Medicaid Funding Opportunities in Support of Perinatal Regionalization Systems
Preterm birth, which accounts for approximately 11.5 percent of all births and 50 percent of pregnancy-related costs, is the largest cause of infant morbidity and mortality. This creates a significant burden on the U.S. healthcare system. A leading strategy for decreasing infant morbidity and mortality related to preterm birth is for states to use perinatal regionalization, a designation system where infants are born in or transferred to specific facilities based on the amount of care needed.
Regionalization of perinatal care is characterized by a tiered system of risk-appropriate care delivery whereby hospitals choose or are given specific designations based on the level of care they can provide. The system’s purpose is to ensure that high-risk mothers and infants are cared for at appropriate level facilities. For example, evidence suggests that an infant born at less than 32 weeks gestation or weighs less than 1500g should be cared for at a Level III facility with a neonatal intensive care unit. Perinatal regionalization has been shown to improve maternal and neonatal outcomes, and to be cost effective.
Today, nearly 40 states have a system of risk appropriate perinatal care. As the payer for nearly half of all births nationwide, Medicaid is a key partner in the financing of perinatal regionalization.
Medicaid covers specific services that can maximize access to risk-appropriate care for mothers and infants, including the coverage of pre- and post-natal care, delivery, and other services such as transportation. Medicaid coverage of neonatal transportation is a critical component of timely provision of care and overall patient health, specifically for high-risk mothers and infants, and a core element of a comprehensive perinatal regionalization system.
A new joint issue brief by the National Academy for State Health Policy (NASHP) and NICHQ explores Medicaid’s role as an important partner in developing perinatal regionalization policies and strategies given its significant investments in a disproportionate share of high-risk births and flexibility in the range and scope of services covered.
For more information, download and read the new issue brief.
State Medicaid agencies have developed various approaches to support risk appropriate perinatal care.
For example, California has identified transportation as a critical element to its perinatal regionalization system and, more broadly, the health of high-risk mothers and infants. The provision of transportation can be challenging due to both the structure of their perinatal regionalization system and the different modalities used for providing transportation under the Medi-Cal Benefit (e.g. Local County Agreements and/or Fee-for-service and Medicaid managed care systems). In regards to transportation services, Medi-Cal currently serves as the payer of last resort. However, when Medi-Cal eligible individuals need coverage for transportation services, Medi-Cal will cover the cost from either fee-for-service or managed care delivery systems. Transportation to a hospital as well as transfer between hospitals is also a common benefit in health plans available under the California Medi-Cal Access Program. Medi-Cal’s Comprehensive Perinatal Services Program also partners with the California Perinatal Transport Systems and Regional Perinatal Programs of California to promote and cover services integral to perinatal regionalization. These two programs are supported by the state Title V Maternal and Child Health Services Block grant.
The Georgia Medicaid Program plays a key role in funding the Georgia Regional Perinatal Care Network (GRPCN) along with state general revenue funds appropriated to the Georgia Department of Public Health (DPH). GRPCN is managed under the DPH. GRPCN is made of up six regional care centers for the treatment of high-risk mothers and infants. These six centers are designated based on regional need and available funding. The GRPCN’s funding comes from Medicaid, state funds appropriated to the DPH and state matched funds. Available funding is intended to support costs associated with cost of care, and regional center administrative costs for outreach, education and transportation services. Georgia also uses the state Title V Maternal and Child Health Services Block grant to support a range of programs and initiatives focused on preventing infant mortality, including perinatal regionalization.
 Anne Rossier Markus, Elie Andres, Kristina D. West, Nicole Garro, and Cynthia Pellegrini, “Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform,” Journal of Women’s Health Issues 23, no.5 (2013): e273, doi:10.1016/j.whi.2013.06.006