By skyforbes by Ana Ramirez
From 2012 to 2015, the Texas Maternal Mortality & Morbidity Task Force found that late or no prenatal care was associated with an increased risk for maternal death in Texas.[1] Presently, the Medicaid Medical Transportation Program offers non-emergency transportation for Medicaid clients in case they lack access to other means of transportation.[2] Yet, clients may not bring their children with them in the dispatched vehicles. This restriction affects mothers by deterring them from utilizing the Medicaid Transportation Program. Hence, through an improved transportation program, women will no longer be burdened with extra costs to take their other children with them or find child care to not miss their appointments, and instead benefit from adequate care at the adequate time. My research focuses on how extending the eligibility of a child riding with the mother in the designated vehicle via Medicaid, will facilitate mothers’ access to prenatal and postpartum services; thus, improving these transportation services would be an attempt reduce Texas high maternal mortality rate.
The maternal mortality rate in the United States has skyrocketed 27 percent from 2000 to 2014.[3] In Texas, specifically, it has jumped from 18.6/100,000 deaths to over 30/100,000 in 2014.[4] Interested individuals from different institutes (Working Partner LLC, Texas Health and Human Services, Children at Risk, Texas Women’s University, etc.), and specifically Doctors, contend the importance to address maternal mortality rate by improving the accessibility of transportation for pregnant mothers. Furthermore, they declare that the majority of maternal deaths are among women who are receiving Medicaid benefits. Evidently, there is an urge to establish a prevention method to avoid more maternal deaths from happening.The project proposal specified that the most accurate data sources to obtain information on the restraints of the Medicaid Transportation Program would be Texans Care for Children Agency and jurisdiction from the Texas House Public Health Committee. However, reports from the Texas Health and Human Services have been extremely helpful to comprehend the subject. For instance, “Fig. 1: Domains of Contributing Factor Themes in a Social-Ecological Model” indicates that System and Community, referring to the lack of continuity of care and access to care of women, play predominant role in determining the appropriate services and the risk of death of individual. The Facility and Provider level factors are two other significant contributors to maternal death, including that the inadequate responses and knowledge performed by facilities or providers delay treatment in pregnancy and lack of continuity of care. If there was a more effective system, many women would not have to undergo such tragedies, mother would not lose their lives and children would not lose their moms.
Further data on Maternal Death Rates by Demographic Characteristics from “Fig.2” reveals that 61% of Maternal Deaths are suffered by minority groups and 57% of the women who suffered Maternal Deaths were part of a Medicaid program.[5] For many moms in both rural and urban areas, obtaining safe and reliable transportation is a major barrier to receiving medical care during prenatal and postpartum stages. For example, “Fig. 6: Patient and Clinic Staff/ Provider Perspectives of Barriers to Receiving Care for Rural Veterans” conveys that rural areas experience barriers to receive appropriate care services such as the distance to drive, limited transportation, geographical barriers, etc. In rural areas, a specialist may be hundreds of miles away. After analyzing these data, the relationship between the conditions living area or footing, like their access to near health care facilities, directly impacts the number of women in these areas who are at risk of passing away. Without reliable transportation and enough resources to take care of kids while their mom attends doctor’s appointment, this can lead to missed appointments or forgoing medical care. As a result of an urgency to seek more resources to reduce the maternal mortality rate and morbidity risk, improving the Medicaid Transportation Program Services would certainly benefit the state.
Federal law contains a broad guideline that state Medicaid plans must specify the methods to provide. Yet, each state is responsible for the operations of their Medicaid programs. In Arkansas, adults who gained eligibility are limited to eight legs of Nonemergency Medical Transportation Program before an extension of benefits is required. Given that Arkansas falls below Texas in America’s Health Rankings with the United Health Foundation, it is deduced that lowering their system is potentially more effective by the number of people who can travel under this service.
The findings of this research do not suggest that the Medicaid Transportation Program is not working. Rather, it suggests that there are still loopholes that can build inclusivity and reduce the deaths of individuals, not only in our state, but nationwide.
As it is earlier mentioned, in many cases the woman’s child cannot accompany the mother using Medicaid Medical Transportation Program services because the child is not eligible for Medicaid and the transportation benefit only applies to the beneficiary. Complications during pregnancy and childbirth have become a major cause of death and disabilities amid pregnant women. Missed visits could be life threatening for both mom and baby. In fact, about 830 women die from preventable causes associated to maternal health.[6]
In response to this severe problem, interested parties argue that extending Medicaid eligibility to a child who is younger than 13 years of age whose mother is recipient of Medicaid and using medical transportation program services to travel for to prenatal and postpartum care services would significantly to reduce maternal mortality and morbidity rates.
[1]Baeva, Sonia, et al. “Identifying Maternal Deaths in Texas Using an Enhanced… : Obstetrics & Gynecology.” LWW, May 2018, journals.lww.com/greenjournal/Abstract/2018/05000/Identifying_Maternal_Deaths_in_Texas_Using_an.3.aspx.
[2]“HHSC’s Medical Transportation Program.” HHSC’s Medical Transportation Program | Texas Health Steps, www.txhealthsteps.com/hhscs-medical-transportation-program.
[3]Maternal Mortality.” World Health Organization, World Health Organization, 16 Feb. 2018, www.who.int/news-room/fact-sheets/detail/maternal-mortality.
[4]Hollier, Lisa, and Carla Ortique. “Maternal Mortality in Texas.” Spina Bifida (Myelomeningocele) | Pavilion for Women, Texas Children’s Hospital Pavilon for Women, women.texaschildrens.org/blog/2016/11/maternal-mortality-texas
[5]Texas Department of State Health Services. “Maternal Mortality and Morbidity Task Force.” Texas Department of State Health Services, www.dshs.texas.gov/mch/maternal_mortality_and_morbidity.shtm.
[6]Maternal Mortality.” World Health Organization, World Health Organization, 16 Feb. 2018, www.who.int/news-room/fact-sheets/detail/maternal-mortality.