After 52 deaths, TennCare wants to extend postpartum coverage from two months to one year

Brett Kelman | Nashville Tennessean

Show Caption Hide Caption TennCare wants to extend postpartum coverage to one year TennCare officials want to expand postpartum health insurance for low-income women in response to a slew of "preventable" deaths of new mothers.

TennCare's postpartum insurance currently lasts only two months.

A pilot program to extend coverage to one year would cost $19 million.

Proposal was spurred by 'preventable' deaths of new mothers in 2017.

TennCare officials want to dramatically expand postpartum health insurance for thousands of low-income women in response to a slew of "preventable" deaths of new mothers who timed out of existing coverage.

Currently, low-income women are eligible for TennCare coverage for two months after giving birth. TennCare Deputy Director Stephen Smith revealed during a budget hearing on Wednesday that the agency hopes to expand this coverage to one year.

Smith said the proposed change was spurred by 52 Tennessee women who died in 2017 within a year of giving birth. Each of these women received TennCare postpartum insurance, but most died after their two-month coverage window ended.

Smith said many of the women suffered from opioid addiction and died of overdoses.

“After delivery, the risk of relapse is considerable, especially in the latter part of that postpartum period.” Smith said. “And so, by extending this coverage, we believe that we can really make a difference here.”

TennCare estimates approximately 4,000 to 6,500 new mothers who are not otherwise eligible for state insurance could get coverage from the extended postpartum program.

TennCare proposes postpartum pilot program

This coverage expansion was publicly proposed during a series of rapid-fire budget hearings before Gov. Bill Lee this week. The hearings allow state agencies to pitch new programs and potential cuts at the start of the budget process.

TennCare envisions the postpartum extension as a three-year pilot program costing about $19.5 million annually. The federal government would need to approve the pilot and pay for $12.8 million of the annual cost, according to a budget presentation.

"In 2017 alone, more than 50 women on TennCare died during or within 12 months of giving birth," Smith said during the presentation.

The governor interjected immediately.

“Are there a number of these deaths connected to drug use?” Lee said.

“Yes, absolutely, they are," Smith said. "That’s what is particularly heartbreaking about these stats. Almost all of these were deemed to be preventable. In fact, all of them but one were deemed preventable, with a number of them related to opioid abuse, other substance abuse and mental health conditions."

TennCare Chief Medical Officer Victor Wu said new mothers who abuse opioids before pregnancy can be especially vulnerable after giving birth. During pregnancy, many women seek increased medical care — including addiction treatment — so they likely have lower tolerance and increased risk if they resume drug use during the postpartum period.

Pilot program may precede block grant

This proposed expansion comes at a time when the Lee administration is pursuing a controversial plan to transform TennCare.

State officials will soon ask the federal government to convert TennCare’s billions in funding to a block grant, which would give the state much more authority over how to spend that money and change coverage. Public reception of the plan has been overwhelmingly negative, but the state must still submit the proposal later this month.

During the budget hearing on Wednesday, Smith said extended postpartum coverage was the kind of program shift that could come from the block grant, but the extension did not need to wait.

“We think that beginning implementation on these today can provide us with data and really set us up for future success,” Smith said.

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.