A Collective Plan for PA Maternal Health Awareness Day

Published January 23, 2024

For PA Maternal Health Awareness Day, over 25 maternal health organizations and groups across Pennsylvania worked together to develop a prioritized list of recommendations for private and public stakeholders to advance in 2024 to improve maternal health and reduce racial/ethnic disparities in Pennsylvania.

These recommendations are designed to support and build on recent developments, including new policies for Doulas and Community Health Workers and increases in WIC enrollment. They also recognize that pregnancy-associated mortality is two times greater for non-Hispanic Blacks than non-Hispanic whites in Pennsylvania.

The Process

A series of three meetings and surveys were used to identify and prioritize recommendations. The first survey in November invited each group to describe their work and top three recommended priorities. This survey resulted in recommendations related to: workforce needs and training (with culturally appropriate care being the most frequently cited sub-theme); access to care (with a behavioral health access program being the most frequently cited sub-theme); supports for families (with community resources being the most frequently cited sub-theme), and payment/reimbursement (with doulas being the most frequently cited sub-theme). Across all the themes, the top two most frequently cited sub-themes included increasing access to Doulas through payment policies and establishing a Perinatal Behavioral Health Access Program.

During the first meeting in December, the groups discussed the most frequently cited recommendations with a focus on Doulas and the Perinatal Behavioral Health Access Program. The group also decided to focus the recommendations on what the State Administration could achieve within a 12-month period.

Following this meeting, a second survey asked each group if they could support the most frequently cited recommendations to increase access to Doulas and establish a Perinatal Behavioral Health Access Program. This second survey also asked each group to rank the other recommendations from the first survey based on the potential impact and 12-month feasibility. Within the culturally appropriate workforce category, the top two ranked priorities included supporting the recruitment and education of diverse maternity care teams and increasing knowledge and application of a Black Birthing Justice Framework. Within the community resources category, the top two ranked priorities included increasing enrollment in WIC and supporting educational campaigns with trusted community partners. Within an other category, the top ranked priority included reimbursement for Community Health Workers.

During the second meeting in January, the group discussed and specified recommendations for these top ranked priorities. A third survey asked each group if they could support the recommendations that were discussed during the second meeting and if they had additional comments. This process resulted in a draft of the Collective Plan that was reviewed and revised during a third meeting in January.

The Outcome

We are pleased to distribute this Collective Plan on PA Maternal Health Awareness Day to increase awareness of the existing maternal health recommendations. Recognizing that many of these recommendations are already being advanced by the Administration, this Collective Plan also notes how stakeholders can help achieve these goals.

Increasing Access to Doulas

Priority: With the goal of increasing access to Doulas who provide emotional, physical, and informational support, submit a Pennsylvania State Plan Amendment by 2025 with input from Doulas across Pennsylvania to add Doulas as a billable provider in the PA Medical Assistance fee-for-service delivery system.

Stakeholders can help by raising awareness about how and why:

• Doulas can now enroll in the Medical Assistance Program to enable Pennsylvania Medical Assistance Managed Care Organizations to enter into network agreements with Doulas (PA DHS’ Medical Assistance Bulletin # 13-24-01)
• Doulas can now receive a state-recognized Perinatal Doula Certification from the Pennsylvania Certification Board
• Existing Doula Training Programs in Pennsylvania can help Doulas receive a Perinatal Doula Certification by including the Certified Perinatal Doula Knowledge Areas in their training
• Doulas can receive a financial subsidy from the PA Doula Commission for the cost of the Perinatal Doula Certification fee
• Doulas and stakeholders can connect with the PA Doula Commission
• Commercial health plans could consider similar sustainable financing opportunities for Doulas with input from Doulas across Pennsylvania
  
  

Establishing the Perinatal Behavioral Health Access Program

Priority: Include funding in the state budget for the Perinatal Behavioral Health Access Program to provide timely provider-to-provider consultation and service navigation support across Pennsylvania, with the goals of helping providers identify and treat maternal mental health and SUD conditions and increasing access to behavioral health services among women and other birthing people. Over time, this consultation and service navigation program could be expanded to also offer timely trauma-informed behavioral health services tailored to the needs of women and other birthing people at risk of adverse outcomes.

Stakeholders can help by increasing awareness about:

• How Perinatal Psychiatric Access Programs have been implemented and operated in 21 other states (see Thriving PA’s report)
  
  

Increasing Access to Community Health Workers

Priority: With the goal of increasing access to Community Health Workers (CHWs)—trusted members of their community who leverage lived experience to contribute to improved health outcomes—submit a Pennsylvania State Plan Amendment by 2025 with input from CHWs across Pennsylvania to add CHWs as a billable provider in the Pennsylvania Medical Assistance fee-for-service delivery system under preventive services.

