Category: Access to Health Opinion

Right now is the right time to vaccinate your child against COVID-19

Posted on by Lindsey Fields

This opinion piece originally appeared in the Topeka Capital-Journal on July 1, 2022. Gretchen Homan, M.D., is president of the Kansas Chapter of the American Academy of Pediatrics and former chair of the Immunize Kansas Coalition. David Jordan is president and CEO of the United Methodist Health Ministry Fund in Hutchinson. Pictured above is Elise, a Hutchinson teen who has long COVID.

With August around the corner, now’s the time to make sure our kids are protected from COVID-19 when they return to school. As parents, we want the best for our kids. It’s our responsibility to make decisions on their behalf to keep them healthy, safe and in a position to thrive.

We never expected parenting would involve a global pandemic, school closures, remote learning and protecting children who were not eligible for vaccines.

Thankfully, in recent weeks the U.S. Food and Drug Administration made it easier for all parents to protect their children from COVID-19 by authorizing vaccines for children ages 6 months through 4 years and boosters for children ages 5 through 11.

Thanks to established vaccine science, research, rigorous clinical trials, and ongoing safety monitoring, adults have been eligible to receive COVID-19 vaccines since December 2020. The results have been amazing — reduced risk of death, severe illness, hospitalization, and spread.

Adults helped us return to “normal,” but kids can keep us there. Children share viruses as easily as they share toys. Kids need protection from COVID-19, just as we protect them from other vaccine-preventable infections.

Following the same process, safe, effective vaccines and boosters have been available for children ages 5 to 17. Over 27 million children ages 5 through 17 have gotten a COVID vaccine.

The vaccines are safe and tested

Early on, we yearned for a return to “normal” and knew a vaccine was critical to achieving that goal. Thanks to established vaccine science, research, rigorous clinical trials, and ongoing safety monitoring, adults have been eligible to receive COVID-19 vaccines since December 2020.

The same rigorous authorization process was used for the vaccines for children under 5.

Children can get very sick from COVID-19

Much of what pediatricians do is preventive health care. Vaccines are a crucial part of that. Administered in a moment, vaccines can provide children with lasting protection from devastating illnesses.

To greatly reduce risks to our children, we must prioritize COVID-19 vaccination. However, in Kansas, only 25% of kids ages 5 through 11 and 53% of kids ages 12 through 17 have been fully vaccinated against COVID-19.

Since the beginning of the pandemic, children have accounted for about 19% of cases in the United States. Children are getting the virus.

Although the long-term effects of COVID-19 on the brain and organs are not entirely clear, we know some people, including children, suffer significant long-term complications that hinder their ability to live full lives. As parents, we should embrace the opportunity to vaccinate our children against COVID-19’s long-term effects.

Elise, a Hutchinson teen, was a healthy 15-year-old when she contracted COVID-19. After her quarantine ended, she returned to school. She didn’t make it through the day. She’d developed long COVID. She had no energy and was short of breath.

Seventeen months later, Elise is still attending school online. She can’t sit up for long periods of time without getting dizzy, and she uses a wheelchair to get around. Thankfully, she recently stopped using supplemental oxygen.

It’s normal to have questions about vaccinating your child. Doctors welcome them. If you have concerns about COVID-19 vaccines, please talk to your child’s doctor. We know appointments go quickly; a good way to prepare is to write your questions down beforehand and bring them with you.

As parents, we both chose to vaccinate our kids against COVID-19. We knew vaccination was critical to preventing illness, keeping them safe, and supporting healthy development.

Previous generations of parents were the first to vaccinate children against measles, rubella, and polio. When our children look back, they’ll realize how important it was for their parents to vaccinate them against COVID-19. Join us in doing everything we can to protect the health and well-being of our children.

You can find a COVID-19 vaccine near you at vaccines.gov or by calling (800) 232-0233.

Statement on HB 2387 veto

Posted on by Lindsey Fields

Statement of David Jordan, president and CEO of the United Methodist Health Ministry Fund, on Governor Kelly’s veto of HB 2387:

“Vetoing this legislation protects Kansas taxpayers and the health of Kansans. Enabling the non-partisan reprocurement process of the state’s $3.9 billion Medicaid managed care contracts to continue as planned ensures our program is able to be designed to best meet the needs of our most vulnerable neighbors. The veto also protects public health. I appreciate Governor Kelly’s leadership in vetoing this bill and for putting Kansans above politics.“

Best way to get back to normal? Be fully vaccinated as you engage with the people around you.

Posted on by Lindsey Fields

This opinion piece by Health Fund President David Jordan originally appeared in the Topeka Capital-Journal on April 28, 2022.

Right now, it feels like the COVID pandemic is over.

We’re excited that things are getting back to normal. COVID infections, hospitalizations and deaths are way down. It’s safe enough in most communities to go maskless inside public places. We’re able to watch our kids’ ball games, visit loved ones and see friends more often.

But we’ve already gone back to normal a few times during this pandemic only to be hit by another wave of infections.

