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Improving Healthcare Access for Mothers in Rural Texas

Overview

The Rural Texas Maternal Health Assembly includes diverse stakeholders, rural healthcare providers and administrators, senior officials from key state entities, and representatives from advisory committees. Selected members of the Assembly serve as a Working Group to delve deeper into the key issues identified through a survey of all Assembly members. To date, 38 Assembly members have responded to this survey to identify key issues and potential solutions for Texas mothers. Potential solutions and policy recommendations will be discussed during an in-person Assembly meeting in Austin, TX on September 6, 2024. The Rural Texas Maternal Health Assembly work group will finalize a Position Paper with comprehensive solutions and recommendations after this in-person meeting in Austin, TX. The final Position Paper with actionable policy recommendations for Texas will be published in mid-October.

On March 1, 2024, Texas implemented House Bill 12, extending Medicaid postpartum coverage to 12 months. Despite this progress, rural Texas mothers still face significant healthcare barriers.

On July 25, 2024, the Rural Texas Maternal Health Assembly was convened to address healthcare access obstacles and key issues faced by Texas mothers and rural providers in Texas.

A comprehensive Position Paper, developed by this diverse Assembly of healthcare experts, aims to address these challenges and propose actionable solutions for Texas.

View Rescue Plan Paper

Overview & Goals

The Purpose of this Assembly

 
To gather experts (rural providers, consumers, health plans, academic institutions, and foundations) focused on rural health in order to inform policy recommendations.
To understand the obstacles faced by mothers and providers and craft pragmatic interventions and recommendations regarding rural maternal health for the 89th Texas legislative session.

The Problem

 
Texas mothers in rural areas face significant barriers to accessing timely medical care and social services throughout their pregnancies. Nearly 50 percent of Texas counties lack obstetrical care clinicians or hospitals.

 

 

Source: March of Dimes

The Process

 
To address these issues, we have convened a Rural Texas Maternal Health Assembly in order to develop comprehensive rural maternal health recommendations and reforms.

Final Product

 
A Working Group is formed to delve deeper into key issues and solutions during an in-person meeting in Austin on September 6, 2024.

This Work Group will finalize a Position Paper with comprehensive solutions and policy recommendations for Texas. The final Position Paper will be published and widely disseminated in mid-October.

Participants

Co-conveners

Kia Parsi, MD

Executive Director
Texas A&M Rural and Community Health Institute
Texas A&M University Health Science Center
Lead Convener


Angie Alaniz, BA

Director of Operations
Texas A&M Rural and Community Health Institute
Texas A&M University Health Science Center
Lead Convener

Tom Banning

Texas Academy of Family Physicians
Co-Convener

Jacquelyn Alvarado, DNP, APRN, CNM, C-EFM

Maternal Fetal Focus Program Manager
Texas A&M Rural and Community Health Institute
Texas A&M University Health Science Center
Lead Convener

Ankit Sanghavi

Executive Director Texas Health Institute
Co-Convener

John Henderson

CEO/Executive Director Texas Organization
of Rural and Community Hospitals
Co-Convener

Assembly Timeline

Participant Timeline

Assembly kick-off meeting

July 25th 12pm, 2024

Survey Completed

38 Experts participated in the survey
47 Assembly members participated in this process

Key Expert Interviews

Month of July and August, 2024

Work Group development of draft position paper

August, 2024

Maternal Health Assembly Work Group

September 6, 2024 (Austin)

Circulate position paper

September, 2024

Publication of the position paper

October 25th, 2024

Contact

Bita Kash, PhD, MBA, FACHE

Texas A&M Rural and Community Health Institute

Consultant
dropthebita@gmail.com

Helen Kent Davis, Senior Advisor

Texas Academy of Family Physicians
Texas Health Institute

Consultant
helen@hkdhealthpolicy.com

Additional Resources

Models to explore

hospital user

Rural OB Access & Maternal Services (ROAMS) in NM

heartbeat

State Perinatal Quality Collaboratives – CDC Division of Reproductive Health: Texas Collaborative for Healthy Mothers and Babies

heart hand

Medicaid reimbursement for non-clinical services such as meals, doulas and other SDOH services

route

CHW and Navigator programs – HRSA Maternal & Child Health (MCH) Navigator

graduate

Kansas recruits rural docs in medical school and pays for their tuition if they serve 4 years after residency

person breastfeeding icon

The Centering Model has been implemented across the US in an effort to improve maternal/neonatal outcomes

