Medicaid Expansion Could Benefit Michigan Babies

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Too many Michigan infants are dying: Roughly 800 Michigan babies died in 2010. The state’s infant mortality rate has been higher than the national average for two decades. Its 2010 infant mortality rate (7.1 deaths per 1,000 births) ranked 37th among the states.1 Medicaid expansion could help reduce Michigan’s high infant mortality rate.

The infant mortality rate is one of a number of measures tracked on the MiDashboard as an accountability strategy initiated by the governor.2 It reflects multiple factors such as maternal health, health care access and quality as well as socioeconomic conditions. The infant mortality rate is an overall indicator of the quality of life in Michigan because it represents the well-being for the state’s youngest and most vulnerable citizens—infants.

RACIAL ETHNIC DISPARITIES PERSIST

 The most glaring disparity in infant mortality rates is between African American infants and white non-Hispanic infants: 14.2 per 1,000 live births compared with 5.5 deaths per 1,000 for white babies.

Low-birthweight—under 5.5 pounds—is considered to be the most important factor explaining the racial disparities between African American and white infant mortality rates. African American mothers have roughly double the low-birthweight rates of white mothers—14% compared with 7% among white mothers.

INCREASED ACCESS COULD REDUCE RISK

The Medicaid expansion, which the federal government will fund at 100% from 2014 through 2016, under the Affordable Care Act extends eligibility to all individuals with an income under 138% of the poverty level.3

Roughly half of all Michigan births were eligible for Medicaid in 2010. The problem is that almost half of these uninsured low-income women, who are at the highest risk for unhealthy births, were eligible only during the pregnancy.4 The Medicaid expansion would allow access to care for more women before and between pregnancies, improving women’s health, birth outcomes and overall infant/child health.

Over a quarter of the newly Medicaid eligible in Michigan due to the Affordable Care Act are women are of childbearing ages (19-44).5 Medicaid expansion in conjunction with policies that work to improve the health of women and mothers could substantially improve birth outcomes.

Expanded eligibility for Medicaid family planning services could also mean significant cost savings for the state. Roughly 60% of women eligible for Medicaid delivery reported their pregnancies were unintended, compared with 27% of privately insured women.6 The estimated state minimum cost of each Medicaid birth is roughly $11,000 without complications.7

More than two of every five infant deaths in Michigan occur within the first 24 hours of birth.8Preterm birth (less than 37 weeks), low-birthweight and inadequate access to prenatal care all put babies at a higher risk of death in their first year.

Research has connected factors including nutritional deficiency, smoking, low maternal pre-pregnancy weight, single motherhood, socioeconomic status and race to low-birthweight.

In 2011, roughly 30 percent of all Michigan births were to mothers who had received less than adequate prenatal care, as measured by the month care began and the number of prenatal visits.

MICHIGAN IS ADDRESSING INFANT MORTALITY

The Michigan Department of Community Health received roughly $800,000 in fiscal year 2013 to begin implementing the Infant Mortality Reduction Plan. For fiscal year 2014, the governor recommended $2.5 million to continue those efforts. Progress so far included the following:

  • Development and implementation of an Adolescent Health Risk Behavior Assessment with the MI Quality Improvement Consortium to reduce unintended pregnancies.
  • Work in high-risk communities to use evidence-based teen pregnancy prevention programming.
  • Production and distribution of public service announcement to promote safe sleep practices in partnership with the Department of Human Services.
  • Update and promotion of safe sleep online training for health and child care providers.
  • Implementation of a Medicaid policy to require birthing hospitals to use evidence-based guidelines for elective delivery before 39 weeks to eliminate medically unnecessary early deliveries. 

WE CAN DO MORE TO REDUCE INFANT DEATHS

Contact legislators to:

  • Support the Medicaid expansion with full benefits to be included in the Community Health FY2014 appropriations bill (HB4213).
  • Approve the Governor’s recommended $2.5 m to implement the Infant Mortality Reduction Plan.

Support policies to:

  • Implement a lifespan approach to maternal and child health by improving women’s health well before conception and between pregnancies.
  • Address and target reducing infant mortality rates in communities of color.
  • Ensure timely prenatal care for all women.
  • Expand access to treatment for chronic diseases, oral health, mental health, and smoking cessation for pregnant women, all of which are associated with poor birth outcomes.
  • Implement PRIME—Practices to Reduce Infant Mortality through Equity—by developing a core curriculum, toolkits, and workshops on combating racism and fostering individual and corporate strategies to educate the public, and health and human services staff on the social determinants of infant mortality.

ENDNOTES:

 1. Data are the latest available from the Michigan Department of Community Health and KIDS COUNT Data Center. [http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?loct=2&by=v&order=a&ind=6051&dtm=12719&tf=133.
2. The 2012 rate cited on the Dashboard is actually the 2008-09 average rate in the 2012 report from America’s Health Rankings. [http://www.americashealthrankings.org/About/SummaryDescriptionofallMeasures]
3. G.M. Kenney et al. Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Coverage? The Urban Institute, Aug. 2012. [http://www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf]
4. Michigan Department of Community Health. Pregnancy Risk Assessment Monitoring System Survey Data. Lansing, Michigan: MDCH, Lifecourse Epidemiology and Genomics Division, 2010 
5. The Urban Institute. Op. Cit.
6. Michigan Department of Community Health. Pregnancy Risk Assessment Monitoring System Survey Data, 2010.
7. Michigan Council on Maternal and Child Health. Does Pregnancy Prevention Funding Work?
8. Jane Zehnder-Merrell. Kids Count in Michigan Data Book 2011. Lansing. Michigan League for Human Services. Page 12.