TennCare’s maternal death rates are 3x those of private insurance – Tennessee Lookout

Tennessee Maternal Deaths and the Impact of TennCare

Introduction

Tennessee has long had one of the highest maternal death rates in the nation, but newly released data shows the risks of dying from pregnancy are exponentially higher for those on TennCare.

Maternal Mortality Rates on TennCare

Pregnant patients with TennCare, the state’s public insurance program for people living in poverty, were three times more likely to die during or after pregnancy than those with private insurance between 2020 and 2022, a report from the state’s maternal mortality review committee found. The report concluded that 76% of Tennessee maternal deaths were preventable.

Key Factors Contributing to Maternal Deaths on TennCare

• Gov. Bill Lee and the Tennessee Legislature have repeatedly rejected efforts to expand TennCare to include more people above the poverty line. States with Medicaid expansions reduced maternal mortality rates.
• TennCare is one of just three Medicaid programs – along with Alabama and Mississippi – that hasn’t adopted a reproductive health care waiver, a narrow expansion of Medicaid to cover family planning services to those who otherwise do not qualify for Medicaid.
• Private insurance companies that manage the day-to-day TennCare patient oversight consistently rank in the bottom quarter of all Medicaid programs in meeting basic benchmarks of prenatal and postnatal care, including depression screenings and timeliness of pre- and post-natal visits.
• Efforts to address racial inequalities in pregnancy deaths, including funding for doulas, have been blocked by the Republican-controlled Tennessee Legislature.

Importance of Sustainable Development Goals (SDGs)

The high maternal death rates on TennCare highlight the urgent need to address the Sustainable Development Goals (SDGs) related to maternal health and reducing inequalities. SDG 3 focuses on ensuring healthy lives and promoting well-being for all at all ages, while SDG 5 aims to achieve gender equality and empower all women and girls.

Efforts to Improve Maternal Outcomes

TennCare has implemented recent policy changes to address maternal outcomes, including an expansion of postpartum coverage from 60 days to 12 months following the end of a pregnancy and integrating screening tools to connect patients to food, housing, and other assistance and case management services.

Improved maternal outcomes in Medicaid expansion states

States that have expanded their Medicaid programs have seen visibly lower maternal mortality rates compared to non-expansion states. The data found that states with expanded Medicaid programs saw a decrease of about 7 maternal deaths per 100,000 live births.

Failed Legislation

Local advocates have criticized the lack of action by lawmakers in supporting policies shown to improve maternal outcomes, such as state funding for TennCare doula services. Doulas are trained advocates who provide physical, emotional, and informational support during pregnancy, labor, birth, and postpartum, improving health outcomes.

TennCare Managed Care Organizations

Medicaid programs like TennCare often face challenges in providing the same resources and access to care as privately-paid insurance coverage. TennCare’s managed care organizations ranked in the bottom 25% of all Medicaid managed care plans for timeliness of prenatal and postpartum care. Efforts to improve the quality of care provided by these organizations are crucial in reducing maternal deaths.

Conclusion

The high maternal death rates on TennCare underscore the urgent need for policy actions to address the Sustainable Development Goals related to maternal health and reducing inequalities. Expanding Medicaid coverage, adopting reproductive health care waivers, improving the performance of managed care organizations, and supporting initiatives like doula services can contribute to improving maternal outcomes and reducing preventable deaths.

SDGs, Targets, and Indicators in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 5: Gender Equality
• SDG 10: Reduced Inequalities
• SDG 17: Partnerships for the Goals

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
• SDG 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age.
• SDG 5.1: End all forms of discrimination against all women and girls everywhere.
• SDG 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.
• SDG 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
• SDG 17.17: Encourage and promote effective public, public-private, and civil society partnerships, building on the experience and resourcing strategies of partnerships.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Maternal death rate per 100,000 live births
• Percentage of preventable maternal deaths
• Percentage of Medicaid programs that have adopted reproductive health care waivers
• Ranking of private insurance companies in meeting benchmarks of prenatal and postnatal care
• Percentage of states with Medicaid expansions and their maternal mortality rates
• Percentage of states with doula coverage
• Ranking of managed care organizations in timeliness of prenatal and postpartum care
• Effectiveness of healthcare providers in following up after positive depression screenings

Table: SDGs, Targets, and Indicators

Source: tennesseelookout.com