Season 2, Episode 1 North Carolina Pregnancy Medicaid Extension Update

 Want a better understanding of Medicaid Extension and postpartum care in North Carolina? This is the episode for you! Listen in to hear Dr. Velma Taormina and Brianna Monk, MPH discuss the extension and the nitty gritty of its direct effect on our postpartum patients.
Show notes:
Postpartum Mediciad Flyer (ncdhhs.gov)
Postpartum Medicaid Flyer (Spanish) (ncdhhs.gov)
Postpartum Extension Provider Fact Sheet: download (ncdhhs.gov)
Postpartum Extension  Provide and Beneficiary FAQ:
Frequently Asked Questions for Beneficiaries | NC Medicaid (ncdhhs.gov)
Postpartum Coverage Extension Frequently Asked Questions (Provider) | NC Medicaid (ncdhhs.gov)
Medicaid Enhanced E Pass Information
Knowl

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https://redcap.mahec.net/redcap/surveys/?s=XTM8T3RPNK 

Transcript

Podcast Recording- NC Medicaid Extension-20230206 1622-1 edited pi 653 (1)

Intro [00:10]: Hi everyone. Welcome or welcome back to just us before birth and beyond. We're so glad to have you here with us today. For those of you who don't know me, my name is Katlyn and I have been a nurse in Western North Carolina for the last 10 years. I've done a little bit of NICU, a little bit of labor and delivery, and some outpatient OBGYN office nursing, and now my job is to provide equitable and evidence-based education and resources to providers and birth workers in Western North Carolina, and that is why I am here today. So, did you know that Medicaid extended benefits to cover patients through the entire year postpartum in 2022? Did you know that now the federal government has given states the option to make this change permanent? Would you like to know how to make sure your patients are aware of these changes? Would you like to know even more about this Medicaid extension? That is why we're here today. That is what this episode is about. So, if any of these things pique your interest, please stay tuned and listen in and we hope that you enjoy.

Caitlin Tanner [01:18]: Good morning. My name is Katlyn Tanner and I will be your host for this episode. I am in the world of perinatal health for the last almost 10 years, I've been a nurse for a whole decade. Makes me feel a little old. Anyway, enough about me. We are here today with Brianna and Dr. T is what I'm going to call her. I'm going to give them both a few minutes to introduce themselves in just a second, but we're so excited to have them both here today to talk to you about the Medicaid extension for postpartum care. We did an episode on this in our last season of the podcast, which we'll have down in the show notes below if you would like to listen to that first episode that we recorded, and today we're here to have some updates to review a little bit about what this Medicaid extension means for our postpartum patients and the postpartum period. We're hoping to get a little bit of data information to see how this extension is affecting our patients and the quality of care that we are able to give here in the wonderful state of North Carolina, and I'm sure there's a lot more information that is coming your way that I don't even know yet, which is why again, we're so glad to have them here with us today. So, Brianna, and Dr. T, would you guys like to take a moment to introduce yourselves and say hi to our audience?

Brianna Monk [02:52]: Absolutely. Hello everyone. We are excited to be here. My name is Brianna Monk. I am the communications and engagement manager here at North Carolina Medicaid. My role is to expand my knowledge of the extended postpartum benefit, and I do this by working closely with our partners and provider groups to make sure we are incorporating any feedback that we are receiving in the development of any educational materials as well as throughout the entire engagement process. So, happy again to be here, thanks for having us.

Dr. Velma Tarnina [03:29]: Hello everyone. I am Dr. Velma Tarnina, known as Dr. T. So, feel free to call me that. I am a board-certified OBGYN, and I have practiced in the state since 1996, Caitlin, so I'm a little beyond you. I have worked in all types of practice settings, but my heart lies in public health. I am currently the associate medical director consultant for Women's health at the North Carolina Division of Health Benefits, otherwise known as North Carolina Medicaid so, thank you for having us.

Caitlin Tanner [03:57]: All right, thank you all again. We're so glad to have you here. So, I'm going to open the conversation up with kind of doing, as I mentioned before, a little recap of what exactly it's we're talking about. So, I think the official term is the omnibus bill, is that how I say it, Dr. T?

Dr. Velma Tarnina [04:18]: That's right. It's technically the 2023 Consolidated Appropriations Act known as the honor for this bill, and that was signed into law on December 29th, 2022. So, this is.

