HB 2280: Expands MO HealthNet benefits for pregnant women to provide substance abuse treatment for up to one year after giving birth

Policy/Theory Exemplar

Year of implementation – 2018-present

Scope

This policy addresses the challenge of achieving the UN SDG #3.5- strengthen the prevention and treatment of substance use disorders (SUD). In the State of Missouri, pregnant women affected by SUD needed funding for accessible community-based treatment, recovery supports, and health and social services. A nurse in Missouri, Sarah Oerther, provided expert testimony to pass State legislation to extend State insurance benefits for up to 24 months post-partum to new mothers with SUD who remained in treatment.

Policy summary

Sarah Oerther used evidenced based research to show extending insurance coverage would provide medication-assisted treatment (MAT), motivational interventions, and comprehensive health and social services. Extending insurance coverage allows pregnant women to recover from addictions and communities to prevent families from being torn apart

Nursing perspective

This case-study provides an example of how nurses can apply the Theory of Integral Nursing (TIN) when developing expert testimony to influence the creation of governmental policies. It is important to remember that four integral quadrants can be applied when developing expert testimony to influence policy at the local level.

First, nurses identified four interrelated challenges (download PDF of NIGH’s Integral Models here).

  • Problem 1 (Global Levels quadrant): The challenge of achieving the UN SDG #3.5- strengthen the prevention and treatment of substance use disorders (SUD)
  • Problem 2  (Individuals quadrant and Grassroots quadrant): In the State of Missouri, pregnant women affected by SUD needed funding for accessible community-based treatment, recovery supports, and health and social services.
  • Problem 3 (The Groups quadrant): Nurses in Missouri needed to provide expert testimony to pass State legislation to extend State insurance benefits for up to 24 months post-partum to new mothers with SUD who remained in treatment. 

By including this four-quadrant approach, nurses developed a deeper understanding of how to influence healthcare policy as they partnered with local community members to solve health challenges relating to the prevention and treatment of substance abuse in pregnant women.

Case Study

In the United States (U.S.), SUD affects people of all ages. Many groups have been disproportionately impacted by SUD due to issues of social justice (Naegle et al., 2019). For instance, at the local level, nurses found that mothers often wanted to overcome their addictions for the sake of their unborn children, but, in the State of Missouri, after 60 days postpartum they lost their insurance coverage to continue to remain in treatment. Nurses knew extending insurance coverage was needed to continue to treat addictions after women gave birth.

Nurses used evidenced based research to show extending insurance coverage would provide medication-assisted treatment (MAT), motivational interventions, and comprehensive health and social services (Jessup et al., 2019). Extending insurance coverage would allow pregnant women to recover from addictions and communities to prevent families from being torn apart. A nurse provided expert testimony at the Missouri State Capitol on the need for extending Missouri HealthNet benefits for up to 24 months post-partum to new mothers with Substance Use Disorder who remain in treatment.  This bill was subsequently adopted by the Missouri state legislature and now serves as a model for other states.

Challenges:

Among Peoples– The Missouri Family Support Division determined that approximately 24,000 women annually lose their insurance, MO HealthNet coverage, after 60 days postpartum. To overcome this problem, nurses used evidence-based research to show extending MO HealthNet services to 12 – 24 months postpartum would provide more positive outcomes for women with SUD and their children (Jessup et al., 2019). For instance, birth spacing, and prevention of preterm delivery, and low birth weight are examples of expected positive outcomes (Sonfield, 2014).

Within Groups– Nurses started this project by working with an inter professional group of law enforcement and healthcare providers attempting to deal with the opioid crisis in their community. Nurses found pregnant women suffering from opioid addiction had social networks to provide support and accountability.  For instance, many churches and community groups seemed to know how to simultaneously extend grace while demanding accountability and transparency. However, these groups were unable to provide the resources needed to medically support recovery for opioid addiction.

Grassroots levels– Nurses met with local residents to learn their personal stories of how they were impacted by SUDs. These stories were included in the expert testimony provided by a nurse to the Missouri state legislature..

Global Level-This project displayed nurse-healer competence because it involved scholarly-based expertise and global endeavors, which initially leveraged UN SDG #3. In order to influence policy, nurses needed to explored new possibilities into the complex nature of healing from many viewpoints surrounding insurance in order to provide an affordable means of keeping people healthy.

The expert testimony on extending insurance benefits for up to 24 months post-partum to new mothers with SUD was based on a nursing perspective, and was provided to help tackle health disparities related to SUD. The process for developing nursing expert testimony was based on TIN. Nurses used TIN to link the relevance of insurance with evidence-based research on SUD, and as well as authentic community engagement with community members and State Legislators. Unique aspects of developing this expert testimony included an assessment of local health needs, stakeholder input, and literature review of best practices.

Key nurse activist 

Sarah Oerther provided expert testimony on extending insurance benefits for up to 24 months post-partum to new mothers with SUD. Her testimony was based on a nursing perspective, and was provided to help tackle health disparities related to SUD. The process for developing nursing expert testimony was based on TIN. She used TIN to link the relevance of insurance with evidence-based research on SUD, and as well as authentic community engagement with community

members and State Legislators. Unique aspects of developing this expert testimony included an assessment of local health needs, stakeholder input, and literature review of best practices.

Outcomes

See the Action History on this bill here

Related Literature

  1. Jessup, M.A., Oerther, S.E., Gance-Cleveland, B., Cleveland, L., Czubaruk, K., Byrne, M., D’Apolito, K., Adams, S., Braxter, B.J., & Martinez-Rogers, N. (2019). Treatment and Advocacy for Pregnant and Parenting Women with a Substance Use Disorder: Actions and Policies for Enduring Therapeutic Practice. Nursing Outlook 67(2), 199-204.
  2. Oerther, S., Hallowell, S., Rossiter, A., & Gross, D. (2018). The American Academy of Nursing Jonas Policy Scholars Program: Mentoring Future Nurse Leaders to Advance Health Policy. Journal of Advanced Nursing,74(10):2253-2257.
  3. Oerther, S., & Olshansky, E. (2018). Stop Using Children to Punish Mothers At The Border And At The Hospital. HuffPost. https://www.huffingtonpost.com/entry/opinion-oerther-olshansky-family-separation-addiction_us_5b43382ee4b07b827cc27da8

About Sarah Oerther

Sarah Oerther testifying at the Missouri Capitol on the need for postpartum Medicaid coverage for women with SUD.

Sarah is enrolled as a PhD candidate at the School of Nursing, Saint Louis University where she is also completing a Family Nurse Practitioner post-master certificate. Sarah’s research is informed by diverse clinical experience, and her practice spans from advanced hospital critical care to community-health for families in rural America. Sarah’s publications include peer-reviewed journal articles, book chapters, and OpEds in The Missouri Times, The Hill, and HuffPost. She has authored multiple policy statements with the American Academy of Nursing. Sarah is Vice President of the Missouri Nurses Association, and is a Section Counselor for the Public Health Nurse Section of the American Public Health Association. Additionally, she was appointed by the Governor to the Missouri Health Net Oversight Committee. In 2019, she received the Excellence in Nursing Award from St. Louis Magazine in 2019, and in 2018 Modern Healthcare Magazine named her a “Rising Star in Nursing”. Sarah was a Jonas Policy Scholar for the American Academy of Nursing (2017-2019).