There is no such thing as somewhat pregnant.
And yet somewhat is exactly how well new mothers understand their maternal health coverage, according to our latest survey of 300 recently pregnant women, their caregivers, and 50 health plan leaders.
- 56% of new mothers said they didn’t fully understand their care plans.
- 58% of health plan leaders admitted their members understand maternity and postpartum coverage only somewhat well.
- Both sides feel the gap but neither has closed it.
A crisis of confusion, not just coverage
Our first report in this series examined the Medicaid maternity cliff: the very real risk that redeterminations will strip coverage from mothers mid-pregnancy or shortly after delivery. This report picks up where that one left off. Even mothers who keep their coverage often don’t understand what their plan covers, for how long, or what it will cost them.
Cost and coverage confusion was a bigger barrier to finding care for those who struggled than finding a provider. This is startling amid chronic provider shortages. Of these members, 38% were most confused about how long their maternal and postpartum coverage lasted.
The impact: 41% of new mothers felt less than fully confident taking their babies home from the hospital.
The question that must be answered: If a mother can’t confidently take her newborn home, whose job was it to make sure she could?
More resources, not necessarily more clarity
It’s not as if payers are doing nothing.
Some 85% of new mothers received health plan support at least once after discharge, but volume didn’t translate to value.
- 53% of members received text messages, but only 28% found those texts genuinely helpful.
- Only 9% found community health worker outreach helpful, even though 46% of health plan leaders believed that channel was effective.
- The biggest drop-off was in the value of patient portal notifications: 41% of members received them but only 16% found them helpful and compared to 34% of plan leaders.
The impact: The gap between health plan intention and effectiveness shows up everywhere in our data.
The question that must be answered: If health plans believe their outreach is working nearly five times better than members do, who is actually being served by that outreach?
What payer leaders can do
Closing the chasm doesn’t require more communication. It requires better-targeted communication, backed by care management that reaches people at the moments that matter. Three priorities stand out:
- Match the channel to the moment. What helps a mother in early pregnancy isn’t what helps her at discharge. Live phone support usefulness roughly doubled between the two stages, from 23% to 50%.
- Close the culture and language gap. More than a third of members (36%) did not always receive communication that reflected their language or culture. That’s not a nice-to-have. It’s a real barrier to care.
- Invest upstream, not just downstream. While there is inconsistency between health plan intention, resources, and execution, there is a saving grace: care management, which payer leaders would fully fund if money were no object.
Unfortunately, money is an object — and a new mother isn’t a number.
The stakes for health plan leadership
Somewhat confident isn’t confident. Somewhat informed isn’t informed. And somewhat aligned isn’t good enough when the fourth trimester affects long-term outcomes for mother and baby alike.
More than half of new mothers (54%) wished something had been different about their experience. Nearly a third wanted better communication specifically.
The data is real, but is anyone in the industry listening? Health plan leaders rank member engagement first as a maternal/NICU priority, but only fifth as an overall strategic priority. Is engagement truly valued — or is it just a service-line problem to contain?
There can be only one conclusion: Mothers need continuity, coordination, and human connection. Health plans must manage cost, quality, and experience. Member engagement in the form of care management — supported by digital resources and the right digital partners — is where they meet.
Next up: Our third and final report in our maternal health series: a focus on the social drivers of health (SDoH) data that health plans are collecting but are only somewhat confident using.