Caitlin Tanner [04:31]: Now, this is a little bit different than the initial extension that started in April of last year. Is that right?

Dr. Velma Tarnina [04:39]: Yes. So, the original one was good for five years. So, in North Carolina, our program was set to expire in 2027. But what this does is that it now allows states to choose to make this permanent in their state, but it will require state legislation and federal approval. So, we're hoping that the North Carolina legislature will make it permanent so that it does not expire in 2027.

Caitlin Tanner [05:05]: Okay. So, what I'm hearing is last spring Medicaid extended benefits to pregnant patients to cover them for the entire year postpartum, and this is postpartum visits, primary care, behavioral health, any specialist they need to see, they were able to stay enrolled in Medicaid and get those things covered for that year after delivery, and now with this new bill, you're saying that this actually, instead of just going from 2022 to 2027, which is what the first part of this allowed, we're looking at possibly being able to make it permanent?

Dr. Velma Tarnina [05:42]: That's correct. But it's not automatic. So, it will require some additional work in our legislature, but we're hoping that in the next four years that we can make that happen.

Katlyn Tanner [05:51]: This is amazing.

Dr. Velma Tarnina [05:52]: I believe.

Caitlin Tanner [05:53]: We talked about that with the last time we did in that first episode, as I mentioned, and that was a hope that we had, that it was something that eventually would be able to keep going forever, and now to have that opportunity is just amazing. I just want to take a moment to offer gratitude for all the work that you all have been doing at the state to make this possible, and also a moment to just acknowledge that hey, dreams can come true we just got to put in a little bit more work and we can make this work for the women and patient of Western North Carolina and the state as a whole of course. So, again, this new extension started spring of last year, so in 2022 since then, does Medicaid have any new data to share on the benefits or have we been able to see any difference in care, any improvement in care since this started last year?

Dr. Velma Tarnina [06:45]: Well, the answer is yes and no. So, if we're looking at just the period from April 22 onward, then it hasn't been long enough to do data analysis on that period because you have to allow that full year plus an additional four months to make sure that all of the care that's been provided, that the claims have been submitted and processed. What Medicaid has done is done a retroactive look back in time because if you can recall what the public health emergency, you know, that allowed funding to come to the states, but in order to receive that funding, the state could not disenroll individuals. So, we had this extended postpartum benefit for almost three years now.

Katlyn Tanner [07:30]: Wow, okay. So, it sounds to me like we're looking at the data that came out of the Covid 19 public health emergency, and we're hoping that the trends we saw during that time will then carry over because of this extended postpartum coverage. Do you have any numbers or projections that you guys have been able to look at?

Dr. Velma Tarnina [07:53]:  We do, and they're hot off the press. So, I mean, I think this just came out in the last four to six weeks. So, Medicaid did look at the time between January of 2019, sopre-pandemicc and then through May of 2021, and what we did see was approximately an 11% increase in the proportion of postpartum individuals that had a primary care provider visit within one year after their delivery, and then we also saw a 7% increase in the proportion of postpartum individuals with a behavioral health diagnosis that then had a behavioral health visit again within one year after their delivery. So, that was reassuring to us that members were hearing about this extended coverage and that they were utilizing those benefits, and we're hoping that with the time that has passed since then and with increased communications such as this podcast, we will continue to educate our members going forward so that we will see those numbers continue to increase over time.

Katlyn Tanner [08:55]: That's so encouraging. So, we've talked a little bit now about the logistics and the extension and some of the positive data that's coming from it and the exciting news that we're hoping, you know, we've been given the opportunity to make it a permanent change in the world of Medicaid. Do you mind if we sort of go back in time a little bit and dig into what exactly this full coverage during pregnancy and that 12 months after what it means for the beneficiaries or the patients who are qualifying for these benefits?

Dr. Velma Tarnina [09:32]: Sure. So, if we think back in time before this went into effect we had some Medicaid members who had full Medicaid, which means that they had full coverage, but approximately half of our pregnant members had Medicaid for pregnant women. So, that was a limited benefit policy that gave them care with conditions that were specifically related to pregnancy but didn't offer the full spectrum that full Medicaid has. So, what this change did is that it now offers everyone full North Carolina Medicaid coverage both during their pregnancy and for 12 months after the end of their pregnancy.