The even more contagious BA.2 version of the Omicron variant is fueling another wave of cases in Europe and Asia. Cases are already rising in the United States and parts of Kansas. This is raising concerns that another wave may follow here.

The pandemic has been particularly hard on rural communities. Compared with urban areas, rural areas have endured higher COVID infection and death rates. This is in part because people in rural areas are typically older, more likely to have underlying health conditions and often live far from health care facilities.

Our rural Kansas communities are also less protected because we’re less likely to be vaccinated. Currently, 61% of eligible Kansans are fully vaccinated, compared with the national rate of 66%. Overall, the vaccination rate in rural areas has lagged more urban areas.

Another wave of infections will also put more stress on our already stressed rural health care system. Many rural hospitals face staffing challenges; an influx of patients with COVID makes it harder to provide the care our rural communities need.

Now’s the time to prepare for another possible wave.

Those of us who live in rural communities pride ourselves on taking care of our own. We look out for our neighbors and lend a helping hand when they’re in need. We check on neighbors when they’re ill.

The best way we can help keep one another safe is by getting all the recommended doses of a COVID vaccine. We’re fortunate to have safe COVID vaccines that work really well to prevent serious infections, hospitalizations, and death. Getting vaccinated also helps protect children under 5 who can’t get vaccinated yet and our most vulnerable, immunocompromised neighbors.

Just as important, vaccination allows us to continue living our lives normally with reduced risk of serious illness.

Father Bob Schremmer spent 45 years as a minister in southwest Kansas. That time taught him to be grateful for your neighbors and your community. Schremmer thanks others for getting vaccinated so that those individuals, their families and their communities can be safe. Getting vaccinated is an act of charity that helps protect others who can’t get vaccinated and who rely on us for protection.

It’s normal to have questions about vaccines. Seek information from credible sources, such as your family doctor or other health care provider. They can answer your questions about vaccines and boosters. You can find information about vaccines in your area at vaccines.gov.

Dr. Bob Kraft’s patients in Salina have heard a lot about the COVID vaccines, and they’ve asked a lot of good questions before making their choice to get vaccinated.  Kraft says: “I’ll share with you the same thing I do with my patients: The COVID vaccine is safe, tested, and free. It’s the best way for us to get back to normal. Here in Kansas, a vaccine has been reserved for you.”

Expanding KanCare would strengthen rural health care, rural communities

Posted on by Lindsey Fields

This commentary by Health Fund President David Jordan on strengthening rural health care through KanCare expansion originally appeared in the Wichita Eagle on March 9, 2022.

Kansas is a rural state with nearly one-third of the population living in rural communities. As Kansans we take pride in self-reliance and taking care of our own.

Yet Kansans living in rural and frontier areas are more likely to be uninsured than those in more populated communities. Kansans living in frontier communities have the highest uninsured rate in the state (12.9%). When it comes to health care and sustaining rural health systems and communities, we need more than self-reliance. We need health insurance.

Many of our uninsured neighbors are hardworking Kansans who earn too much to qualify for KanCare, the state’s Medicaid program, and too little to qualify for health insurance through the Affordable Care Act. In fact, a single parent of two kids earning more than $4.00 an hour earns too much to qualify for KanCare.

These hardworking Kansans are our neighbors. Kansans like Jim, an uninsured farmer who enjoys working with crops and large machinery. He lost his health insurance after a seasonal job ended. Getting insurance now is beyond his means.

He’s dealing with diabetes and an injured foot. The bones were broken, but Jim hasn’t been able to get it addressed. He calls it a “Catch-22.” He was hurt and needs money to get well, but he can’t work to make money because of the injury.

Without health insurance, Jim is scraping by and going without regular care.

Emergency room care is often the only option for uninsured Kansans like Jim. But hospital bottom lines and viability are threatened if uninsured patients can’t pay bills. Currently, 70 rural Kansas hospitals are financially vulnerable and categorized as at-risk of closing, more than in any other state.

Rural and frontier towns rely on hospitals for health care and to anchor communities.

According to the Kansas Hospital Association, in 2020, 12% of Kansas employment was in the health services sector. The health care sector was the fifth largest producer of total income and of total sales.

For health and prosperity, a sustainable health system is crucial to the future of our rural regions and our rural way of life.

Kansas can take an immediate step to strengthen rural health systems and communities by expanding KanCare, the state’s Medicaid program.

Multiple studies show that hospitals, particularly rural ones, are at significantly higher risk of closure in states that have not expanded Medicaid. A 2018 study published in Health Affairs found “Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion.”

Expanding KanCare would cut our uninsured rate in half. Expansion would boost hospital finances by covering 25% of the uncompensated care in rural hospitals and 44% in frontier hospitals.

Kansans know expanding KanCare is the right thing to do. Expansion has broad support across geography and political party. A new survey finds almost 8 in 10 Kansas voters (78%) support expanding KanCare.

All neighboring states have expanded their Medicaid programs. Expanding KanCare would keep us competitive — adding nearly 23,000 new jobs to the state’s economy and increasing economic output by $17 billion.

