Funding Strategies for Maternal Health Programs
One way to create a sustainable maternal health program is to identify stable funding. Rural programs addressing maternal health are using various forms of funding to support their programs.
Some previously uninsured women may be eligible for Medicaid if they become pregnant and meet income eligibility thresholds, which vary across states. Medicaid will pay for all expenses associated with pregnancy, birth, and postpartum, up to 60 days after giving birth. Medicaid pays for 43% of all births in the U.S. and 51% of rural births.
Medicaid provides hospitals reimbursement for childbirth expenses, but provides lower reimbursements for these expenses than private insurers. This increases the financial vulnerability of obstetric providers and practices because reimbursement is lower than the actual costs of providing obstetric care.
In addition to Medicaid, other federal agencies can be important sources of supporting rural maternal health programs. The federal government funds Title V Maternal and Child Health Services Block Grants to states and territories to support improvements in the health and well-being of women and children. Other funding opportunities are available through the Maternal and Child Health Bureau, U.S. Department of Health &Human Services Office on Women's Health, and Indian Health Service. The National Institute of Child Health and Human Development and the NIH Office of Research on Women's Health provide funding for clinical and community research addressing maternal health and maternal mortality.
Funding focused on rural communities is available through the Federal Office of Rural Health Policy, including through the Health Resources and Services Administration's Rural Maternity and Obstetrics Management Strategies (RMOMS) Program. Other federal funding opportunities can be found at Grants.gov, with a search for Maternal Health.
There is considerable variability across states in funding and policy for rural maternity care. Every state provides comprehensive coverage for prenatal care, labor and delivery, and other related services through their state-specific Medicaid program, to women who meet Medicaid eligibility requirements. Some states have opted to expand Medicaid's post- and intrapartum services to cover contraception for women who do not qualify for comprehensive Medicaid coverage. Some states have also started to reimburse for doula services through Medicaid.
States and territories also utilize Title V block grant dollars differently. Some states, for example, provide seed funding for local pilot programs. Advocacy organizations, such as the March of Dimes, can work with rural communities to advocate for maternal health funding in the state budget, which can help support sustainable rural maternal health programs.
By December 2018, 45 states and the District of Columbia had established maternal mortality review committees (MMRCs). These states must also have systems in place to address the committees' findings, which they can use to advocate for state policy changes to ensure the availability of quality maternal healthcare. For example, Illinois' MMRC was developed in 2000. The committee found that hemorrhage was the leading cause of maternal mortality in the state of Illinois. An Obstetric Hemorrhage Education Project (OBHEP) subcommittee was created to develop a statewide OBHEP for all obstetric providers practicing in Illinois. This training is now mandatory by state law. Developing a diverse committee with representatives from all communities affected (including rural and communities of color) may be helpful to inform what language to include in state legislation. There is considerable variability among states in how frequently the MMRCs meet, which data are collected, data collection methods, and who can access the data.
Other Funding Sources
Collaborating with other organizations to consolidate and leverage resources can help sustain initiatives. Rural communities should also attempt to secure diverse sources of funding in addition to federal and state dollars. Funding opportunities can be found in RHIhub's Rural Funding & Opportunities section.
Resources to Learn More
Legislation to Improve Maternal Health
Summarizes federal legislation focused on improving maternal health outcomes and addressing racial disparities in maternal mortality.
Organization(s): National Partnership for Women & Families, Association of Maternal & Child Health Programs
to Success for Medicaid Coverage of Doula Care
Discusses the most significant challenges to Medicaid coverage of doula care services and offers recommendations on how advocates can overcome these barriers.
Author(s): Chen, A.
Organization(s): National Health Law Program, California Preterm Birth Initiative