Katlyn Tanner [10:13]: Oh wow. Okay. And I mean we're talking like we mentioned before, primary care, specialty visits, behavioral health, which is a huge topic right now in the world of maternal health as it should be. Are there any other benefits that this also allows? I feel as though social determinants of health is a really big conversation, we're having in healthcare right now and addressing the things that are happening in our patient's life, maybe outside of their direct physical health or mental health that still affects how they're able to get care when they're able to get care. Are there any added benefits to this extension that maybe addresses some of those outlying causes for gaps or needs?

Dr. Velma Tarnina [11:01]: Yeah, so when I look at that population, especially the ones that have, that are in the Medicaid for Pregnant Women program, initially the other thing that we had happening at this time is that we transitioned to managed care Medicaid. So, what we now have is that beneficiaries, they're are all now enrolled with one of the North Carolina Medicaid managed care companies. So, they have the advantage of being able to offer other services that traditional Medicaid could not do before. So, if you go to each of their websites, you will see that they'll have a laundry list of added benefits that are specific to each company. But for instance, I mean you can get vouchers for your local farmer's market. You can get transportation assistance to the pharmacy to go and pick up your medications.

They have cell phones with data plans, diapers, and doula services. I mean, there's a whole list of add-on benefits and you may not be eligible for all of them, but on the other hand, you would need to reach out to that respective managed care entity to see which ones you qualify for and how do you enroll in that program. For me personally, I love the fact that I think all of them offer assistance with getting your GED. I am strongly prepared for education and just the fact that they will help you with that. I think's just again, you're looking at what are the other determinants that are going to improve their healthcare, and that is just a simple list of some of the extra benefits.

Katlyn Tanner [12:39]: And just to be clear to our audience, beneficiary, and patient, correct me if I'm wrong, are interchangeable. That's why they kind of mean the same thing. Beneficiary is sort of insurance world term and then the patient is more of the clinical office visit kind of term. So, I guess my question is, if I can figure it out, my goodness Kayla, how do our patients know about these benefits? And are they being tracked, do you feel that the utilization rate of these perks, if you'll is being tracked, how can we share this information with our patients? Because I had no idea, especially like you said, the GED thing, I mean education is a realm of social determinants of health that I don't always go to immediately versus I do transportation or food or housing or things like that. So, how can our patients make sure that they are taking full advantage of what their insurance is now offering?

Dr. Velma Tarnina [13:40]: Well, I encourage everyone to go to their plans homepage and to look at the benefits. So, on one hand, each of the plans should have sent them communications about what these add-on benefits look like to them, especially when they acknowledge that they're pregnant because some of the benefits are specific to pregnancy, but every one of their homepages has a section that's called add-on benefits or something similar to that, and if they can just become familiar, number one with knowing who their plan is. So, do you have healthy blues? Do you have complete health? There are five different entities so they need to know, number one, who they have and then get on either their smartphones or their computers and look up what those benefits are. We're hoping that provider offices can also help by printing out the fact sheets that some of the health plans provide so that they can hand them out to their offices. DSS can assist them with that, by letting them know, number one, who they're enrolled with, and number two, how to get that actual information.

Caitlin Tanner [14:46]: Awesome. And this is information, we as healthcare providers and birth workers love to have because it is, a lot of times I feel patients do come to us and ask us questions about their insurance that a lot of times we can't answer because there are so many plans, and so many different things. So, to be able to give our patients, listen, here is who. You call the number on the back of your insurance card, and they have a webpage. To have all this information is so helpful, not only for our patients but for us. So, we can direct them to the right place. So, speaking of providers and birth workers, other than sharing this information with our patients and making sure that they understand where they can go to be a part of their health, and the benefits that they're getting, what can providers do to help their patients who have North Carolina Medicaid?

Dr. Velma Tarnina [15:42]: So, how long do we have, I can talk about this forever, the simple thing is just to make sure that you have processes in place in your office to capture, number one, who are you providing prenatal care to? And then having a tickler system of some type that prompts you to know who should have delivered in the last, say four to six weeks, and making sure that you have a process in place for reaching out to them and making sure that they come back in for the visit. Because if they don't come in for that postpartum visit, then they may be so overwhelmed with life in general that before they know it, six to eight months have gone by and they haven't been able to fully utilize this benefit. So, developing a tickler system of some type is very important. You know in my world of working in the local health department, none of the local health departments provide deliveries anymore. So, although many will provide prenatal and postpartum care, they don't do the deliveries. So, it's going to be even more important in that setting to make sure that they have a way to follow up with those individuals to make sure that they have an appointment.