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Tandem Teen Prenatal and Parenting Program Mobile Units and home visiting programs

Rural Maternal Health Resources

Background Materials/Data Resources
Texas Health Data - Maternal Health 
2022-MMMRC-DSHS-Joint-Biennial-Report.pdf (texas.gov) 
Maternal Health: Availability of Hospital-Based Obstetric Care in Rural Areas | U.S. GAO 
TCHMB 
2024 State Scorecard on Women’s Health and Reproductive Care | Commonwealth Fund 
State Policy Lever Checklists - Prenatal-to-3 Policy Impact Center (pn3policy.org) 
A Worsening Crisis: Obstetric Care in Rural America (harvard.edu) 
U.S. maternal health: State shares of rural hospitals without maternity care (axios.com) 
HRSA Invests Nearly $90 Million to Address Maternal Health Crisis | HRSA 
Creating Health Care Models to Improve Maternal Health | MCHB (hrsa.gov) (Bexar county hospital district received funding) 
Task Force on Maternal Mental Health National Strategy to Improve Maternal Mental Health Care (samhsa.gov) 
 
Maternity Care Access
Can Family Doctors Deliver Rural America From Its Maternal Health Crisis? - KFF Health News 
2023 March Of Dimes Report Card For United States | PeriStats | March of Dimes 
Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity | March of Dimes 
Maternal Health in Rural Communities 
Rural Obstetric Unit Closures - The University of Minnesota Rural Health Research Center (umn.edu) 
Restoring Access to Maternity Care in Rural America | Commonwealth Fund 
Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities - The University of Minnesota Rural Health Research Center (umn.edu) 
Microsoft PowerPoint - Hospital Webinar FINAL (nationalacademies.org) 
Rural resilience: The role of birth centers in the United States - Jolles - 2020 - Birth - Wiley Online Library 
Promoting Safety in Community-Based Birth Settings | AAFP 
Assessment of interprofessional collaboration at free-standing birth centers: Does collaboration influence outcomes? - ScienceDirect 
Postpartum Newborn Home Visits | SCDHEC 
Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them | KFF 
 
Innovation
HRSA Administrator Carole Johnson, Joined by Rep. Lauren Underwood, Launches New National Maternal Health Initiative | HRSA 
Rural Maternal Health Toolkit - RHIhub (ruralhealthinfo.org) 
HRSA Rural Maternal Health Initiatives - RHIhub Webinar (ruralhealthinfo.org) 
Rural Maternal Health – Models and Innovations - Rural Health Information Hub 
Expanding Telehealth for Improved Maternal Outcomes - Maternal Health Learning and Innovation Center 
Maternal Opioid Misuse (MOM) Model | CMS 
rural-case-study-meeting-essential-health-services-and-reimagining-obstetrics-in-a-rural-community-rural-case-study-april-2024.pdf (aha.org) 
Postpartum Primary Care Engagement Using Default Scheduling and Tailored Messaging: A Randomized Clinical Trial | Public Health | JAMA Network Open | JAMA Network 
Maternity Care Payment Reform | National Partnership for Women & Families 
Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing | National Partnership for Women & Families 
Postpartum Discharge Transition Staging | AIM (saferbirth.org) 
Community-Based Models Improve Maternal Outcomes and Equity | Commonwealth Fund 
Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States | BMC Pregnancy and Childbirth | Full Text (biomedcentral.com) 
Improving access to maternal care in rural communities | AHA News 
Mapped: Over half of rural hospitals don't offer maternity care (advisory.com) 
Proposed Solutions for Improving Maternal Health Care in Rural America - PubMed (nih.gov) 
The Role of the Family Physician in Rural Maternity Care 
CNM/CMs Fill the Gap in Rural Maternal Care 
The Need for Reliable Robust Maternal Transport Program to Improve Maternal Outcomes in Rural America 
Text And Telephone Screening And Referral Improved Detection And Treatment Of Maternal Mental Health Conditions | Health Affairs 
Mental Health Conditions Increase Severe Maternal Morbidity By 50 Percent And Cost $102 Million Yearly In The United States | Health Affairs 
Centering Healthcare Institute | CenteringPregnancy 
Medicaid-Payment-Initiatives-to-Improve-Maternal-and-Birth-Outcomes.pdf (macpac.gov)
Chapter 4: Maternity Care (hcp-lan.org) 
 
