opioids, maternal health, pregnancy, Medicaid, innovation


Objective As we enter the third decade of the opioid crisis, opioid misuse continues its devastating toll on young women, specifically mothers on Medicaid in rural areas. The evolving Medicaid policy landscape has led to coverage and benefit expansion, yet gaps remain for pregnant women with opioid misuse. Further, the myriad of state specific policy decisions related to maternal eligibility and substance abuse benefits have created a seemingly disjoint policy arena for tackling a specific subgroup’s unmet needs. This policy scan aims to investigate the newly implemented 1115 demonstration model for Maternal Opioid Misuse by comparing the approaches of four rural states.

Methodology All documentation for each demonstration model and waiver were reviewed and analyzed for rural specific content. Policy language referencing rurality or rural concepts were then identified, categorized, and codified for comparison across the four sample states. Finally, policy and programmatic approaches which were inherently rural were identified and compared between the four states. This analysis concludes with a brief synthesis of the results, as well as a discussion on what gaps may remain.

Results Of the two states submitting 1115 Waivers, both (IN, MO) expand eligibility to Medicaid for mothers with opioid-use disorder, but only MO expands Medicaid benefits. Of the three states (CO, IN, ME) implementing the demonstration model, two (CO, IN) leverage health insurance payers as partners while ME partners with local health system providers. Three states (CO, MO, ME) add telehealth and peer support services as authorized Medicaid benefits for mothers with an opioid-use disorder. Only ME used the innovation model to authorize Medicaid to reimburse, provider-to-provider telehealth capacity building models.

Conclusion This study highlights and reaffirms the variation in Medicaid policy at the state level. Expanding Medicaid benefits to reimburse necessary telehealth and peer support services may help address service availability gaps in rural regions. Future research should leverage the continual expansion of these MOM models, especially evaluating differences between rural and non-rural outcomes. The excessive morbidity facing these young mothers warrants prompt evaluation and dissemination to promote diffusion across the country until this public health crisis is fully extinguished.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.