Katlyn Tanner [16:55]: I love the term, was it tickler?

Dr. Velma Tarnina [16:58]: A tickler system.

Katlyn Tanner [16:59]: A tickler system. I love that. How joyous, A joyous way to describe a reminder, that hey, patient delivered. Have they come back for their postpartum visit? If not, let's reach out, let's check in, let's make sure that they're okay. And again, that they know about the benefits that they now have through this extension and make sure that we're doing all we can to help them understand how to utilize those benefits, and I believe as well that links into the community resources that are available because, we know that as healthcare providers seeing multiple patients a day, it's sometimes we need help from the community and community resources to get our patients the help that they need. So, I just wanted to highlight again, and maybe even if you have a couple of examples of how this new extension helps get patients to those community resources to help stabilize or resolve any conditions that maybe they wouldn't have had access to before this extension because that postpartum coverage ran out in that first 12 weeks.

Dr. Velma Tarnina [18:10]: Yes. I mean, there are so many things that we need to consider, when I have an individual in front of me at that postpartum visit, you know, and again, we used to historically think that we wanted to see them like six to eight weeks after delivery, but we now want you to bring these individuals in two to three weeks after delivery. Number one to make sure that they're doing okay. I mean they've got this beautiful new newborn that they've brought into their life. So, how's the newborn doing? How are they doing? But then most important is doing what I call a comprehensive assessment of what their needs are, both clinical and non-clinical. So, if I'm looking at it from a non-clinical perspective, first I would say just again, going over what you traditionally think of as the social determinants of health.

Do they have safe housing? Do they have enough food? Do they have transportation to get where they need to go? Just those basic things but then as the clinician, making sure that I am fully aware of what their medical conditions look like holistically. So, what did they come into that pregnancy with? What new medical conditions came up during their pregnancy, during their delivery, or now in the postpartum period? And most importantly those conditions that came up, what resources do they need from either a primary care provider, a behavioral health provider, or a specialist of some type in the next 10 to 12 months so that we can ensure that either their next pregnancy is going to have the best luck with, not luck, that's not the right word, so you can go into the next pregnancy and the best physical and mental state that you can.

So, making sure that any chronic medical conditions are stabilized and under treatment as they head into a future pregnancy, or if they've decided that they have completed their family, what is it that they're going to need basically to put them in the best physical state for the rest of their lives. What chronic medical conditions are going to impact them 10, or 20 years down the road Make sure that they have the referrals to a primary care provider or to a medical specialist that they need to make sure that those conditions are identified, reviewed, and that we have a management plan in place for the future.

Katlyn Tanner [20:37]: Dr. T thank you so much for that wonderful explanation of these benefits and the changes in how we as healthcare providers and birth workers can help our patients take advantage of all these wonderful additions to our Medicaid plans. So, we're going to switch gears a little bit and hear from Brianna, who, if you remember from the beginning of the episode, introduce herself and talked a little bit about the work she's doing, which revolves heavily around communication and community engagement. So, Brianna, my first question to you is, what can community organizations do to help spread the message, and why is it important that we get our communities, you know, even outside of the healthcare community involved in sharing this information and getting the word out there about these amazing changes?

Brianna Monk [21:26]:  Yeah. So, Dr. T has just shared so much important information today related to this new extension of postpartum care benefits. So, NC Medicaid, we recommend that community organizations use educational materials that we have available on our website to help spread the message and promote this new benefit extension to their community members. Our community organizations we've worked with in the past have also leveraged a lot of these materials to promote the new extension on their social media platforms and newsletters and on their websites, and we've noticed a lot of beneficiaries and, and those who are taking advantage of these benefits come back and just tell us that they may not have known again about some of the benefits that Dr. T went over extended benefits that Dr. T went over earlier that may be covered under full NC Medicaid coverage, and so that's really why it's so important to get the word out about this new postpartum extended benefit. We are also in the process right now of developing a social media toolkit for our partner organizations that will be available to download and continue to share this messaging. So, kind of an easier process there for our partners.

