NASHVILLE – Tennessee has long had one of the highest maternal mortality rates in the country, but newly released data shows that the risk of pregnancy death is exponentially for people at Tenncare It shows that it is high.
Pregnant patients from Tenncare, the state’s public insurance program for people living in poverty, are Three times more likely to die Reports were found between 2020 and 2022, or from the state’s Maternal Mortality Review Board, compared to those with private insurance.
Each death is the result of personal and often complicated factors ranging from preexisting health to postnatal depression, but the majority (76%) of Maternal Deaths in Tennessee are preventable, according to the report. concluded.
Experts say the collective deaths of pregnant and postnatal women at Tenncare raise urgent questions about the state’s policy actions and inactions behind the tragic consequences. among them:
- Gov. Bill Lee and the Tennessee Legislature have repeatedly rejected efforts to expand Tenncare to include more people who cross the poverty line. States with Medicaid expansion reduced maternal mortality.
- Tenncare, along with Alabama and Mississippi, is one of only three Medicaid programs and does not adopt a reproductive health waiver. This does not employ a narrow expansion of Medicaid to cover family planning services to those who do not qualify for Medicaid.
- Private insurance companies that manage daily ten care patients’ surveillance will meet basic benchmarks of prenatal and postnatal care, including screening for depression and timeliness of prenatal and postnatal visits. It is consistently ranked across all Medicaid programs’ lower quarters.
- Efforts to address racial inequality in pregnancy deaths, including funding Doulas, have been blocked by Republican-controlled Tennessee Legislature
“There’s a tragedy behind these statistics, and the state should treat it as a crisis,” says Michele Johnson, executive director of Tencare’s expansion and Tennessee Judicial Center and executive director of Tennessee Judicial Center. states. Quality improvement.
A spokesman for Tenncare said mother deaths are a national concern, and Medicaid programs such as Tennessee often serve higher risk groups than private insurers.
“Tenncare continues to be committed to improving maternal health and supporting members during and after pregnancy,” a spokesman said, adding that Tenncare has implemented recent policy changes to address maternal outcomes. said Amy Lawrence.
These include expanding postpartum coverage 60 days to 12 months after pregnancy, integrated screening tools to help patients with food, housing and other support, and case management available to all obstetric patients. It’s an effort to connect it to service.
Improving maternal outcomes in Medicaid expansion conditions
Tenncare covers approximately 50,000 pregnant women each year. This accounts for about half of all births in the state. Approximately two-thirds of the cost of the $18.6 billion program is handled by the federal government.
Tennessee taxpayers pick up about a third of the tabs. The program primarily covers older people or children and individuals with disabilities.
Since the adoption of the Federal Affordable Care Act in 2014, states have had the option to expand Medicaid to cover more uninsured people than they have been allowed in the past, but Tennessee State lawmakers quickly adopted laws requiring approval before Tenkea expands. Neither Republican-controlled Congress nor Gov. Bill Lee supports expansion.
However, states that have expanded their Medicaid programs have seen a particularly noticeable decline among non-Hispanic black women, as maternal mortality rates are “visibly lower” than non-expanding conditions so far. Federal Health Data. Data found that states with the expansion of the Medicaid program reduced the deaths of approximately seven mothers per 100,000 births.
Pregnancy-related deaths in Tennessee have fallen 26% overall after surged at the height of the COVID epidemic in 2022. Tenncare’s pregnancy-related mother mortality rate is 81 maternal mortality rate per 100,000 births, almost three times more than private health insurance in Tennessee. The maternal mortality rate for Tenesians covered by private insurance was 29 per 100,000 births.
The expansion of Medicaid gives patients critical access to ongoing and preventive care before pregnancy, says Eugene DeKrukaku, a professor of community health sciences at the Boston University School of Public Health.
Maternal deaths in Tennessee fell in 2022 after high COVID, but the gap remains
“Birth is not the only way to get maternal health,” Declercq said. “It’s about women’s health and social support systems. We want to focus on mother mortality because it’s so tragic, but the reality is that this is about women’s overall health. It means it’s something.”
Mental disorders, including substance abuse and cardiovascular disease, account for the majority of all Tennessee maternal deaths that continuous treatment may address before pregnancy.