Stakeholders can help by raising awareness about how and why:

• CHW services can now be billed to Medicare (see “Community Health Integration Services” in the Federal Register)
• CHWs can be funded by Pennsylvania Medical Assistance Managed Care Organizations under the 2024 HealthChoices Community-Based Care Management (CBCM) program
• CHWs and stakeholders can connect with the PA Community Health Worker Collaborative, a statewide coalition that exists to unite and empower Pennsylvania CHWs through active collaboration, education, advocacy, and support
• CHWs can now receive a state-recognized Community Health Worker certification from the Pennsylvania Certification Board for future Pennsylvania Medical Assistance reimbursement opportunities
• Existing CHW training programs in Pennsylvania can become an accredited CHW training provider to help CHWs receive the CHW certification
• Commercial health plans could consider similar sustainable financing opportunities for CHWs with input from CHWs across Pennsylvania
• Other professionals who qualify as CHWs, but are not certified, should consider obtaining their CHW certification in order to participate in Medicaid billing
  
  

Building Culturally Appropriate, Diverse Perinatal Health Workforce

Priority: Build a perinatal health workforce in Pennsylvania that reflects the races, ethnicities, and cultures of the people they serve by:

• providing state-funded stipends, grants, or tax breaks for perinatal clinical educators, including but not limited to midwives, to serve as clinical preceptors for students in underserved areas;
• providing state-funded scholarships for Black people and other people of color to pursue education in perinatal health disciplines and careers;
• providing workforce development grants, apprenticeship opportunities, and state funding opportunities to support existing doula training programs in the community and foster team-based relationships between clinical providers and doulas; and
• voicing support for the U.S House Perinatal Workforce Act, which would provide grants to grow and diversify the perinatal workforce.

Stakeholders can help by:

• Increasing knowledge and application of the Black Reproductive Justice Policy Agenda and the Black Birthing Bill of Rights
• Increasing awareness in high schools and community colleges about the professional career paths and training programs for perinatal health advocates, including Doulas and Community Health Workers
• Educating university students in clinical perinatal training programs about Doulas through simulations and curriculum in partnership with community organizations that provide doula services
• Establishing scholarships for diverse candidates within organizations and institutions of higher education for healthcare education and training programs (e.g., the Pennsylvania Affiliate of the American College of Nurse Midwives created a scholarship specifically for Black people and other people of color who were enrolled in an accredited Nurse-Midwifery or Certified Midwifery program or doctoral and postdoctoral studies)
• Spreading best practices about how clinical settings can foster working relationships with Doulas and recruit and retain a diverse perinatal health workforce
• Making a public statement that they are committed to recruiting and hiring a diverse perinatal health workforce

Streamlining and Increasing Enrollment in WIC

Priority: To increase and streamline enrollment in WIC, add a WIC enrollment button to the Pennsylvania Medical Assistance’s COMPASS enrollment platform, increase awareness about the importance and benefits of enrolling in WIC across state departments and programs that serve the eligible population, continue text messaging outreach to SNAP and Medical Assistance eligible families about WIC, create a statewide outreach campaign that supplements local campaigns, support WIC mobile units, continue the virtual visit options for WIC, and voice support for fully funding WIC at the federal level.

Stakeholders can help by:

• Increasing awareness about WIC’s eligibility, local offices, benefits, and maternal health services (e.g., nutrition services, breastfeeding support, and health care and community resource referrals) (https://www.pawic.com/) among state legislators and providers and programs who serve the same populations
• Increasing awareness about why all eligible families are not enrolled and the recommended solutions (see Thriving PA’s reports)

Supporting Community-Level Educational Campaigns

Priority: Provide adequate funding to trusted community partners to educate community members about how to prevent adverse maternal health outcomes and perinatal health disparities, maternal health and well-being, and the perinatal services available in the community (e.g., WIC, Doulas, Community Health Workers, nutrition programs, safe sleep resources, home visiting, care management, trauma-informed behavioral health services, local domestic violence programs, and housing).

Stakeholders can help by:

• Ensuring that lists of available perinatal services in the community are accessible and up-to-date among health plans, providers, and resource and referral tools (e.g., PA Navigate)
• Sharing information through diverse channels of the resources available to pregnant and postpartum people, and expanding the resources available.
• Using diverse methods of communication to inform the public of the availability and types of services accessible to the perinatal population
  • For example, examples of safe sleep communication materials include: a partner catalog: https://cribsforkids.org/partner-product-catalog/, YouTube Play List: https://www.youtube.com/@CribsforKids/playlists, Safe Sleep Ambassador https://cribsforkids.org/safe-sleep-ambassador/, and Safe Sleep Academy https://safesleepacademy.org/

• Partnering with trusted community organizations to tailor and disseminate perinatal health information to communities affected by high rates of maternal mortality, morbidity, and disparities
• Raising awareness among their communities about risks and life-threatening warning signs for women and other birthing people

If your organization would like to be added to the list of organizations supporting this plan to improve maternal health in Pennsylvania, please complete the form below. Organizations will be added on a rolling basis.