Katlyn Tanner [22:49]: That's awesome, and to carry it into social media, I mean, it's so practical. I mean, it's the world we live in, although I'm going to tell you all I do not have a social media account. I think I'm one of the last people on earth.

Brianna Monk [23:00]: Oh, no.

Katlyn Tanner [23:02]: I don't have any of it, but I see the importance of it, and the importance of this is where the audience is. So, this is where we have to go to get this word out. So, I commend you all for moving that over to the social media world. I don't feel like you see that a lot in state government or state organizations. So, I mean that's awesome and a great way to get the word out. Brianna, you also mentioned that there are some educational materials available for providers, community organizations, and faith-based organizations. Do you want to tell us a little bit about what those educational materials kind of look like?

Brianna Monk [23:39]: Yeah. So, NC Medicaid has developed several educational materials, and we did this in partnership with our provider groups that we work closely with and community organizations, and we held focus groups, and gathered feedback and we encourage our partners again to review these materials to become more familiar with the benefit, and these materials include a beneficiary friendly fact sheet frequently asked questions document, and we've also developed a postpartum extension flyer that's available on our website to share out, and that also includes a QR code that links back to our website for more information, all of our materials are available in both English and Spanish, and the webpage also does include some very important background information just on the postpartum benefit, and again, just on those who may be eligible to apply for the benefit.

Katlyn Tanner [24:37]: So, much great material to get the word out, and guess what listeners, you better believe we will have all these things linked in the show notes. So, if you're driving, you're in the grocery store, please do not panic. We will have all this information linked and it'll be at your fingertips. You'll just need to jump down in those show notes and click the links. And Brianna, am I correct if there are questions or further information that someone needs, is there a way to reach out to you all or communicate with the department to ask maybe questions that aren't covered in some of the packets or educational handouts?

Brianna Monk [25:12]: Yeah. So, NC Medicaid welcomes all opportunities for collaboration. We are a resource for all of our partner organizations, provider groups, and faith-based organizations. If you have questions or you need help spreading the word, definitely reach out to us. We can collaborate with you all to spread the word on this new postpartum benefit providers and community organization groups can send in an email request for our team to come and present during a webinar or a community event in the community, and those requests can be sent to Medicai.NCengagement@dhhs.nc.gov, and again, as you mentioned, it will be linked and community organizations and providers can also contact our NC Medicaid contact center for support if or if they need more information, and they can be contacted at 888-245-0179 and they will be able to assist and provide more information if they have questions about this postpartum extension benefit as well.

Katlyn Tanner [26:28]: Amazing. We'll have all this information again, linked down in the show notes. So, an amazing way for healthcare workers and community partners, and leaders to reach out and help share the word. So, if you're listening to this and you have, have an upcoming event or a series or some platform that would give you the opportunity to share this information, we highly encourage you to reach out to these amazing folks and help us spread the word. How about on the side, is there a way, an easy way, I know we talked about using the insurance card and calling the number on the back or going to the webpage or contacting the DSS office for patients to get more information about their benefits and what it means to have this extension. Are there any other ways that we might encourage patients to understand their benefits better?

Dr. Velma Tarnina [27:23]: Again, I would encourage them to go to the NC Medicaid beneficiary portal to just read about what those benefits mean, but I would also encourage them to enroll and get an enhanced EPASS account. One of the struggles that we heard from our beneficiaries was how hard it is for them to either get back to their local DSS office in person or play phone tag with their case worker. So, one of the things that Medicaid has just released on their beneficiary portals is the ability for beneficiaries to report changes such as the birth of a baby or any changes in their circumstances they can do that online now instead of having to go to their local DSS. So, that's called an enhanced EPAs account. Again, we can, we'll give you the links and you can put that in the show notes, but just from the struggles that someone has, especially there and the first 10 days, it's just one less thing for them to have to leave the house for.

Katlyn Tanner [28:26]: Amazing. So, yes, Dr. T again, she is right. We'll have it all linked. All, of it, I believe that we have come to a time together. Thank you both again so much for sharing all this amazing information and for being part of the team that is actively working to get the women and birthing people in the state of North Carolina, the benefits and the help that they need to have the healthiest, not only pregnancies, but also postpartum periods. Thank you all so much for your time, and we look forward to catching up.

Dr. Velma Tarnina [29:01]: Thank you.