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Medicaid expansion could lower infant mortality rate, report says

Lansing State JournalApril 21, 2013Articles

A proposed statewide expansion of Medicaid could bolster recent efforts to lower infant mortality rates in Ingham County, a new report concludes.

By providing healthcare for low-income women before pregnancy, the proposed Medicaid expansion beginning next year would give more babies a healthier start at birth, according to the report by the Michigan League for Public Policy.

Low-income women without children now only become eligible for Medicaid when they become pregnant.

“It’s absolutely a policy decision that will position both primary care and public health professionals to go after the root causes of infant mortality,” Ingham County Health Officer Renee Canady said.

Historically, Ingham County has ranked in the bottom half of 83 Michigan counties in infant mortality with an average annual rate of 6.3 deaths per thousand between 2006 and 2010, according to state officials. But the rate for black infants is much worse at 17.1 deaths per thousand annually on average.

Last year, Canady expanded efforts to address infant mortality with a $2 million federal grant to hire more nurses to partner with the highest-risk pregnant women. Since August, the county has hired eight nurses for its Healthy Starts and nurse-family partnership programs. They began seeing pregnant women in September.

Canady said it’s too soon to measure any impact from those programs, but she hopes it will cause the county’s infant mortality rates to fall.

Canady said the Medicaid expansion, if approved, would reduce infant deaths by targeting more resources to improve the overall health of low-income women, ensuring safer deliveries.

Whether Michigan will go ahead with the proposed expansion is unclear.

Gov. Rick Snyder has recommended proceeding with the expansion in his 2013-14 budget proposal, but Republican-controlled budget committees in the House and Senate have rejected the expansion.

By expanding Medicaid eligibility to 133 percent of the federal poverty level, the measure would add up to about 500,000 more people to the Medicaid rolls. The federal government would pay for the expansion for the first three years. Eventually, the state would pay 10 percent of the costs — an estimated $200 million annually.

Many Republican state lawmakers have been reluctant to support the expansion, saying they fear Michigan will get stuck with a higher share of the cost in coming years.

But Jane Zehnder-Merrell, project director for Kids Count in Michigan, a nonprofit group that monitors the health of Michigan’s children, said it makes sense to expand Medicaid to curb the high incidence of infant mortality — even though pregnancy qualifies a woman for coverage.

That’s because it can take a woman several weeks to qualify for Medicaid coverage once a pregnancy is detected, and it can then take days or weeks for a woman to find a doctor willing to accept Medicaid, Zehnder-Merrell said. That can leave a low-income woman without prenatal care for several weeks, she said.

“We know a lot of development occurs in those first three months,” Zehnder-Merrell said.

“Looking at Medicaid recipients, we found that half of them had less than adequate prenatal care,” she said.

Canady said with expanded Medicaid, health agencies can better address depression in low-income women before and during pregnancy, which can adversely affect an infant’s health.

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