the biggest indicators of being able to access health care, as financial barriers to care are hugely determinant of health outcomes with a lot of people choosing to delay medical care due to these financial barriers.

JOHNSON: 

ASTHO's Lexa Giragosian on the work to improve access to health care for pregnant people and infants in rural areas left reeling by the closure of nearly 200 hospitals since 2005.

GIRAGOSIAN: 

There's been a lot of states that have been adopting this policy of extending Medicaid coverage up to 12 months postpartum. And while the postpartum period is the most dangerous time in pregnancy with the highest rates of death, this is really promising to improve access to care and reduce a lot of these preventable deaths and morbidities that occur.

JOHNSON: 

Giragosian says value-based care systems as part of state Medicaid programs also hold promise.

GIRAGOSIAN: 

So, a lot of systems nowadays are 'fee-for-service' and value-based care really focuses on improving quality care, while lowering the prices for patients. And the way this kind of is done is through examples, you know, like incentive payments. So, they provide providers and hospitals with kind of incentivized rewards, monetary incentives, to provide this higher quality care and lessen their negative health outcomes.

JOHNSON: 

Likewise, Medicaid's initiative to cover doulas opens another option for people in rural areas.

GIRAGOSIAN: 

So, getting coverage for doulas under Medicaid will open up the opportunity for people to access doulas as they're a very valuable resource in navigating the process of accessing quality care, despite geographic barriers. And you know, more than half of states as of now have implemented this expansion, and many are pursuing a related agenda.

JOHNSON: 

ASTHO has a new brief on this topic. There's also a blog article. You can read both using the links in the show notes.

Anxiety and mood disorders before and after childbirth are becoming more common. That's according to a new report in Vermont. This is Ilisa Stalberg with the Vermont Department of Health.

ILISA STALBERG: 

Perinatal mood and anxiety disorders, which we also refer to PMADs, are among the most common complications of pregnancy and childbirth.

JOHNSON: 

Screening is key to treatment, but Stalberg says stigma and shame can make it hard to help those in need.

STALBERG: 

So, by screening universally, were picking up potential concerns earlier and ones that may go unnoticed or people may be unwilling to come forward with. We want to treat and refer because there's a whole lot of evidence to suggest that there are highly effective treatments for PMADs that range from perinatal support, support groups, therapy, medication, and others that can be tailored to the needs and wishes of individuals who are experiencing them and their families.

JOHNSON: 

Stalberg urges agencies to try new approaches in the areas of supporting individuals and families.

STALBERG: 

In Vermont, we've been able to test some of those innovations whether or not they're, you know, specific adaptations to evidence-based curriculum for indigenous populations or developing curriculum and support groups for immigrant and refugee populations, has been a major focus of ours.

JOHNSON: 

You can read Vermont's report and news release using the link in the show notes.

Also today, Vermont's Health Commissioner Dr. Mark Levine will discuss disparities impacting LGBTQ+ youth during an ASTHO webinar planned for next Monday, July 17. You can join the online event. There's a link in the show notes.

Finally this morning, the mental health of kids in schools continues to be a key concern. O'Keyla Cooper has more about a discussion planned tomorrow.

O'KEYLA COOPER: 

Don't miss your last chance to register for tomorrow's discussion on schools' vital role in providing mental health services to students, including those with serious mental illness. Gain valuable insights from the National Center for School Mental Health and discover North Carolina's efforts to improve access. Secure your spot now via the link in the show notes.

JOHNSON: 

That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information. I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.