The Bureau of Business and Economic Research was approached by the Governor’s Women’s Health Advisory Council to submit a proposal to the Division of Insurance for a study of maternity benefits as provided by public programs (e.g., Medicaid, SCI, PAM) and by private insurers writing both for the group and the individual insurance markets in New Mexico. The study will explore models for comprehensive maternity coverage that include prenatal care, delivery and post-natal care, with associated timelines and details on services to be provided. The goals of this study on comprehensive maternity coverage (CMC) in New Mexico are to identify gaps in coverage and to assist consumers in comparing available plans.  We intend to answer the following questions:

1.            How do we define CMC (prenatal, delivery and postnatal details and length of time)?

2.            How do women cover the health care expenses related to child-birth?

3.            What do maternity benefits include in terms of group and individual plans, Medicaid, PAM, other state and federal programs?

4.         Who does the individual market serve?

5.         Why are companies not offering CMC in individual plans?

6.         How can consumers access information to compare plans?

 

 

Task 1. Literature review on comprehensive maternity coverage (CMC) and on the types of maternity benefits provided in public programs, by the private sector, specifically the private insurance market in the US and NM, and as may be mandated by law. 

Task 2. Assemble reports and collect published data and information bearing on the health insurance coverage provided to women in different socio-economic and demographic groups and for prenatal, delivery and postnatal care in New Mexico. Sources include HPC surveys on healthcare coverage and access, PRAMS, and other surveys e.g., MEPS. 

Task 3. Interview knowledgeable individuals in State agencies (e.g.,DOI, DOH, HSD) and collect information regarding programs and policies governing provision of CMC, regarding the nature of the maternity benefits provided in policies written for the group and the individual markets by non-profits (Blue Cross), Managed Care plans (Presbyterian, Lovelace), and by other major health care plans. 

Task 4. Conduct semi-structured interviews with a select sample of health insurance plan managers, hospital benefits coordinators, and health care providers regarding costs and coverage of maternity benefits and cost-sharing.

Task 5. Analyze data developed in Tasks 2, 3 and 4 to present a picture of how pre-natal delivery and postnatal health care needs are met in New Mexico, including the roles of different types of insurance and of direct health care services (e.g., as provided by public health facilities, like Indian Health Service hospitals/clinics) in meeting these needs. 

a. Identify gaps in coverage and explore ways in which public policies could address these gaps.

b. Provide the beginnings of a road-map to guide women in navigating public programs and insurance options to get the maternity benefits and health care access they need and depending upon where in New Mexico they live.