Expanding KanCare would strengthen rural health care and help ensure rural Kansans get the health care they need while improving their economies. The time to expand is now.

Medicaid expansion would help all Kansans

Posted on by Lindsey Fields

The following is an opinion piece by Health Fund President David Jordan.

Eight years of inaction by policymakers have resulted in Kansans paying more for health care, our communities’ ability to deliver health care being pushed to the brink, and billions of dollars in lost economic opportunity.

Today, the Kansas legislature begins its annual legislative session, providing yet another opportunity to expand KanCare, Kansas’ Medicaid program. Kansas is one of only 12 states that has not expanded Medicaid, to the detriment of the 165,000 hardworking Kansans who fall in the coverage gap.

Who’s in the coverage gap?

A Kansas family of three with an annual income of $8,345 makes too much to be covered by KanCare, and too little to receive Affordable Care Act (ACA) marketplace subsidies. In this case, a single mother with two kids who works a minimum wage job 23 hours per week falls into the coverage gap – earning too much to qualify for KanCare and too little to qualify for health coverage through the ACA. 

According to the Alliance for a Healthy Kansas, more than two-thirds of adults eligible for insurance through Medicaid expansion work or are in working families, and most are employed in industries less likely to offer affordable health insurance, such as service, construction, and retail.

At a time when all Kansans are experiencing the pinch of increased costs to provide for our families, health care is no exception. Expanding KanCare would not just benefit those in the coverage gap, it would also help bring down the costs of health care for Kansans and reduce costs for businesses.

As policymakers return to Topeka, it is important to remind them that expanding KanCare is a budget-neutral Kansas-specific policy that would help 165,000 hardworking Kansans who fall in the coverage gap access health care and reduce their risk of medical debt and bankruptcy.

Beyond improving health and economic security, expanding KanCare would add nearly 23,000 good-paying jobs to our state, increasing our economic output over the next three years by $17 billion and the personal income of Kansans by $6.3 billion. Expansion would also help protect access to care for our rural neighbors; 76 hospitals in Kansas are currently at risk of closing. Expanding KanCare would help rural Kansans access the care they need while boosting their local economies.

Join the conversation

To learn more about the state of KanCare and its potential expansion, you can attend a virtual lunch on January 13 with key leaders within the health sector to discuss the path forward for Medicaid expansion in Kansas.

Kansas Lt. Gov. David Toland, who also serves as the Kansas State Secretary of Commerce, will provide an update on the Governor’s plans around KanCare expansion and will share current data on the economic impact expansion will have in Kansas.

Sen. Doll, a Republican legislator from Garden City and longtime advocate of KanCare expansion, will discuss the path forward for expansion through the legislative process and how health leaders can help leverage their voices and positions to support this work.

Expanding KanCare is critically important to improving health, reducing costs for Kansas families, and creating jobs. To achieve this goal, we all need to engage in the discussion and let our policymakers know that we can’t afford to wait another year to expand KanCare.

Register for the lunch here.

Extending postpartum Medicaid coverage in Kansas will improve health of mother and infant

Posted on by Lindsey Fields

This opinion piece by Health Fund President and CEO David Jordan and Topeka Public Schools Superintendent Tiffany Anderson originally appeared in the The Topeka Capital-Journal on December 21, 2021.

Kansas can improve future health outcomes for families by extending health care for new mothers and infants.

Unfortunately, significant racial disparities exist in maternal and child health. According to the Kaiser Family Foundation, national pregnancy-related mortality rates among Black and American Indian and Alaska Native women are more than three and two times higher, respectively, compared to the rate for White women.

In Kansas, non-white minority women are nearly twice as likely to die within a year of pregnancy as non-Hispanic white women.

To ensure mothers and babies have a healthy start to life and to reduce these inequities, we must ensure all mothers have health coverage for the first year of their child’s life.

In 2018, KanCare covered 39% of Kansas births. Before the COVID-19 public health emergency, each year over 9,000 mothers lost KanCare coverage 60 days postpartum.

Extending postpartum KanCare coverage to 12 months can save lives, improve health outcomes, prevent interaction with the child welfare system, reduce disparities and save the state money.

Recent federal policy change creates the opening for Kansas to extend postpartum coverage. Other states like Indiana and Tennessee are taking advantage of this opportunity.

A 2021 report released by the Governor’s Commission on Racial Equity & Justice detailed 13 recommendations for improving maternal and child health, including extending maternal Medicaid coverage to 12 months postpartum. The report recognized the important role of improving access to care in reducing health disparities.

Extending coverage can save lives. The U.S. Department of Health and Human Services reported 66% of all pregnancy-related deaths are preventable. The Kansas Maternal Mortality Review Committee found that between 2016 and 2018 nearly one-quarter of Kansas pregnancy-related deaths occurred between 43 days and one year postpartum. Nearly half of all pregnancy-associated deaths occurred in the same period.

A child’s health is tied closely to their parent’s health and access to health care. Parental enrollment in Medicaid is associated with a 29% higher probability that a child will receive an annual well-child visit.

