Medicaid prenatal program considered

Members of the Health and Human Services Committee heard testimony Feb. 7 on a bill that seeks to provide support for low-income Nebraska mothers who are at risk for adverse birth outcomes.

LB857, as introduced by Lincoln Sen. George Dungan, would create the Nebraska Prenatal Plus Program to cover the cost of prenatal and postpartum services for at-risk mothers. The bill defines an at-risk mother as a woman who is eligible for Medicaid or the Children’s Health Insurance Program who is pregnant or in the postpartum period and determined by a health care provider to be at risk of having a negative maternal or infant health outcome.

Dungan indicated that he would file an amendment to clarify that the program would apply to prenatal services only. The bill’s purpose is to reduce the occurrence of low birth weight, preterm birth and other adverse birth outcomes, he said, while also addressing lifestyle, behavioral and nonmedical aspects of an at-risk mother’s life that may impact the health and well-being of a mother or child.

The state Department of Health and Human Services would be responsible for filing a state plan amendment or waiver to authorize the program no later than Oct. 1, 2024. The department also would be required to submit an annual report to the Legislature beginning Dec. 15, 2024, regarding the number of mothers served by the program, services offered and birth outcomes.

Dungan said LB857 is based on a similar program in Colorado that has been operating successfully for more than 20 years. The program has resulted in a substantial reduction in low-birth weight babies and has provided systemic, ongoing cost savings to the state, he said.

“Low birth weight leads to vision problems, respiratory complications, cognitive impairment, gastrointestinal issues, higher death rates [and] lower performance in school,” Dungan said. “The fact that they were actually able to see [a reduction] … is huge.”

Ann Anderson Berry, medical director for the Nebraska Perinatal Quality Improvement Collaborative, spoke in support of the measure. She said gestational diabetes diagnoses have increased from 8% to 13% over the last six years in Nebraska. The diagnosis is associated with preterm deliveries, medically induced deliveries and cesarean sections, she said.

“Mothers with hypertension, obesity and diabetes are at an increased risk for delivery by C-section, postoperative infection, postpartum hemorrhage and long-term cardiovascular disease,” Anderson Berry said. “Ideally we’d start this Prenatal Plus program and then those mothers could get nutritional counseling and perhaps avoid [diagnosis] altogether.”

Chad Abresch, chairperson of the Department of Health Promotion at the University of Nebraska Medical Center, also spoke in favor of the proposal. Testifying on his own behalf, Abresch noted the success of a similar program in Palm Beach, Florida, which specifically sought to address racial disparities in infant mortality rates.

Prior to the program’s implementation, he said, minority infants were dying at nearly four times the rate of white infants. The county now has the lowest Black infant mortality rate in the state, he said.

“After five years of their implementation of Prenatal Plus … the data demonstrates that the disparity in Black [and] white infant mortality had been more than cut in half,” Abresch said.

Representing the Nebraska Catholic Conference, Marion Miner also testified in support. He said factors such as inadequate nutrition and untreated physical or mental health disorders relate directly to the long-term health of mothers and children and can be addressed.

“Mothers of preborn and newborn babies who are without adequate family and social support ought to be … a special focus for a society attempting to realize a culture of life,” Miner said.

No one testified in opposition to LB857 and the committee took no immediate action on it.