Policy Brief outlines plan to reduce Nebraska infant mortality rates

The ALIGN Nebraska Prenatal Care and Infant Mortality Policy Brief, funded by UnitedHealthcare and the University of Nebraska Medical Center College of Public Health, was recently released by an innovative partnership of health organizations aiming to decrease infant mortality rates in Nebraska.

The release of the Policy Brief marks an important first step toward that goal by authors including Partnership for a Healthy Nebraska, the Nebraska Perinatal Quality Improvement Collaborative, and the University of Nebraska Medical Center College of Public Health.

The Policy Brief identifies barriers to care and makes recommendations to improve early and adequate access to prenatal care, reduce preterm births and NICU admissions, and ultimately lower Nebraska infant mortality rates.

Two goals cited in the Policy Brief are:

• Reducing Nebraska’s infant mortality rate from 5.5 deaths per 1,000 live births in 2020 to <4 deaths per 1,000 births by 2030.
• Increasing the receipt of early and adequate prenatal care for Medicaid covered births in all Nebraska public health districts to >80% by 2025, which will contribute to achieving a reduced infant mortality rate.

How Nebraska infant mortality rates rank compare with other states

While the infant mortality rate in Nebraska is near average compared with other states, the partnership is dedicated to reducing the rate further.

In 2020, the latest year for which data is available, the Centers for Disease Control and Prevention (CDC) ranked Nebraska 26th out of 50 states with an infant mortality rate of 5.5% per 1,000 births. The lowest infant mortality rates were in California (3.92%), Massachusetts (3.94%), and Rhode Island (3.96%). Mississippi had the highest ranking for infant mortality at 8.12%.¹

Increasing prenatal care for Medicaid-covered births in Nebraska

According to 2020 statistics cited in the Policy Brief for births with Medicaid as payment source: 12 of the 19 public health departments in Nebraska were under the >80% goal for births with adequate prenatal care.

However, 8 of those 12 were not significantly under, being 75% or better. The two lowest public health departments were 67.1% and 69.5%.²

The partnership’s plans for progress will help those 12 departments improve their percentages and help Medicaid-covered pregnant receive early and adequate prenatal care. All Nebraska public health districts would benefit from improved prenatal management of hypertension and diabetes, which would potentially reduce preterm births and NICU admissions.

Medicaid covered more than one-third of Nebraska births in 2020

Out of 23,480 total births in Nebraska in 2020, Medicaid covered 34.6% of births (8,119); Private Insurance covered 59% of births (13,854); and Other covered 6.4% (1505).³

Coverage costs include prenatal care, birth, and postpartum care. An eligible pregnant person remains Medicaid eligible through a 60-day postpartum period, and there is continuous eligibility for the newborn through their first birthday.⁴

The Policy Brief notes, “Although Medicaid managed care plans have programs to assist pregnant women with social barriers to access care and services, there are often significant delays between a woman receiving her first prenatal assessment of risk factors and communication of those risk factors to Medicaid managed care plans or referral. Shortening the time between these events could successfully address some of the identified barriers.”

Barriers to care for pregnant women eligible for Medicaid

Through focus groups and interviews, Policy Brief researchers found varied factors that often limit early and adequate prenatal care for pregnant individuals eligible for Medicaid in Nebraska. These barriers include:

• Awareness: Many people of childbearing age are not aware of Medicaid eligibility.
• Medicaid enrollment difficulties: especially for those with lower health literacy, language barriers, or immigrant/refugee status.
• Employment issues: uncertainty about employee rights and insurance coverage, penalties for taking time off for prenatal care appointments.
• Anxiety/fear regarding care: lack of transportation or childcare while at appointments, limited evening/weekend appointments, adherence to cultural norms against seeking prenatal care in some demographic groups.
• Misunderstandings: concern that applying for Medicaid will affect immigration status or visa applications.

Recommendations for improving data and overcoming barriers

The Policy Brief suggests designing better data delivery to provide the timely information that policy makers need, streamlining Medicaid enrollment for patients, and developing communication initiatives to overcome barriers to prenatal care.

Data delivery:

• Devising systems for more frequent and timely Vital Records hospital births data.
• Developing an updated, evidence-based, universal pregnancy risk assessment that is communicated to Medicaid Managed Care Plans, resulting in more timely referrals for high-risk conditions.

Medicaid enrollment:

• If possible, streamline the application for Medicaid Eligibility and set a goal of <2 weeks from application start to preliminary Medicaid Managed Care Plan assignment while awaiting eligibility determination.

Communication:

• Public education campaigns to make sure all demographic groups are aware of the importance of early and adequate prenatal care. Delivery sites should include K-12 schools, ethnic community organizations, and entities that serve Nebraska refugee populations.
• Up-to-date lists of community resources in all public health districts so that people of childbearing age can more easily access assistance in applying for and receiving early and adequate prenatal care.
• Recruitment and training of people in minority and refugee populations to share curriculums in those populations for community health work, community breastfeeding support, and doula support.

Healthier mothers, thriving babies, stronger communities

Reducing its infant mortality rate to less than 4% will make Nebraska one of the leading states for maternal and infant health, improving the wellbeing of its residents overall.

UnitedHealthcare Community Plan of Nebraska’s funding support for the Policy Brief, together with funding support from the University of Nebraska Medical Center College of Public Health, are integral contributions toward the success of the partnership.

Access to prenatal care is a significant factor in healthier mothers and infants, resulting in better outcomes for families, providers, health plans and Nebraska communities.

Visit HealthyNebraska.org to read the full ALIGN Nebraska Prenatal Care and Infant Mortality Policy Brief.