Transforming maternal care: State-based reforms in Ohio include use of value-based payment model

One obstetrical practice in Ohio recently opened a “fourth trimester” clinic to meet the needs of new mothers — for example, support for postpartum depression or help with breastfeeding.

In another practice, group-based pregnancy education services now operate under an “opt out” model: all expectant mothers in the practice are presumed to want and get these additional prenatal care and social supports, unless they say otherwise.

Other providers have begun hiring lactation specialists, behavioral health counselors or other staff.

Driving these types of innovations is a new payment model known as Comprehensive Maternal Care, an initiative within Ohio’s Medicaid program to incentivize quality care, address infant and maternal mortality and morbidity, and reduce health disparities.

“It’s pretty phenomenal how well they’re doing after just one year [of the program],” Ohio Medicaid Director Maureen Corcoran said about advances being made by the participating practices. Corcoran made her remarks as part of a July presentation at the Midwestern Legislative Conference Annual Meeting.

Led by the MLC Health and Human Services Committee, the session focused on how states and their legislators can improve outcomes for mothers and infants.

“Your lever is Medicaid,” said Sinsi Hernández-Cancio, vice president for health justice at the National Partnership for Women & Families, who joined Corcoran as a featured presenter.

That is because the public health insurance program for low-income families is such a large payer of maternal care; in 2022, it financed one-third or more of births in most Midwestern states.

Medicaid is the largest such payer in Ohio, and the state has embarked on a series of reforms since the passage of SB 332, a bill from 2017 that established new goals and policies to reduce infant mortality.

Comprehensive Maternal Care is one of Ohio’s newest policy reforms. According to Corcoran, 137 practices already are enrolled (the program launched in 2023) and eligible for an additional value-based payment via the state’ s managed-care system for Medicaid. The monthly payment is $15 for each low-risk pregnancy, $40 for each high-risk pregnancy. For even a smaller practice with 200 lower-risk and 150 higher-risk deliveries a year, that adds up to $80,000 a year, Corcoran noted.

Ohio also has made other changes in Medicaid-based maternal care over the past five years. It has begun to cover nurse home visiting and group prenatal care; extended postpartum coverage to 12 months; expanded coverage for lactation counseling; and targeted investments in community-based services in the counties and neighborhoods with the highest rates of infant mortality.

One of the most important advances, Corcoran said, has been working with the state’s managed-care and maternal-care providers on a reporting system that ensures the health system can reach expectant mothers early in their pregnancy and connect them to services.

At the federal level, Hernández-Cancio said, a new 10-year Transforming Maternal Health Initiative has opened up a new funding opportunity for states. To qualify for the grant program, states must adopt a series of policies to improve care for expectant and new mothers. That includes development of a value-based payment model such as Ohio’s.

 

 

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Honoring The Rehabilitation Act of 1973

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By Mary Greenfield

The Rehabilitation Act of 1973 passed crucial supports for people with disabilities that remain central to the Vocational Rehabilitation (VR) system we know today. Known simply as the Rehab Act, this legislation stands on the shoulders of decades of public rehabilitation laws in the United States. In celebration of the anniversary of the Rehab Act, The Center for Advancing Policy on Employment for Youth (CAPE-Youth) honors this legislation by outlining its history and importance for youth and young adults with disabilities.  

A Short History

The earliest acts establishing rehabilitation services in the United States were passed in 1918 and 1920. These rehabilitation acts provided soldiers returning injured from World War I and civilians with disabilities, respectively, access to employment services. While helpful for supporting veterans and some of the general population in obtaining employment, these initial acts limited the provision of VR services to people with specific disabilities.

The federal government passed subsequent amendments to these acts in 1943, 1954, and 1965. Overall, these amendments:

  1. Provided VR services to a greater diversity of disability types;
  2. expanded infrastructure for VR centers;
  3. diversified the types of services VR could offer; and
  4. increased funding for the public VR system as it grew in popularity across the United States.

By the end of the 1960s, the VR system was streamlined to serve tens of thousands of people with disabilities, while its earliest iterations only served thousands. Disability rights activists around this time began lobbying for a renewed focus on serving people with the most significant disabilities.