DeclercQ, who is on the Maternal Death Review Board in Maternal Death Review Board, praised the work of Tennessee’s Maternal Death Review Board in reporting the disparity in outcomes between Medicaid and private insurance. Not all state reviews of mother deaths are like that, he said.
The law failed
Local advocates repeatedly fund the Tencare Doula Service to help pregnant patients, a measure that has been repeatedly rejected by the state’s vast majority GOPs. repeatedly criticised the lack of action by lawmakers who support policies that have been shown to improve maternal outcomes.
“It was a tough five years of struggle,” said Brianna Perry, interim director of the nonprofit healthy, free Tennessee. “We know that Doulas is not the only solution, but we know that Doulas is a supportive player who plays an important role in the intervention.”
Doulas is a trained advocate in providing physical, emotional, informational support and improving health outcomes, providing pregnancy, childbirth, birth and postpartum.
Perry said Doulas could also play an important role in reducing discrimination and discriminatory treatment by health professionals. Overall black women in Tennessee are twice as likely to die as white women as a result of pregnancy. A Tennessee Maternal Mortality Review Report published in 2023 concluded that it contributed to 22% of pregnancy-related deaths in Tennessee. Most of these deaths that occurred in 2021 were preventable, the report found.
Sen. London Lamar, a Memphis Democrat, first introduced a law in 2022 that required compensation for Doulas’ Tencare. After enforcement from Republicans, the bill was rewritten and called for a study of Doulas’s interests, and ultimately became law. The research is still underway.
Lamar has failed to reintroduce laws requiring Doulas compensation in 2023 and again in 2024. She reintroduced the law for the fourth time last week.
The 13 states and the District of Columbia all have a lower maternal mortality rate than Tennessee, so they have some form of doula coverage, while 12 other states have implemented Doula coverage. According to the Georgetown University Children and Families Center.
Lamar said he was irritated not only by his colleagues who blocked the bill in the past, but also by Tenncare officials who failed to advocate for maternal patients.
As national authorities break in, reviews of mother’s death become political
“I think they have a big responsibility to speak up,” she said of Tenkea. “The inability to take on more solution-based initiatives directly contributes to more deaths.”
Among Lamar’s past efforts was a bill to create evidence-based ones. Implicit bias training For health professionals related to maternal and infant mortality. Another bill would have set up an 11 maternal and maternal advisory committee within the Tennessee Department of Health.
Discrimination was a contributing factor for 22% of Tennessee’s maternal deaths in 2021. State report found..
The training measures were not passed, and the measurements of the 11 Maternal Committee were only successful after being rewritten to add four community members to the state’s existing Maternal Mortality Review Board.
“I’m not shocked to see more women die at Tenkea,” Lamar said. “Tenncare, like my Republican colleagues, is responsible for silence over these deaths and these racial inequality.”
Tenncare managed care organizations rank in the bottom 25% for prenatal measures
Medicaid programs such as Tenncare generally do not offer the same choice when selecting a doctor or accessing the same medication covered by personal insurance coverage. .
“These systems don’t get the same resources,” Dr. Scott said. “And often patients are not in optimal health or have no housing, food or other challenges.”
Scott advocates for better data on severe maternal morbidity. Patients who are surviving as a result of pregnancy, childbirth, or postpartum complications but have poor health outcomes.
Tennessee has not yet studied these results. The state health department is currently developing reports to measure them.
However, one measure of the Medicaid program is the performance of individually run managed care organizations contracted by state contracts to administer the TENCARE program.
Each of Tenncare managed care organizations is ranked in the bottom 25% of all Medicaid managed care plans in at least one region of the state due to timeliness of prenatal and postnatal care. National Committee on Quality Assurance (NCQA)measures the quality and performance of health insurance companies.
One Tenncare managed care organization says that after a patient tested positive for prenatal and postnatal depression screening, its healthcare provider followed up and how effectively it is close to the bottom Ranked.
“Tenncare covers a high-risk population due to low income and high incidence of existing chronic conditions,” said Johnson, executive director of the Tennessee Judicial System.
“But good, timely care can alleviate these factors. Tenncare Quality Report provides adequate prenatal and postnatal care, compared to other states’ Medicaid programs. To do this, it is throwing a disturbing light on the decline in performance of Tenncare managed care contractors.”
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