Maternal Health Outcomes

MCIP funding and design raised concerns: MCIP contributed $383.2 million (Feb 2020–Mar 2024) but focused on policies and protocols that were often already in place; several milestones duplicated existing LDH initiatives (e.g., breastfeeding policy milestones; risk-stratification tool); some milestones incentivized improvements already addressed by LaPQC or other LDH programs.

Pregnant women in Louisiana experienced an increase in not receiving prenatal care as recommended, with pregnant Medicaid beneficiaries representing a disproportionate share of this population.

Natality data show the percentage of all pregnant women not receiving prenatal care in the first trimester increased from 22.5% in 2018 to 25.9% in 2023; among pregnant Medicaid beneficiaries, 76.4% did not have timely access to prenatal care, higher than the national rate of 57.8% for pregnant Medicaid beneficiaries (2018-2023).

Medicaid complaint data indicate issues with pregnant beneficiaries not being able to access obstetric care; provider networks show gaps, with 163 of 893 OBGYN Medicaid providers having no claims (Jul 2023-Dec 2023) and 24 of 64 parishes had no OBGYNs providing services (Dec 2023).

LDH case management data show limited outreach and service delivery: only 8,680 of 32,836 births in 2023 identified for case management (26.4%), and only 1,706 of them had a plan of care; 1,174 had postpartum visits; 6,795 were not assessed (with 92.6% of non-assessment reasons blank).

Rural access and provider reimbursement concerns suggest provider networks are not robust; increased reimbursement rates and CNM access could improve care.

Statewide maternal health quality initiatives include LaPQC SBI and MCIP; MCIP initiatives not always outcome-oriented and duplicative of LDH initiatives.

LDH began an initiative in March 2024 to improve network accuracy of provider directories by requiring MCOs to identify low-activity providers; network adequacy reports showed discrepancies between reported networks and actual services.

Recommendations highlight a focus on data improvements (population-specific complaint tracking), expanding services and reimbursement (group prenatal care, remote monitoring, postpartum home visiting, higher birth-related reimbursements), CNM directory updates, high-risk population definitions in MCO contracts, ongoing case management monitoring, and improved MCIP oversight.

MCOs identified and enrolled a small percentage of pregnant/postpartum beneficiaries for case management (8,680 of 32,836; 5.2%), with many not receiving timely assessments (only 1,814 of 8,680 within 90 days; 6,795 not assessed; many blank reasons).

LDH should improve its oversight and approval process for MCIP Approved Incentive Arrangements to ensure that they are implementing new reforms that are linked to measurable improvements in patient outcomes.

LDH should add a field to beneficiary complaints that allows for analysis of population-specific concerns for beneficiaries, such as maternal health related concerns.

LDH should consider offering additional services and/or enhanced reimbursement to address issues with maternal health outcomes, such as providing reimbursement for group prenatal care, remote monitoring during pregnancy, postpartum home visiting services, and increasing provider reimbursement for birth related services.

LDH should consider updating the Medicaid provider directory to include CNMs as a provider specialty to potentially increase CNM beneficiary access.

LDH should specify high-risk populations who potentially require case management services in MCO contracts, such as pregnant Medicaid beneficiaries.

LDH should continue to monitor case management outreach to pregnant beneficiaries to ensure MCO compliance.

LDH should improve its oversight of care provided by the MCOs by analyzing Medicaid data over time to ensure MCOs identify and provide outreach to pregnant and postpartum beneficiaries who may benefit from case management services.