Remarks to the Association of Maternal and Child Health Programs

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by HRSA Administrator Mary K. Wakefield

February 12, 2013
Washington, D.C.

Thank you, Michael (Fraser, CEO of AMCHP), for your terrific leadership of AMCHP in its long-time – and from our perspective – extremely important partnership with HRSA.  And thanks to all of you for being here.  It’s good to be back among friends and colleagues on this 50^th anniversary of newborn screening services – services that we know save and improve the lives of thousands of babies across the U.S. every year.

If you weren’t before, by now most of you are familiar with Dr. Michael Lu, Associate Administrator of our Maternal and Child Health Bureau.  I imagine that many of you heard him speak on Sunday, so you have a good idea why we are so fortunate to have his commitment and his expertise at HRSA.

I’d also like to recognize HRSA staff that are here – please stand.  MCHB has a terrific group of experts with an incredible commitment to the issues that bring us here today.  If you haven’t personally connected with them, please take a moment to do that.

Well, I am particularly pleased to be asked to be here.  The agenda for this meeting looked great, and I understand it’s been very productive thus far, with much reflecting on the state of MCH programs and the future for the work that you do.  And what an incredibly bright future it is.  For those of us who have worked in health care our entire professional lives – including so many of you in this room – we are really at an historic moment.

We are on the home stretch of implementation of the Affordable Care Act, or ACA, which is still being rolled out but already making a difference in the lives of millions of women and children in America.  This morning I’d like to spend the time we have together talking about the ACA, and how we can work together to make the most of this new era in health care.

I know you’ve heard this before, but it bears repeating.  The ACA is making it possible to have access to preventive services with no co-payments.  The ACA prevents insurers from denying health insurance coverage to women because they’re pregnant, or because they gave birth by c-section, or because they’re a breast cancer survivor, or because they’re a victim of domestic violence.

The ACA helps to make insurance more affordable.  Eliminating barriers such as copays, co-insurance, and deductibles will increase access to services that improve the health of women and their children.  Not just caring for them when they are sick but – when possible – helping to ensure they stay healthy in the first place.

And one of the ACA’s signature new programs in support of women and children, as you know, is the Home Visiting program.  This is one of the most significant investments in Maternal and Child Health in a lifetime, and I just want to take a moment to thank those of you who have played an important leadership role in standing up this program in your home states.  This program works best when we have strong partnerships, and many of you in this room are our very essential partners in this effort.

For 2013 we have established two new frontiers for Home Visiting:  quality improvement and systems integration.  We’ll continue to support our shared commitment for quality improvement through technical support and collaborative learning, and this spring we will be launching a Collaborative Improvement and Innovation Network, or CoIIN, to drive quality improvement in Home Visiting – an approach similar to that taken by the CoIIN for infant mortality.

We also want to make sure that Home Visiting is well-integrated within a comprehensive system of services for children and families.  Both Home Visiting and the Early Comprehensive Childhood Systems program can play very important roles in driving systems integration for early childhood, and in linking to Community Health Centers, Early Head Start and Head Start, and other early childhood programs.  The Home Visiting program shouldn’t be in a silo by itself – as we continue to strengthen this investment, we need to ensure that it is seamlessly integrated with other highly relevant, complementary programs.

More broadly, provisions of the ACA like Home Visiting bring opportunities to think about your programs in a new context. In this rapidly evolving health care system, you can, of course, continue to count on HRSA for help in your efforts to promote the health and well-being of women, children, and families through the Title V MCH block grant program.  And with health care reform we have an amazing opportunity to re-envision Title V and the systems it supports, even as we work to help states fully implement the ACA. 

This is one of our top priorities at HRSA.  Over the past 20 years, State Title V programs have played a critical role in expanding Medicaid for pregnant women and the Children’s Health Insurance Program.  Now we need your leadership again.  

State Title V programs will play a very important role in:

• Informing the implementation of both the new insurance exchanges and ACA-related Medicaid expansion;
• In helping families access care and understand changes to the health care system; and
• In ensuring that women, children and families receive high-quality care in this reform era.

I really urge you to consider ACA implementation as an opportunity to leverage the contribution of your MCH programs.  Your expertise and experience in building systems of care, integrating services, and monitoring population health are extremely important to the robust implementation of the law.  And HRSA broadly and MCHB specifically are committed to making sure that the unique needs of women, children and families, including those members with special health care needs, are at the forefront of the law’s implementation. 

From HRSA’s vantage point, MCHB is pursuing several avenues to advance this agenda, including: 

• working with key national organizations, such as AMCHP;
• ensuring that HRSA staffers are able to help MCHB grantees leverage investments that support ACA implementation; and
• making sure that all of our grantees are able to take advantage of the opportunities that the ACA presents.

To take full advantage of the potential created by health care reform, we need to align Title V programs with the ACA goals of expanding access to care, reducing health disparities, and growing a well-prepared workforce.

Title V programs can play a key role in outreach and enrollment, in helping children and families navigate the new health systems through care coordination and case management, and in promoting systems integration.

And, for example, Title V programs will continue to play a lead role in newborn screening, lead screening, injury and violence prevention, and in promoting breastfeeding, immunization, safe sleep and so forth through health promotion and public education.

And Title V programs can track ACA’s impact on access for children and families through data and surveillance.  Your expertise is critical to informing all things ACA as they relate to maternal and child health populations.

Also, for our part, to help increase states’ understanding of the ACA and to support a learning collaborative for states, MCHB is supporting the development of a series of technical reports and resources tailored to state Title V programs.

These are just a few highlights about the ways in which ACA and MCH programs fit together -- and I want to call on you to do even more.  We must ensure that the populations you care about and have responsibility for fully participate in the ACA provisions for which they are eligible.  And we need you to help get the word out back home about the new opportunities afforded through the creation of the state-based Health Insurance Marketplace later this year. 

The best place to learn about the Marketplace and other coming benefits is a specific website, www.healthcare.gov.  Through healthcare.gov, you can learn how people can get health insurance and accurate information on different plans.

That is, consumers – and providers – will be able to get comprehensive information about insurance benefits and quality, side by side with facts about price, in order to help them make the best coverage decision.

They’ll also be able to learn, with a single application, whether they qualify for a free or low-cost health insurance plan, or a new kind of tax credit that lowers their monthly premiums.  And, as I mentioned earlier, because the law outlaws discrimination against pre-existing conditions, nobody will be turned away because of her health status.

So I encourage you to go to healthcare.gov often to learn more about upcoming changes.  And please link it, email it, put it in newsletters, recommend it as an information source to your patients, friends, and family members and through civic and professional organizations. 

To help women in your communities, we really do need you to help connect people to this information source.  We all have a key role to play in ensuring that all Americans get the coverage and care they need.  

To summarize, going forward our challenge is to align the values and traditions of Title V with the Affordable Care Act as we pass through this transition period leading to the law’s full implementation.

By committing to both Title V and the ACA, we can make an unprecedented and lasting difference in the lives of America’s women, infants and children.  With our new tools, and with renewed determination to work across programs and health sectors, we at HRSA are very much looking forward to engaging this vitally important work with AMCHP and with each of you.  I really can’t think of better partners than you or an era with more opportunity.

Thank you for inviting me to be with you today.