Postpartum care provides mental health services as women gain services for clinical depression. Nearly 20% of Kansas women below 200% of the federal poverty level experienced postpartum depression in the year after giving birth.

According to the Kansas Department of Health and Environment, between fiscal years 2012 and 2017, parental substance use was the primary reason 70% of children under the age of one entered foster care. Extending postpartum coverage would enable mothers to access substance use services that could prevent interaction with the child welfare system.

Extended postpartum coverage is predicted to lead to a decrease in long-term Medicaid costs through the provision of early medical interventions and coordinated care, preventing postpartum complications and worsening chronic conditions resulting from delays in early identification and intervention.

Due to the public health emergency, Kansas cannot discontinue postpartum coverage after 60 days. This temporary policy change has enabled mothers to access critical health care and mental health services.

With new mothers experiencing isolation and mental health challenges due to the public health crisis, it’s critical to extend coverage to maintain postpartum checkups and treatment of chronic health conditions to prevent future adverse health outcomes.

The public health emergency is set to end this spring. The time to act is now, or each year 9,000 new Kansas mothers will lose KanCare coverage to the detriment of their health, their children’s health and long-term family stability.

Let’s create better outcomes for Kansas families by permanently extending postpartum Medicaid coverage to 12 months.

Tiffany Anderson is the superintendent of Topeka Public Schools and co-chair of the Governor’s Commission on Racial Equity and Justice. David Jordan is the president and CEO of the United Methodist Health Ministry Fund and a member of the commission.

Organizations Urge Kansas Senate Delegation to Support Health Provisions in Build Back Better Act

Posted on by Lindsey Fields

As many Kansans struggle with the high costs of everyday bills like health care, child care and food, the United States Senate is debating the Build Back Better Act, which could help make health care and child care more affordable for Kansas families.

In Kansas, nearly 1 in 10 adults (9.1%) is uninsured and more than 1 in 20 (5.8%) children lacks health coverage. As a result of a high uninsured rate, too many Kansas women and children are not getting the healthiest start to life, Kansans are not accessing health care needed to support their return to the workforce, and the cost of health care is too high for too many Kansans.
 
The Build Back Better Act makes critical investments in making health care more affordable for all Kansans, which will support the health of all Kansans, especially mothers and children.

The United Methodist Health Ministry Fund and its partners have sent a letter urging the Kansas delegation in the U.S. Senate to support key provisions in the Build Back Better Act that will address health inequities in our state. A PDF of the letter is available and the full text is below.

To learn how the Build Back Better Act benefits Kansans, check out the podcast episode from the Kansas Reflector that focused on how the transformative policy proposal would impact health, child care, persistent poverty and address longstanding racial and gender inequities.

December 16, 2021

Dear Senators Moran and Marshall,

As organizations that represent thousands of Kansans, we are writing to you to urge you to support the Build Back Better Act. Our organizations are dedicated to improving the health of Kansans and working to ensure mothers and children have the best start in life.

In Kansas, nearly 1 in 10 adults (9.1%) is uninsured and more than 1 in 20 (5.8%) children lacks health coverage.[1] As a result of a high uninsured rate, too many Kansas women and children are not getting the healthiest start to life, Kansans are not accessing health care needed to support their return to the workforce, and the cost of health care is too high for too many Kansans.

The Build Back Better Act makes critical investments in making health care more affordable for all Kansans, which will support the health of all Kansans, especially mothers and children. Additionally, these provisions will address longstanding health inequities within the state. We ask that you support the plan because it:

