February 25, 2024
CT maternal health care system faces several issues, officials say

Medicaid implementation, substance use disorder and service cuts are just some of the critical issues facing people who give birth in Connecticut, according to leaders, advocates and state officials who gathered at the Capitol on Tuesday to discuss barriers to maternal care.

As several attendees noted, the maternal mortality rate is rising in Connecticut. Tiffany Donelson, president of the Connecticut Health Foundation, pointed out that the dangers of childbirth don’t impact everyone equally.

“We recognize that there are extreme disparities amongst women of color here in our state related to their birthing experiences,” said Donelson. “In particular, Black women are 2.6 times more likely to die following having a child as opposed to a white woman here in our state.” 

In recent years, the state has made expansions to Medicaid, known as HUSKY, in an effort to address those racial disparities.

In 2021, the legislature passed a law to expand HUSKY coverage to include one year of postpartum care for anyone with a qualifying income, regardless of immigration status. 

But Bianca Noroñas, the director of the maternal health center at the Hispanic Health Council, said that staff at hospitals and Access Health CT, the state’s health insurance exchange, are telling women without immigration status that they don’t qualify for coverage.

“It’s very hard for me, because I’m on the phone call with them, and I hear the Access Health worker say, ‘No, you are not eligible,’” said Noroñas. “I don’t understand why we have people in hospital settings that still don’t know that women in postpartum, for the first year, no matter what, [even if they] don’t have immigration status, they can have health insurance.”

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A spokesperson with Access Health CT said that call center staff have been trained regarding postpartum coverage eligibility regardless of immigration status. Additionally, regular auditing of calls has “not identified any instances of undocumented women who were eligible for the 12 months of postpartum coverage being denied.”

The Department of Social Services is also in the process of rolling out a new bundled payment structure for maternity care under HUSKY that’s specifically geared toward “rectifying historical disparities in maternity care.” The program will cover lactation and doula services and is estimated to launch in September 2024.

Siobhan Dolan, the chair of obstetrics and gynecology at Stamford Health, called the bundled care “very exciting,” but she said that it could also run into implementation challenges if Medicaid reimbursement rates aren’t addressed.

“There have been no details, to our knowledge, on the reimbursement rate. And we do have sincere concerns that if the reimbursement rate does not change, and there’s not additional resources added to the HUSKY bundle, it could really impact access.”

No one with knowledge of the maternity bundle at the Department of Social Services could be reached for comment.

A spokesperson said the agency hadn’t been invited to the roundtable, which was organized by Comptroller Sean Scanlon’s office, but had asked to be involved in future events so DSS officials could address questions in real time.

Representatives from Sharon and Windham also raised concerns about the closures of labor and delivery units. Since 2020, the state has received proposals to shutter birthing services at three rural hospitals — Sharon Hospital, Windham Hospital and Johnson Memorial Hospital in Stafford. 

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On Dec. 1, the Office of Health Strategy, or OHS, announced the approval of the application to close labor and delivery at Windham. The other two applications are still pending. 

“One of the reasons that we have a high rate of maternal mortality is because we’ve cut out services to communities,” said John Brady, a registered nurse and the executive vice president of AFT CT, a union representing health care professionals, teachers and public employees.

Katherine Campbell, the medical director of inpatient obstetrical services at Yale New Haven Hospital, said that substance use disorder among patients giving birth has also become a “very common” issue for her department. 

“They come to us very late in the course of their disease. And even with experts in maternal fetal medicine, experts in addiction medicine, the problems are unsolvable,” she said. “We need to invest in grassroots substance use disorder programs that can serve as a well-functioning safety net.” 

Among the other solutions that the group discussed were increased training for Access Health CT staff, a focus on the roll-out of the HUSKY maternity bundle, more funding for OHS to regulate unit closures and greater adoption of telehealth programs that can increase access to care.