To healthy starts: How CareOregon is helping members access pregnancy benefits

One of the most acute health care crises in the United States is maternal health. The country continues to have the highest rate of maternal deaths of any high-income nation, and the mortality rate is significantly higher for Black mothers. According to data from the Centers for Disease Control and Prevention, more than 80 percent of these deaths are likely preventable.

Medicaid finances four out of every 10 births in the U.S., and it is the largest single payer of pregnancy-related services in the country. Although Medicaid covers enhanced benefits such as greater dental coverage, as well as vision coverage, CareOregon’s unique CareBaby program, goes above and beyond this by offering benefits like prenatal vitamins, lactation consultants and newborn support.

In order to access enhanced pregnancy benefits, Oregon Health Authority requires that members tell them they are pregnant. But just a few years ago, only about half of our members had done so at the time they gave birth. That means half of pregnant members were missing out on important benefits—for themselves and their babies. 

“It made sense to us that we needed to figure out how to change this,” says Christina Clay, a Senior Population Health Specialist at CareOregon. “And through our research, we found that this was due to a knowledge gap, rather than members intentionally not updating their status.”

Thanks in part to some creative work from CareOregon’s population health team, the percentage of known pregnancies through enrollment has increased from 50 percent to 78 percent in a few short years. 

The importance of accurate pregnancy enrollment

“In 2024, our focus was on pregnancy identification,” says Clay. “We can’t do postpartum outreach if we never know they are pregnant. That's going to be our focus for the next couple of years, until we get close to 100 percent.” 

This includes working with clinic and community partners to get rosters of pregnant members, as well as educating members on accurate enrollment—especially since self-reporting is the fastest way to update their status. “We know if we can make members aware of their benefits, they're more likely to utilize them,” Clay says. “If they have accurate enrollment status, that means they have access to dental and vision, and doula services.” (A doula is a trained professional who provides physical and emotional support to a person during pregnancy, labor and shortly after birth.)

Last year, CareOregon started a targeted outreach in a two-year pilot program to increase accurate enrollment and promotion of the CareBaby program pregnancy benefits. It included looking at pregnancy-related claims coming from members who were not identified as pregnant, so their status could be updated. It also focused on communicating with providers, reminding them to encourage pregnant members to update their status. And it included phone outreach to members to explain the CareBaby program. Of the outreach calls made, more than 50% of members asked to learn more about enrollment updates and benefits. 

In follow-up evaluations, members shared how the program made a difference during a vulnerable time. One member reflected, “CareBaby brought back some ‘human’ into the health care system. So often it feels as if we are only a number and not a person.” Another shared, “If our little baby could speak and understand, she too would say ‘thank you.’” These voices underscore the value of timely outreach and the importance of making benefits accessible when they’re needed most.

Why prenatal and postnatal care matters

Knowing which members are pregnant helps us identify people who have high-risk pregnancy. It also prevents escalation of potentially dangerous issues in pregnant mothers like gestational diabetes or preeclampsia, and helps providers manage members’ chronic conditions during pregnancy. Early outreach also improves prenatal visit adherence. 

In addition, prenatal care is important for babies: mothers who do not have prenatal care are three times as likely to deliver an infant with a low birth weight, and babies whose mothers received no prenatal care are almost five times more likely to die than those born to mothers who had early prenatal care. 

“The support of a comprehensive program like CareBaby leads to indirect savings for the health care system, and better quality of life for members: reduced emergency visits, better birth outcomes, and lower postpartum complications,” Clay adds.

CareOregon's CareBaby program means healthy outcomes for both parent and child—during pregnancy, postpartum, and for years to come.

Pop Health series

Our "Population (Pop) Health" series highlights the key factors that define prevalent conditions shaping the lives of CareOregon members. Through these stories, we explore how our ongoing innovation with partners and industry leaders can improve health outcomes, address the complicated influences in health care access and close the gap in community services.