Enacting the Rehabilitation Act of 1973

In response to these sentiments, President Nixon signed the Rehabilitation Act of 1973. There are seven titles in the Rehab Act. A few of the great things the Rehab Act achieved was:

  • creation of Independent Living Services Program; the Centers for Independent Living Program; and the National Institute on Disability, Independent Living, and Rehabilitation Research;
  • renewed focus on VR service delivery to people with the most significant disabilities;
  • customization of VR services to meet the individual needs of people with disabilities; and
  • reduction of physical barriers to attaining employment.

Section 504

One of the reasons the Rehab Act is so famous is found in Title V. This title is a civil rights provision – the first civil rights legislation for people with disabilities in the United States. The standards established in this title were used in Title I of the Americans with Disabilities Act. Section 504 of the Rehab Act is particularly important for youth and young adults with disabilities, the focus of CAPE-Youth’s work.

Section 504 states:

No otherwise qualified individual with a disability in the United States, as defined in section 705(20) of this title, shall, solely by reason of his or her disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance or under any program or activity conducted by any Executive agency or by the United States Postal Service.

Simply, Section 504 makes it illegal for the government, and any program or organization using government funding, to discriminate against individuals with disabilities in employment practices or in program participation.

Regulations for enforcing Section 504 of the Rehab Act were only passed after a protest movement of the disability community. The movement included many young adults and people from varied backgrounds who demanded 504’s implementation and full civil rights.

Equal Access to Education

The education system is one of the largest entities in the United States receiving federal funds. For youth and young adults with disabilities, Section 504 requires education systems to provide reasonable accommodations to promote equal access to all aspects of the educational experience while in school.

Outside of the classroom, Section 504 regulations mandate the accessibility of school buildings and facilities to students with disabilities. In the classroom, Section 504 defines a qualifying student with a disability. This definition serves as the guideline for who has access to receiving a Free Appropriate Public Education (FAPE) under the Individuals with Disabilities Education Act (IDEA). Providing a FAPE entails accommodating students with disabilities so they can participate and benefit from the educational environment to the same extent as nondisabled students. Because of Section 504, schools now identify students that are eligible for specialized accommodations because of their disability, then outline what services should be provided. Schools also have procedures in place to evaluate the effectiveness of supports and rework accommodations if needed.

A 504 plan is a document outlining the accommodations, interventions, and resources a student with a disability needs to successfully perform in a generalized education setting. This is usually administered by school staff in consultation with a 504 team made up of teachers, guidance counselors, and a parent/guardian. A 504 plan operates similarly to an Individualized Education Program (IEP), but outlines changes that can be made to the learning environment instead of accommodations related to the curriculum.

When students reach the postsecondary level, or college, many of the federally mandated supports from the high school level no longer apply. However, these students with disabilities are still protected under Section 504, which requires Institutions of Higher Education receiving federal assistance to provide necessary supports for students with documented disabilities. Postsecondary accommodations under 504 are available through an application process, which vary depending on institutional requirements. Generally, students share any documentation of their disability with a disability services representative and work with them to determine what they need for success in a postsecondary environment.

Equal Access to Workforce Services

Section 504 also has implications for students entering the workforce. It says that employers who receive federal funding (i.e., covered employers) cannot discriminate against qualified applicants with a disability. For example, Section 504 limits covered employers from asking medical questions about a disability during the job application process.

Section 504 also requires covered employers to provide reasonable workplace accommodations and supports to employees with disabilities, as needed and requested, as long as the accommodations will not create an undue hardship. Regulations also prohibit an employer from retaliating against employees who ask for accommodations. The protections and requirements of Section 504, paired with the vocational training resources put in place by other sections of the Rehabilitation Act, provide a network of resources for youth and young adults with disabilities to access the workforce.

To learn more about the protections of Section 504, click here. To stay up to date with CAPE-Youth, follow @CSG_CAPEYouth on Twitter/X and like CAPE-Youth on Facebook. If you have questions about the policies or programs in your state that support youth and young adults with disabilities, check out our website or submit a free request for technical assistance.