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State health officials highlight maternal mental-health supports, Medicaid postpartum extension and maternity deserts
Summary
Officials told the Kentucky Commission on Women that substance use and social determinants drive most pregnancy-associated deaths, the state expanded postpartum Medicaid coverage to one year, and a new resource line and provider consultation program ("Kentucky Compass") will target perinatal mental-health needs while addressing gaps in rural maternity care.
Lucy Gentry, chair of the Kentucky Commission on Women, convened a virtual session on Kentucky women's health that focused on maternal outcomes, mental health and efforts to expand access to postpartum and perinatal care.
Dr. Connie White, deputy commissioner for clinical affairs at the Kentucky Department for Public Health, said the department has used Medicaid expansion and policy changes to increase coverage and continuity of care. "In 2022, we expanded postpartum care ... for up to 1 year," White said, noting that extending coverage beyond the traditional six-week postpartum window helps address health needs that emerge after delivery.
White said about 93% of reproductive-age women in Kentucky now have health insurance, attributing gains to Medicaid expansion but acknowledging that roughly 7% remain uninsured for multiple reasons, including language and health-literacy barriers, immigration status, jobs without benefits, and limited online access in rural areas. "Some of them make just enough money that they don't qualify for Medicaid, but they don't work in a job that offers health insurance," she said.
State reviews show substance use disorder and other social determinants are major contributors to pregnancy-associated deaths. White told commissioners that "80 percent of our deaths have a social determinant of health factor, either substance use disorder, mental health, homicide, car wrecks," and said the state's maternal mortality review and a related morbidity-mortality task force are translating case reviews into actionable recommendations.
To address perinatal mental-health needs and provider capacity, White described an initiative launching in October called Kentucky Compass (Consultation and Outreach for Maternal Psychiatry and Support Services). The program will include a provider consultation line staffed by perinatal psychiatry specialists and a patient-facing 1-800 hotline; an outreach worker will, with patient permission, connect callers to local supports such as postpartum groups, community health workers, doulas and social services.
White also noted programs that address substance use in pregnancy: the state has increased inpatient treatment options that allow pregnant people to bring children to residential programs, and it runs the HANDS (Health Access Nurturing Development Services) home-visiting program in all 120 health departments. "HANDS is the gem of our public health," she said, highlighting observed reductions in preterm birth, low birth weight and smoking among program participants.
The conversation also highlighted geographic care gaps. White said about 40% of Kentucky counties are "maternity deserts" without a birthing hospital or obstetrical provider, a factor that contributes to disparities in access and outcomes.
The session closed with resources and follow-up: the department's perinatal and maternal mental-health resource page and the Commission's plan to share the compiled resource list with providers and the public.
Next steps noted during the call include promoting newly available perinatal resources to providers, implementing Kentucky Compass consultations, and continuing maternal mortality review recommendations into operational programs.
