Across the U.S., more state Medicaid agencies are starting to cover essential maternal health services like remote patient monitoring (RPM) for blood pressure and doula care. These changes are exciting because they’re a step toward providing value-based care—focusing on quality, outcomes, and preventive support for mothers and babies.
But here’s the catch: the policies aren’t delivering the impact they promise. Why? Because Medicaid’s low reimbursement rates and complex administrative requirements make it challenging for providers to use these services effectively.
Take RPM for blood pressure. Many Medicaid programs now offer reimbursement for RPM to help manage hypertensive disorders in pregnancy, like preeclampsia, which can lead to serious complications -- and, incidentally, high costs for the health system. One study found that women with hypertensive disorders during pregnancy had medical costs up to $9,000 higher than those without. However, the reimbursement for RPM setup and ongoing monitoring often falls below the national standard set by Medicare. This makes it hard for clinics to cover expenses, especially in low-resource areas.
In theory, expansion of Medicaid policy to reimburse maternal health services should be elevating the quality of care. In practice, these discrepancies between Medicare and Medicaid rates discriminate against pregnant women, effectively denying them access to the life-saving solutions that are provided to geriatric patients through Medicare. Many private OB/GYN practices don't accept Medicaid because they can't cover their costs -- and hospitals and maternity wards that do are being forced to close because of financial insolvency. These are almost exclusively located in areas of high social vulnerability, where care is needed the most.
The same is true for doula services. Research shows that doula support can reduce the risk of preterm births, saving costs and improving outcomes. However, even in states with doula coverage, many doulas don’t participate in Medicaid due to low pay and the administrative hoops. For instance, in New Jersey, Medicaid reimburses about $1,500 per birth for doula care, which is often not enough to cover the full extent of a doula’s services.
This lack of support hits certain groups the hardest. Medicaid covers 41% of births in the U.S., and the rates are even higher among Black and Hispanic mothers, at 64% and 58%, respectively. These women already face higher maternal health risks, and without adequate coverage, they miss out on the benefits of comprehensive services like RPM and doula care.
To make Medicaid policy changes meaningful, policymakers need to ensure reimbursement rates cover real costs and make services sustainable. By involving providers and setting realistic rates based on the CMS Physician Fee Schedule, Medicaid could start delivering on its promise to improve maternal health for all.
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