Improving Access to Maternal Care in NC: Mid-Project Update

Blog | February 23, 2022


In the most recent data from 2019, North Carolina’s maternal mortality rate was 27.6 per 100,000 births, slightly lower than the national average but higher than the previous year’s rate of 12.1 per 100,000 births. Causes of increasing maternal morbidity include mothers becoming pregnant at older ages, pre-pregnancy obesity, preexisting conditions, and C-section deliveries. In the most recent available data on severe maternal morbidity, from 2017, North Carolina's rate was 73.5 per 10,000 delivery hospitalizations, higher than the national rate of 70.9 per 10,000 delivery hospitalizations.


These numbers are striking enough, but they highlight a deeper problem: Black women in our state have a maternal mortality rate of 56.8 deaths per 100,000 births, nearly two times that of White women.


Access to high-quality care before, during, and after pregnancy can prevent maternal mortality and morbidity. In an effort to improve access to and receipt of quality care for North Carolina mothers, and address continuing inequity, the North Carolina Department of Health and Human Services (NC DHHS) has partnered with the NCIOM to convene the Maternal Health Task Force to identify evidence-based solutions and develop a Maternal Health Strategic Plan for the state. The task force first met in June 2020.


One recommendation of the task force has already been implemented: expanding continuous postpartum medical coverage for Medicaid-eligible women in North Carolina. In the 2021 Appropriations Act, the North Carolina General Assembly extended Medicaid benefits for low-income mothers for one year after a child is born, from the six weeks postpartum that had previously been guaranteed. The state budget appropriated $62.8 million through 2023 for this effort, paid from additional hospital assessment receipts.


Another working recommendation of the task force involves expanding access to comprehensive prenatal care for undocumented women through NC Medicaid. Undocumented women in North Carolina deliver more than 10,000 babies each year and typically use presumptive Medicaid eligibility for two months of prenatal services and emergency Medicaid for delivery. These services are covered at the standard federal match (67%) percentage. Most women are able to receive some prenatal care at a health department, community health center, or a hospital-based clinic. However, when ultrasounds, other diagnostic tests, or specialty consultations are recommended, many women have no ability to access these services.


The Federal Government allows states to use a special Children’s Health Insurance Program (CHIP) to cover prenatal care, labor, delivery, and the immediate postpartum period for undocumented immigrant women. Sixteen states across the country have chosen to use this option, and one evaluation has shown that women covered under this option have lower rates of extremely low birth weight infants (1.55/1,000) and infant deaths (1.04/1,000). Babies born to women covered by this program were also more likely to receive recommended screenings and immunizations.


Patient Education & Support

Nationwide, only a few states (e.g., Minnesota, Oregon, Indiana, and New Jersey) include doula services as a covered benefit in their state Medicaid programs, despite the Centers for Medicare and Medicaid Services Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid/CHIP’s 2013 recommendation that Medicaid provide coverage of “continuous doula support during labor. In addition to a lack of coverage for doulas, doulas are not licensed in the state of North Carolina, so there are no uniform standards around training, certification, and how doulas function as part of the perinatal team.


Patient support is paramount to ensuring access to high-quality maternal care. In that vein, the NCIOM’s Maternal Health Task Force plans to recommend the state undertake an analysis of existing doula support services, partner with community-based doulas and doula-training programs, develop doula services and coverage reimbursement options for NC Medicaid and private insurers to consider, and create a statewide directory of providers.


The task force also plans to recommend the establishment of a statewide 24-hour breastfeeding support hotline and promotion of screening for maternal risk factors during well-child visits.


Read more about the Maternal Health Task Force here.