How States Promote Recovery for Pregnant and Parenting Women with Substance Use Disorder

Substance use disorder (SUD), including opioid use disorder (OUD), is prevalent among pregnant and parenting women, and these women have unique and often un-met treatment needs. Despite significant efforts, states report that access to treatment continues to lag for this population. In 2014, half of pregnant women with OUD who were enrolled in publicly-funded treatment programs received medication-assisted treatment (MAT) – considered the standard of care for people with OUD. New mothers are also at increased risk of relapse and overdose during the postpartum period.

The number of women with opioid use disorder during pregnancy has increased dramatically, affecting 6.5 of every 1,000 women at delivery in 2014.

Recognizing the needs of this population, Congress recently passed the SUPPORT for Patients and Communities Act, which orders a Government Accountability Office study into the coverage gaps that persist for pregnant and postpartum women with SUD who were eligible for Medicaid during pregnancy. And last week, the federal Center for Medicare & Medicaid Innovation announced the Maternal Opioid Misuse Model, which will offer cooperative agreements to up to 12 states to transform their delivery systems for pregnant and postpartum women with OUD and reduce fragmentation in delivery of care.

As SUD impacts mothers, it also affects their children. Between 2000 and 2012, rates of neonatal abstinence syndrome (NAS), caused by opioid exposure during pregnancy, rose five-fold, accounting for $462 million in Medicaid hospital costs in 2014. Exposure to other substances, such as alcohol, can also affect child development and parental substance use is linked to increased risk of child welfare involvement and childhood trauma.

A new National Academy for State Health Policy (NASHP) report, State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder, supported by the Health Resources and Services Administration Office of Women’s Health, identifies promising strategies from Colorado, Pennsylvania, and Texas to support pregnant and parenting women with SUD. These states:

  • Support access and coverage through early identification of substance misuse by expanding postpartum coverage for SUD treatment, and by facilitating transitions between care settings. In Texas, a state that has not expanded Medicaid, women may become ineligible for Medicaid coverage 60 days after giving birth. As a result, they face challenges continuing SUD treatment beyond 60 days postpartum. To address this issue, Texas expanded state-funded SUD treatment slots for postpartum women. Under this initiative, when a woman’s Medicaid coverage ends after giving birth, she can seamlessly transition to a treatment slot funded by state general revenue without being on a waiting list, and experience no change or disruption in her providers or services.
  • Implement innovative care delivery models that consider the unique needs of women and families, such as integrating reproductive health care and SUD treatment, family-centered care models, and supports for social determinants of health. For example, Pennsylvania offers a Centers of Excellence (COE) program, funded by Medicaid and state general revenue, which provides coordinated and team-based care to individuals with OUD. Six COEs focus on meeting the unique needs of pregnant and postpartum women. These COEs coordinate services including SUD treatment, obstetric and postpartum care, and services that address social determinants of health, such as housing and transportation.
  • Promote cross-system financing and collaboration to develop alignment across policies and programs and to leverage multiple federal and state funding streams. For example, Colorado’s Special Connections program offers comprehensive and coordinated SUD treatment services for Medicaid enrollees who are pregnant and the services continue up to 12 months postpartum. The program is administered through a partnership between the state’s Department of Health Care Policy and Financing and Office of Behavioral Health. The program weaves together funding from Medicaid (authorized under the Medicaid state plan and a 1915(b) waiver), the federal Substance Abuse Prevention and Treatment Block Grant, and state general funds.

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