GROUP PRENATAL CARE
WHAT IS GROUP PRENATAL CARE AND WHY IS IT IMPORTANT?
Group prenatal care is a model of prenatal care facilitated by a trained healthcare provider and delivered in a group setting. The model integrates health assessments, education and skills building, and peer social support.1
Group prenatal care typically serves a group of 8 to 12 expectant parents with low-risk pregnancies who do not require individual monitoring. Expectant parents receive 15 to 20 hours of prenatal care over the course of their pregnancies, compared to 2 to 4 hours of traditional individual care.2
Nationwide, approximately 15.5% of births report not receiving adequate prenatal care, and the rate of inadequate prenatal care is nearly double for Black women compared to White women.3 By augmenting the services and support typically available in individual prenatal care, group prenatal care programs may act as a protective factor for parents’ psychosocial health and increase contact with medical providers, which may better serve the need of participants.4
WHAT PROGRESS HAVE STATES MADE SINCE THE 2020 ROADMAP TO INCREASE ACCESS TO GROUP PRENATAL CARE?
6 States Have Begun Offering Enhanced Reimbursement Rates to Incentivize Group Prenatal Care
Since October 2020, six states have begun offering an enhanced Medicaid reimbursement to incentivize group prenatal care. Previously, California, Louisiana, Montana, New Jersey, South Carolina, Texas, and Utah offered enhanced reimbursement rates at varying levels, starting as low as $7 per patient, per visit in New Jersey and ranging up to an additional $30 per patient, per visit in South Carolina. Over the last 5 years, Arizona, Georgia, Maryland, Missouri, North Carolina, and Ohio all began offering enhanced Medicaid reimbursement rates to bring the total number of states offering enhanced reimbursement rates up to 14 in 2024.
Despite having billing codes and enhanced reimbursements, some states do not always “turn on” or use the billing codes for reasons such as lack of education about the services/codes and/or low reimbursement rates. For example, although Louisiana, Montana, and Utah offer enhanced reimbursement rates for group prenatal care, the states did not have any CenteringPregnancy sites in 2023.
States Are Offering Increasingly More Generous Reimbursements for Group Prenatal Care
Since October 2020, the six states that have implemented enhanced Medicaid reimbursements to incentivize group prenatal care are offering more generous rates than most states that previously implemented enhanced payments. CenteringPregnancy, the only program with rigorous evidence of effectiveness, recommends that states reimburse providers at least an additional $45 per patient, per visit.
States that have begun offering enhanced Medicaid reimbursements in the last 5 years have implemented rates more aligned with CenteringPregnancy’s recommendation. Ohio kicked-off this trend by offering the full $45 per patient, per visit in 2021. In 2022, Maryland began offering $50 per patient, per visit, which remains the highest rate in the country. One managed care organization in Louisiana also offers enhanced reimbursement at $50 per patient, per visit. Further research is needed to better understand the extent to which rates incentivize providers to take on start-up costs and to recruit group prenatal care patients.
For more information on state progress to increase access to group prenatal care, check out the 2024 Prenatal-to-3 State Policy Roadmap.
Moving Forward: States Can Work to Provide More Generous Rates and Address Disparities in Group Prenatal Care Access
The current evidence base does not identify a specific policy lever that states should adopt and implement to effectively provide group prenatal care services to all individuals who want this type of care. More evidence is needed to better understand the impact of an enhanced Medicaid reimbursement rate to incentivize group prenatal care in states.
States can continue to expand access to group prenatal care through additional investment. For example, new investments at the federal level promote the expansion of group prenatal care.5 As group prenatal care becomes more available to expectant parents, the impact of the approach can be observed across a diverse range of families.
Additionally, better evidence is needed to assess the impact of group prenatal care from an equity standpoint. Black mothers participating in group prenatal care are significantly less likely to receive inadequate prenatal care or have a preterm birth compared to Black mothers who did not participate in group prenatal care. These results, however, are not sufficient to conclude that group prenatal care addresses racial disparities in prenatal care or birth outcomes. Future research must focus on examining the differential impacts of group prenatal care by race and ethnicity.
NOTES AND SOURCES
- American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
- Ickovics, J.R., Kershaw, T.S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S.S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Journal of Obstetrics and Gynecology, 110(2 Pt 1), 330-339. dx.doi.org/10.1097/01.AOG.0000275284.24298.23 [Group Prenatal Care Evidence Review Study C]
- National Center for Health Statistics (NCHS), final natality data 2022. Retrieved April 16, 2024, from www.marchofdimes.org/peristats. Variation by race and ethnicity data are NCHS final natality data averaged across 2020-2022 (retrieved April 16, 2024).
- Centering Healthcare Institute (n.d). CenteringPregnancy. https://www.centeringhealthcare.org/what-we-do/centering-pregnancy
- Centers for Medicare and Medicaid Services. (n.d). Transforming Maternal Health (TMaH) Model. Retrieved October 1, 2024 from https://www.cms.gov/priorities/innovation/innovation-models/transforming-maternal-health-tmah-model