  • Closes the coverage gap. The provision to permanently close the coverage gap in the states that have not expanded Medicaid will benefit more than 100,000 Kansans who earn too much to qualify for Medicaid but too little to qualify for subsidies for coverage through the marketplace. Kansas is one of only 12 states that has not expanded Medicaid. A Kansas family of three with an annual income of $8,345 makes too much to be covered by Medicaid, and too little to receive marketplace subsidies.[2] According to the Alliance for a Healthy Kansas, more than two-thirds of adults eligible for insurance through Medicaid expansion work or are in working families, and most are employed in industries less likely to offer affordable health insurance, such as service, construction, and retail.[3]
  • Extends postpartum coverage. The provision to permanently extend postpartum coverage to 12 months will ensure mothers maintain health coverage at a crucial time. Without the extension, each year approximately 9,000 Kansas mothers will lose coverage a mere 60 days postpartum once the public health emergency expires. Nearly 40% of Kansas births are covered by Medicaid.[4] Nearly one-quarter of Kansas pregnancy-related deaths occur between 43 days and one year after pregnancy.[5] Children will benefit as well—parental enrollment in Medicaid is associated with a 29% higher probability that a child will receive an annual well-child visit.[6] Extending postpartum coverage will save lives and lead to healthier starts for mothers and children.
  • Advances birth equity. The Build Back Better Act contains all 12 bills originally included in the Black Maternal Health Momnibus Act. The Momnibus addresses maternal health equity through growing and diversifying the perinatal workforce, by investing in organizations focused on promoting maternal health equity, and by addressing social determinants of maternal health, among others.[7] The maternal health crisis highlights longstanding racial disparities. In Kansas, non-white minority women are nearly twice as likely to die within a year of pregnancy as non-Hispanic white women.[8]
  • Makes the Children’s Health Improvement Program (CHIP) permanent. The provision to make federal CHIP funding permanent would increase stability in children’s health coverage by ensuring that states have the federal funding needed to maintain and expand their programs. Currently, the program is funded through September 30, 2027. The bill would also permanently extend the Medicaid and CHIP stability provision for children, meaning that states cannot make it more difficult for eligible children to enroll.[9]
  • Makes health coverage more affordable. The provision to extend Marketplace subsidies through the end of 2025 will help the nearly 90,000 Kansans who received additional federal dollars this year to reduce their health insurance premiums and deductibles. This will leave more of their monthly budget to spend on housing, food, and other necessities.[10]
  • Streamlines access to Medicaid and CHIP through 12 months continuous coverage and use of express lane eligibility. The plan reduces burdens on families by using available information from other benefit programs to establish eligibility for Medicaid and CHIP. The plan also ensures all children and youth enrolled in Medicaid and CHIP can stay enrolled for 12 continuous months,which will reduce the risk that children experience gaps in coverage or lose it altogether. Nationally, 1 in 10 kids experiences a period without coverage during the year, and that number rises to more than 1 in 8 kids in families below 250% of the federal poverty level.[11]

These provisions in the Build Back Better Act will create more affordable coverage for Kansans. When all Kansans can afford health coverage, we all benefit. Hospitals will be on stronger financial ground—especially those in rural areas where proximity to care can save lives. More insured Kansans will lead to less uncompensated care and reduced Medicaid costs for our state. Kansans will be healthier and able to return to work. Most importantly, mothers and children will have the health care needed to have the strongest start to life, which in the long run will improve health and reduce costs.

We urge you to support these provisions in the Build Back Better Act that will lead to healthier kids, healthier mothers, and healthier Kansans. Thank you for your consideration.

Sincerely,

Child Advocacy and Parenting Services

CKF Addiction Treatment

Community Care Network of Kansas

Community Health Council of Wyandotte County

Cradle Kansas City

D&R Tender Loving Care Home Health Services

Ellsworth County Medical Center

Faith Voices for Medicaid Expansion

Flint Hills Wellness Coalition

International Pain Foundation

KanCare Advocates Network

Kansas Academy of Family Physicians

Kansas Action for Children

Kansas Appleseed

Kansas Birth Equity Network

Kansas Breastfeeding Coalition

Kansas Chapter, American Academy of Pediatrics

Kansas Head Start Association

Kansas Health Foundation

Kansas Interfaith Action

Kansas Public Health Association

KL Connections

League of Women Voters of Kansas

Mainstream Coalition

Martin Luther King, Jr. Child Development Center

MORE2

NEK-CAP, Inc

New Hope and Love Community Church

Nurture KC

Oral Health Kansas, Inc.

Sisters of Charity of Leavenworth Office of Justice, Peace, and Integrity of Creation

The Neighboring Movement

Therapy Services LLC

United Methodist Health Ministry Fund

Wichita Medical Research and Education Foundation

Women for Kansas

[1] Kansas Health Institute, Health Insurance in Kansas: Annual Insurance Update 2021, accessed December 3, 2021, https://www.khi.org/assets/uploads/news/15012/annual_insurance_update_2021_(december_2021)_2.pdf.

[2] “Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level,” Kaiser Family Foundation, accessed December 3, 2021, https://www.kff.org/health-reform/state-indicator/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level.

[3] Alliance for a Healthy Kansas, KanCare Expansion: Just the Facts (February 2020), accessed December 3, 2021,https://expandkancare.com/wp-content/uploads/2020/02/Working-Families-Feb-2020.pdf.

[4] “Births Financed by Medicaid,” Kaiser Family Foundation, October 2019, accessed December 3, 2021, https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/.

[5] Kansas Maternal Mortality Review Committee, Kansas Maternal Mortality Report 2016-2018: Including Severe Maternal Morbidity, 2016-2019 Topeka, 2020).

[6] Maya Venkataramani, Craig Evan Pollack, and Eric T. Roberts, “Spillover Effects of Adult Medicaid Expansions on Children’s Use of Preventive Services,” Abstract, PubMed.gov. November 13, 2017, doi: 10.1542/peds.2017-0953.

[7] Office of Representative Lauren Underwood, “Underwood’s ‘Momnibus’ Passes House in Build Back Better Act; Makes Largest Investment to Advance Birth Equity in American History,” news release, November 19, 2021, https://underwood.house.gov/media/press-releases/underwood-s-momnibus-passes-house-build-back-better-act-makes-largest.

[8] Kansas Maternal Mortality Review Committee, Kansas Maternal Mortality Report 2016-2018: Including Severe Maternal Morbidity, 2016-2019 Topeka, 2020).

