Bolstering State Efforts to Screen for Postpartum Depression
In late January, the U.S. Preventive Services Task Force released a recommendation that clinicians screen the general adult population, including pregnant and postpartum women, for depression.
Depression screening for pregnant and postpartum women is not a new idea. The Medicaid program, as a major payer of perinatal health care covering 48 percent of all U.S. births in 2010, has recognized its role in addressing this issue. Several states (Illinois, Minnesota, Utah, North Carolina) took on this issue over a decade ago through the Assuring Better Child Health and Development (ABCD) initiative supported by The Commonwealth Fund, testing practices and enacting policies to integrate maternal depression screening along with pediatric social-emotional screening into primary care.
The Illinois state Medicaid agency began reimbursing primary care providers for maternal depression screening of pregnant women and women with children under age 1, on December 1, 2004. At least four other state Medicaid agencies (Colorado, Minnesota, North Dakota, and Virginia) reimburse pediatric primary care providers for maternal depression screenings under the child’s Medicaid ID number, if the screening is done at an infant’s well-child or other pediatric visit. This policy recognizes that maternal depression can affect parent-child relationships and is a significant risk factor for the well-being and development of the child.
Screening for Clinical Depression and Follow-Up Plan (CDF) is now included among the 2016 Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set). Challenges in implementing screening, referring to available services, billing, and data tracking remain. At least two states, Minnesota and Ohio, have developed quality improvement projects (QIPs) to increase postpartum depression screening as part of their Adult Medicaid Quality (AMQ) Grant Program activities.
Promoting early identification and screening, making tools available to help providers implement short screening protocols in practice, and making treatment more accessible through referral and follow up systems such as the Illinois statewide Perinatal Mental Health Consultation Service can improve the health and lives of women and their families. The Task Force recommendation should bolster these efforts.