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Alabama First in Program for Pre-term Babies

By Susan Britt
Alabama Political Reporter

MONTGOMERY—Alabama becomes first state to add smoking cessation to its Plan First family planning program. The state received federal approval in April 2012 to add counseling and medications to current service.

In Alabama, 15 percent of all pregnant females smoke, according to data from the Alabama Department of Public Health. There are estimates that up to 35 percent of low-income Medicaid mothers smoke.

According to a January 2012 study published by George Washington University Center for Health Policy Research found that for every dollar invested in a smoking cessation program for pregnant women, Medicaid could expect $3.12 in savings.

However, in November 2011 the March of Dimes gave Alabama an F rating for premature birth and infant mortality because of its 16 percent rating although down from a rating of 18. 2 percent in 2006. To earn an A, a state has to have a rate of at least 9.6 percent, which is the March of Dimes goal for the U.S. to reach by 2020.

Alabama is one of several Southern states with a high rate of preterm births, largely because of smoking, obesity, teenage pregnancies and lack of prenatal care.

According to the March of Dimes, preterm birth is the leading cause of newborn deaths in the United States. Babies born prematurely potentially face other lifelong health problems, such as cerebral palsy, chronic lung disease, vision and hearing problems, intellectual disabilities and higher rates of hospitalization.

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According to a June 2012 a report from the National Conference of State Legislatures Medicaid pays for about 40 percent of births.

One in eight babies is born before 37 weeks with the associated medical costs totaling more than $20 billion per year, about $51,600 per infant.

In Wisconsin, a preterm baby with a very low birth weight (2.2 to 3.3 pounds) in the first four years of life costs $61,902 compared with $7,260 for a normal weight baby, according to the state’s Department of Health Services.

States are required to cover pregnancy-related services for women with incomes below 133 percent of the federal poverty guidelines.

Several states are using different methods to reduce the rates of preterm births and low birthweights.

Louisiana is increasing the use of prenatal services by pregnant women in Medicaid with a program called Birth Outcomes Initiative. Their website states their mission as “The Birth Outcomes Initiative is a targeted cross-departmental and cross-sector initiative to improve the outcomes of Louisiana’s births and health of Louisiana’s moms and babies.”

Louisiana’s goal is the reduction of non-medically indicated deliveries before 39 weeks by early induction or cesarean. They account for more than 10 percent of births and have increased over recent decades because of cultural preferences, convenience and doctor’s schedules.

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The Healthy Texas Babies Initiative is a collaboration of state agencies, healthcare providers, insurance companies and community members. Its goal is to decrease infant mortality and reduce Medicaid costs by $7.2 million over two years. The state plans to accomplish this by increasing prenatal health awareness and access to care for women on the Medicaid rolls with high-risk pregnancies by promoting awareness and providing education campaigns.

Their website states their vision “For all Texas babies to have a healthy, happy first birthday.”

Funded by a 2007 grant from the Centers for Medicare and Medicaid Services, the Ohio Perinatal Quality Collaborative has reduced early elective deliveries by educating patients and healthcare providers. Over a three year period, 20,700 early elective pre-term births were prevented saving around $25 million as a result of fewer admissions to neonatal intensive care units.

South Carolina’s Birth Outcomes Initiative in 2011 decreased early elective deliveries among its Medicaid enrollees and is saving around $1 million in delivery costs and $7 million from fewer infant hospitalizations per year.

According to the National Conference of State Legislatures’ report, “In February 2012, [Centers for Medicare and Medicaid Services] CMS launched the ‘Strong Start’ initiative, which provides $43.2 million in grants to providers, state Medicaid agencies, and Medicaid managed care organizations to reduce early elective deliveries and test new approaches to better prenatal care for women with high-risk pregnancies.”

The program will test three evidence-based maternity care service options. The Innovation Center offers grant funding for three approaches: Enhanced Prenatal Care Through Centering/Group Visits, Enhanced Prenatal Care at Birth Centers and Enhanced Prenatal Care at Maternity Care Homes. It intends to fund the cost for prenatal care for 30,000 Medicaid women for each program, 90,000 in total over three years.

Eligible applicants include: Providers of obstetric care, states, Medicaid managed care organizations and conveners in partnerships with other applicants. Applicants must be able to serve 500 women at risk for premature births.

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Prenatal care including screening and diagnostic tests that identify problems early, manage chronic conditions and educate mothers about risky behavior is shown to reduce the likelihood of underweight birth by half.

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