[9] Edwin Park, “Build Back Better Reconciliation Bill Would Take Big Strides in Expanding Health Coverage and Access for Children and Families,” Say Ahhh! (blog), Georgetown University Health Policy Institute, October 29, 2021, https://ccf.georgetown.edu/2021/10/29/build-back-better-reconciliation-bill-would-make-big-strides-in-expanding-coverage-and-access-for-children-and-families.

[10] Suzanne Wikle, “Kansans Will Benefit from Health Provisions In Build Back Better Legislation,” Opinion, Kansas Reflector, November 30, 2021, https://kansasreflector.com/2021/11/30/kansans-will-benefit-from-health-provisions-in-build-back-better-legislation.

[11] Joan Alker and Aubrianna Osorio, “Why is Medicaid/CHIP Continuous Eligibility So Important for Kids?” Say Ahhh! (blog), Georgetown University Health Policy Institute, October 8, 2021,https://ccf.georgetown.edu/2021/10/08/why-is-medicaid-chip-continuous-eligibility-so-important-for-kids.

Groups Urge Committee to Support Postpartum Coverage

Posted on by Lindsey Fields

29 Organizations Signed a Letter Urging the KanCare Oversight Committee to Support Extending Postpartum Coverage to 12 Months

Today, the Health Fund and its partners sent a letter to the Robert G. Bethell Joint Committee on Home and Community Based Services and KanCare Oversight urging the committee to support extending postpartum KanCare coverage to 12 months.

A PDF of the letter is available and the full text is below.

Senator Richard Hilderbrand
Senate Majority Whip
Kansas State Senate
300 SW 10th St
Topeka, KS 66612

Representative Brenda Landwehr
Chair, House Health Care Committee
Kansas House of Representatives
300 SW 10th St
Topeka, KS 66612

December 6, 2021

Dear Chair Hilderbrand, Vice Chair Landwehr, and members of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight,

As organizations that represent thousands of Kansans, we are writing to you to support the extension of postpartum KanCare coverage to 12 months.

As a result of the ongoing public health emergency, Kansas cannot currently discontinue coverage for new mothers after 60 days. Kansas has seen the benefits of this temporary policy change. Extending Medicaid coverage postpartum from 60 days to 12 months has enabled mothers to access critical health care and mental health services, ensuring mothers and their babies have the healthiest start to life. This coverage will end when the public health emergency expires, meaning someone who gets pregnant today may have worse postpartum care than people who recently gave birth.

Extending postpartum coverage for new mothers enrolled in KanCare would have a significant impact in Kansas, where nearly 40% of births are covered by KanCare.[1] Prior to the COVID-19 pandemic, each year most mothers covered by KanCare—9,000 women—lost coverage 60 days after giving birth.[2] The Kansas Maternal Mortality Review Committee found that between 2016 and 2018 nearly one-quarter of all Kansas pregnancy-related deaths occurred between 43 days and one year postpartum. Nearly half of all pregnancy-associated deaths (while pregnant or within one year of pregnancy regardless of cause) occurred in the same period. Non-White minority women were nearly twice as likely to die within a year of pregnancy as non-Hispanic White women.[3]

In Kansas, between 2016 and 2018 casesrevealed that women covered by Medicaid during pregnancy and delivery were more than three times as likely to die within one year of pregnancy when compared to women covered by private insurance, in part this is because of women who died after losing their coverage. Extending postpartum Medicaid coverage to 12 months creates opportunities to improve access to quality health care for high-risk populations, before, during, after and between pregnancies, potentially reducing pregnancy-associated deaths and closing the disparity gap.[4]

As highlighted by the Kansas Department of Health and Environment’s impact paper, with many of the pregnancy-associated deaths involving health care and occurring months after delivery, the data suggest that a Medicaid postpartum coverage extension will help more women access care necessary to address critical, potentially fatal health concerns. National data published in February 2019 by the American Journal of Managed Care (AJMC) reveals that extending Medicaid coverage to 12 months postpartum is associated with 1.6 fewer maternal deaths per 100,000 women compared to rates for states that only provide coverage for the required 60-day time period.[5]

Recent federal policy change creates the opportunity for Kansas to extend coverage. Already, other states like Indiana and Tennessee are taking advantage of this opportunity. Extended postpartum coverage is predicted to lead to a decrease in long-term Medicaid costs through the provision of early medical interventions and coordinated care, preventing postpartum complications and worsening chronic conditions due to a delay in early identification and intervention.[6]

Before the pandemic, pregnant Kansans were eligible for Medicaid coverage through the duration of their pregnancy and 60 days postpartum if their household income was at 171% or less of the federal poverty level. Although their newborn remained covered by Medicaid through their first year of life, the postpartum mother lost coverage on day 61 unless her household income was at 38% or less of the federal poverty level (FPL).[7] A married woman with a single child would lose coverage on day 61 if her combined annual household income was above $8,345.