Preventive/Primary Care
Access to and Use of Midwifery Care for Rural Residents - The University of Minnesota Rural Health Research Center (umn.edu) 
New Recommendations for Number of Required Prenatal Visits - The ObG Project 
A Toolkit for Implementing Two-Generation Postpartum Care - I PROMOTE-IL (ipromoteil.org) 
UMN-Case-Series_Postpartum-Support_8.4-final.pdf 
MiPath Infographic for Providers (acog.org) 
Telemedicine in Low-Risk Obstetrics - ScienceDirect 
Obstetrics & Gynecology (lww.com) 
Postpartum care needs assessment: women’s understanding of postpartum care, practices, barriers, and educational needs | BMC Pregnancy and Childbirth | Full Text (biomedcentral.com) 
Provider Perspectives on Barriers and Facilitators to Postpartum Care for Low-Income Individuals - PMC (nih.gov)
 
NMDOH
Food Insecurity, Chronic Disease, and Health Among Working-Age Adults (usda.gov) 
Getting around rural America without a car is hard. These communities developed solutions | KCUR - Kansas City news and NPR 
Rural Hunger and Access to Healthy Food Overview - Rural Health Information Hub 
Food Insecurity in the Rural United States: An Examination of Struggles and Coping Mechanisms to Feed a Family among Households with a Low-Income - PMC (nih.gov) 
Systematic Review of Interventions Addressing Food Insecurity in Pregnant Women and New Mothers - PMC (nih.gov) 
Food Insecurity and Cardiovascular Health in Pregnant Women: Results From the Food for Families Program, Chelsea, Massachusetts, 2013–2015 (cdc.gov) 
Pregnant and hungry: addressing food insecurity in pregnant women during the COVID-19 pandemic in the United States - PMC (nih.gov) 
Food insecurity among pregnant women living in high-income countries: a systematic review - The Lancet
 
Relevant Peer-Reviewed Papers Published since 2020
Ahn, R., Gonzalez, G. P., Anderson, B., Vladutiu, C. J., Fowler, E. R., & Manning, L. (2020). Initiatives to reduce maternal mortality and severe maternal morbidity in the United States: A narrative review. Annals of Internal Medicine, 173(11_Supplement), S3-S10. https://www.acpjournals.org/doi/full/10.7326/M19-3258 
Singh, G. K. (2021). Trends and social inequalities in maternal mortality in the United States, 1969-2018. International Journal of Maternal and Child Health and AIDS, 10(1), 29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792749/ 
Chinn, J. J., Eisenberg, E., Dickerson, S. A., King, R. B., Chakhtoura, N., Lim, I. A. L., ... & Bianchi, D. W. (2020). Maternal mortality in the United States: research gaps, opportunities, and priorities. American journal of obstetrics and gynecology, 223(4), 486-492. https://www.sciencedirect.com/science/article/abs/pii/S0002937820307420 
Ziller, E., & Milkowski, C. (2020). A century later: Rural public health’s enduring challenges and opportunities. American journal of public health, 110(11), 1678-1686. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2020.305868 
Kozhimannil, K. B., Interrante, J. D., Tuttle, M. K., & Henning-Smith, C. (2020). Changes in hospital-based obstetric services in rural US counties, 2014-2018. Jama, 324(2), 197-199. https://jamanetwork.com/journals/jama/article-abstract/2768124 
Leider, J. P., Meit, M., McCullough, J. M., Resnick, B., Dekker, D., Alfonso, Y. N., & Bishai, D. (2020). The state of rural public health: enduring needs in a new decade. American journal of public health, 110(9), 1283-1290. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2020.305728 
Mehta, L. S., Sharma, G., Creanga, A. A., Hameed, A. B., Hollier, L. M., Johnson, J. C., ... & American Heart Association Advocacy Coordinating Committee. (2021). Call to action: maternal health and saving mothers: a policy statement from the American Heart Association. Circulation, 144(15), e251-e269. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001000 
Shah, L. M., Varma, B., Nasir, K., Walsh, M. N., Blumenthal, R. S., Mehta, L. S., & Sharma, G. (2021). Reducing disparities in adverse pregnancy outcomes in the United States. American heart journal, 242, 92-102. https://www.sciencedirect.com/science/article/abs/pii/S0002870321002258?via%3Dihub 
Merkt, P. T., Kramer, M. R., Goodman, D. A., Brantley, M. D., Barrera, C. M., Eckhaus, L., & Petersen, E. E. (2021). Urban-rural differences in pregnancy-related deaths, United States, 2011–2016. American journal of obstetrics and gynecology, 225(2), 183-e1. https://www.ajog.org/article/S0002-9378(21)00144-7/abstract