Medicaid covers more than 41% of births in the United States, making it the country's single largest payer of pregnancy-related services. This statistic alone is enough to argue for its crucial role in improving maternal health outcomes -- and there's more.
Medicaid covers a greater share of births in rural areas, among minority women, young women (under age 19), and women with lower levels of educational attainment. It covers a greater share of births in maternity care deserts, and a greater percentages of those receiving inadequate prenatal care.
Essentially, those most likely to suffer from poor maternal health outcomes are disproportionately covered by Medicaid. While the ultimate goal is to improve maternal healthcare across the board, delivering quality maternal health support to Medicaid enrollees provides an immediate opportunity to positively affect the greatest portion of vulnerable mothers.
That means taking a focused look at the particular barriers to maternal health engagement that face the Medicaid population, and offering tools built to address those issues.
the digital divide
Lack of internet access is often raised as a barrier to digital healthcare for low-income individuals and families -- those most likely to rely on Medicaid for health coverage. And while it is true that overall access to the internet is limited among Medicaid enrollees, that stat doesn't tell the whole story.
Internet insecurity disproportionately affects elderly Medicaid enrollees (60+). Pregnant Medicaid members of reproductive age (15 - 49 years), however, are more than 84% likely to have access to a home internet connection (i.e., broadband) at the lowest income levels, and that percentage increases with income level.
When it comes to mobile broadband, many people are able to access online resources using their smartphones (i.e., mobile broadband or cellular data). In fact, Medicaid enrollees own smartphones and other digital devices at comparable rates to those covered by private insurance, and often use them at higher rates than the average person because they lack home internet access.
Digital health solutions that operate via a smartphone, with workarounds to place less burden on data plans (e.g., graceful degradation of service, SMS-based communication, use of bluetooth for data transmission), are viable options to serve pregnant Medicaid members.
THE LITERACY ISSUE
In their focus on the barrier of technology access, industry leaders and policy-makers often overlook a greater issue for pregnant Medicaid enrollees: health literacy.
Health literacy goes beyond the ability to read and understand health information, which is already a problem for those with lower levels of education or English proficiency. It also encompasses the range of skills and knowledge that enable people to make informed decisions about their health, navigate healthcare systems, and engage in behaviors that promote well-being.
Communities of color, who make up a large portion of the Medicaid population, tend to have lower levels of trust in government and healthcare institutions, which are often the sources for guidance on navigating the healthcare system and understanding risks.
To improve health literacy, innovators need to work with care givers and leaders who are integrated into communities and understand their particular challenges and burdens, to directly support pregnant Medicaid members and also to guide the development of culturally competent and accessible solutions.
EDUCATION LEVEL & ITS DOWNSTREAM EFFECTS
Lower levels of education correlate to lower income levels and greater social barriers to care. Pregnant women with a high school degree or lower are more likely to work hourly-based jobs; more likely to be single parents -- they are more likely to experience food insecurity, transportation barriers, and lack of childcare.
These obstacles are among the primary factors leading to insufficient prenatal care for Medicaid members and its associated consequences, including a heightened risk of preterm birth, C-section delivery, and other pregnancy-related complications.
To overcome these barriers, solutions for pregnant Medicaid members need to go beyond the limitations of traditional care. In-person appointments that focus on clinical risk in a traditional healthcare setting are failing to move the needle on their own -- even when social health determinants don't prevent enrollees from accessing them.
Hybrid solutions that reach pregnant Medicaid members in their community, in the comfort of their home, at the convenience of their timeline are essential for improving their health outcomes. There needs to be a solution to capture data and communicate it to the care provider even when a member misses the bus or has to work overtime or can't find childcare, or any number of reasons that Medicaid enrollees fail to make appointments.
Furthermore, these solutions need to address these non-clinical risks facing the Medicaid population, that get little airtime in a traditional healthcare setting but are disproportionately related to health outcomes. Worry about where the next meal is coming from or the stress of keeping a job or finding safe housing has an outsized affect on a pregnancy journey and the health outcomes of mother and child, and we need to be providing solutions that address those concerns.
Plus, download our health equity infographic for more info on disparities:
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