Extending KanCare coverage to a continuous 12 months postpartum can improve health outcomes for mothers, children, and families across the state. It is important to note that a child’s health is tied closely to their parent’s health and access to health care. Parental enrollment in Medicaid is associated with a 29% higher probability that a child will receive an annual well-child visit.[8] Therefore, it is important for the health of the mother and child during the critical 12-month postpartum period that both mother and child can access health care.

Nearly 20% of Kansas women below 200% of the federal poverty level experienced postpartum depression in the year after giving birth. In addition, according to KDHE, between state fiscal years 2012 and 2017, parental substance use was the primary reason that 70% of children under the age of one entered foster care.[9] Extending postpartum coverage would enable mothers to get substance use services that could prevent interaction with the child welfare system. For these reasons, it is vital that mothers have access to mental health and substance use services beyond 60 days.

We urge you to support expansion of postpartum KanCare coverage to 12 months in order to save lives, improve health outcomes for mothers and babies, increase health coverage for kids, prevent interaction with the child welfare system, reduce disparities and save the state money. We welcome the opportunity to work with you to strengthen the health of our state.

Sincerely,

United Methodist Health Ministry Fund

Alliance for a Healthy Kansas

American College of Obstetricians and Gynecologists

American Heart Association

Behavioral Health Association of Kansas

Build Your Village

Child Advocacy and Parenting Services

Community Care Network of Kansas

Community Health Center in Cowley County, Inc.

Community Health Council of Wyandotte County

KanCare Advocates Network

Kansas Action for Children

Kansas Birth Equity Network

Kansas Breastfeeding Coalition

Kansas Chapter, American Academy of Pediatrics

Kansas Head Start Association

Kansas Infant Death and SIDS Network, Inc.

Kansas State Nurses Association

Metro Organization for Racial and Economic Equity

Motherhood Redefined (TJZ Therapy, LLC)

Nurture KC

Oral Health Kansas

Postpartum Support International Kansas Chapter

REACH Healthcare Foundation

Russell Child Development Center

Success By 6 Coalition of Douglas County

The Holding Space KC

Thrive Allen County

Wichita Birth Justice Society

[1] Kaiser Family Foundation. 2019. Births Financed by Medicaid. October. https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/.

[2] Governor’s Commission on Racial Equity & Justice. 2021. Social Determinants of Health – First Report. Topeka: State of Kansas.

[3] Kansas Maternal Mortality Review Committee. 2020. “Kansas Maternal Mortality Report 2016-2018: Including Severe Maternal Morbidity, 2016-2019.”

[4] Kansas Maternal Mortality Review Committee. 2020. “Kansas Maternal Mortality Report 2016-2018: Including Severe Maternal Morbidity, 2016-2019.”

[5] Rosenberg, Jaime. 2019. Medicaid Expansion Linked to Lower Maternal Mortality Rates. February 6. https://www.ajmc.com/view/medicaid-expansion-linked-to-lower-maternal-mortality-rates.

[6] Members of the Equitable Maternal Health Coalition. 2020. “Making the Case for Extending Medicaid Coverage Beyond 60 Days Postpartum: A Toolkit for State Advocates.” The American College of Obstetricians and Gynecologists Web site. June. https://www.acog.org/-/media/project/acog/acogorg/files/advocacy/state-white-paper-making-the-case-for-extending-medicaid-coverage-beyond-60-days-postpartum-a-toolkit-for-state-advocates.pdf.

[7] Ranji, Usha, Ivette Gomez, and Alina Salganicoff. 2021. Expanding Postpartum Medicaid Coverage. March 9. https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/.

[8] Venkataramani, Maya, Craig Evan Pollack, and Eric T. Roberts. 2017. “Spillover Effects of Adult Medicaid Expansions on Children’s Use of Preventive Services .” PubMed.gov. November 13. https://pubmed.ncbi.nlm.nih.gov/29133576/.

[9] Kansas Department of Health and Environment. 2021. “Extending Kansas Medicaid Postpartum Coverage to 12 Months.” Topeka.

Women & Children First

Posted on by Lindsey Fields

Addressing maternal and child health disparities in Kansas

This opinion piece by Health Fund President David Jordan originally appeared in the Fall 2021 issue of Kansas Child magazine.

All Kansans should get to live in communities where good schools, healthy environments, safe homes, quality jobs, and access to health care and high-quality goods and services are the norm.

To achieve that goal in Kansas, we need to address long-standing racial and ethnic disparities in health, poverty rates, and educational attainment. Addressing these inequities is complex, but improving the health and well-being of mothers, infants, and children is a critically important strategy. It is predictive of future public health challenges for families, communities, and the health system.

We need to address long-standing racial and ethnic disparities in health, poverty rates, and educational attainment.

Unfortunately, significant racial disparities exist in maternal and child health. A recent Kaiser Family Foundation brief highlighted:

  • Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to white women.
  • Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women are more likely than white women to have births with risk factors that increase the likelihood of infant mortality and that can have long-term negative consequences for children’s health.
  • Infants born to Black, AIAN, and NHOPI women have markedly higher mortality rates than those born to white women.

These disparities, in part, reflect increased barriers to health care among people of color. To improve access to health care for people of color in Kansas and to ensure every Kansan has an opportunity for a healthy start in life, we must:

  • Invest in prenatal care and equity-­based birth education.
  • Improve access to prenatal services for women of color.
  • Improve access to comprehensive health care by expanding Medicaid eligibility, extending postpartum coverage to 12 months for new mothers, and continuously covering children ages 0-5.
  • Invest in a culturally competent health care workforce.

Investing in maternal and child health policies can address long-standing inequities in Kansas as well as improve health outcomes, school readiness, and long-term financial earnings.

More Than Baby Steps

Posted on by Lindsey Fields

Kansas Collaboration Advances Maternal Depression Screening

This opinion piece by Health Fund President David Jordan originally appeared in the Kansas Reflector on Thursday, October 14, 2021.

When Anjali Kansal-Rill gave birth in 2016, things did not go as planned. Anjali had an emergency cesarean section and faced challenges with breastfeeding. One week postpartum, she didn’t feel like herself. Her doctor said she would prescribe medication if Anjali was still feeling “down” at her next appointment, in eight weeks.

Maternal depression, also known as perinatal or postpartum depression, occurs during pregnancy or the 12 months immediately following delivery. It is the most common obstetric complication in the country. Perinatal depression is linked to an increased risk of preterm birth and low birthweight. Postpartum depression can lead to adverse effects for mothers and infants, affecting the course of children’s health and development. 

Maternal depression, like maternal mortality, disproportionately impacts women of color. According to the CDC, 2018 postpartum depression rates were higher among non-Hispanic women of color. Addressing these disparities is essential to ensuring mothers and babies have every chance to be healthy.

As a social worker, Anjali was aware of maternal depression. She thought she may have been overreacting, but her condition worsened.

One night her daughter woke up crying.

“I changed her diaper, but she was squirming so much I couldn’t get her back in her swaddle,” she said. “I got so frustrated I started to cry. … I was afraid I would hurt the baby. I yelled at my husband to take over. He brought her to me to nurse, but my breasts were so painful I broke down sobbing. What good was a mother who couldn’t calm or even feed her child? I told him they would be better off without me.” 

The next day, Anjali’s husband made an appointment with her doctor, who diagnosed her with postpartum depression and prescribed medication. 

Kansas mothers needed screenings

According to the 2018 Kansas Pregnancy Risk Assessment Monitoring System, approximately one in five mothers reported experiencing depression during pregnancy and one in seven mothers exhibited symptoms of postpartum depression. However, 17% reported they did not receive treatment. Most cited cost or that “it seemed too difficult” as barriers.

Anjali obtained treatment. Originally, she was scheduled for evaluation more than 60 days postpartum, which is when 9,000 Kansas mothers are dropped from Medicaid enrollment each year. Many of these mothers had no way to be screened or treated for maternal depression.

The 2018 Kansas PRAMS data showed 98.9% of new mothers reported their newborn had a well-child visit. In 2016, federal guidance allowed states to cover maternal depression screening during the well-child visit.

To take advantage of this option, Kansas needed to adopt a billing policy change. As of 2019, Kansas was one of only 10 states that had not changed its policy.

In 2019, Kansas joined the Pediatrics Supporting Parents Medicaid/CHIP State Implementation Workgroup, a national effort to develop policies that leverage the pediatric well-child visit to improve social and emotional health. The team of early childhood stakeholders and providers, led by the Kansas Department of Health and Environment with support and facilitation provided by the United Methodist Health Ministry Fund, prioritized expanding maternal depression screens to improve maternal and child health. 

The team developed recommendations to allow maternal depression screens to be billed as part of the well-child visit. Kansas Medicaid approved the policy, which became effective this year. 

According to Mathematica Policy Research, undetected and untreated maternal depression could cost as much as $17,100 per mother-child pair, meaning Kansas will save millions of dollars by identifying and treating maternal depression as a result of this policy. 

What about Anjali and the important work ahead?

Anjali Kansal-Rill stands with her daughter. (Anjali Kansal-Rill)

Anjali said, “I love my daughter more than I ever could have imagined. It scares me to think about where she would be if I hadn’t gotten help.”

Thanks to maternal depression screenings, more Kansas mothers’ depression will be identified. But barriers to treatment remain, including health care coverage and costs. 

New federal policy allows states to extend Medicaid coverage to 12 months postpartum. Kansas needs to adopt this policy change to ensure mothers get the treatment they need.

Anjali Kansal-Rill stands with her daughter. (Anjali Kansal-Rill)

Extending coverage would prevent more pregnancy-related deaths — which disproportionately impact Black women in Kansas. It would also ensure mothers and babies have the healthiest start, save the state money by averting future care and decreasing interaction with the child welfare system, and reduce inequities. 

Maternal depression screenings are an important baby step in improving the health of families in our state. Let’s take the leap for Kansas mothers and extend postpartum coverage.

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