Medicaid for Low-Income Moms

September 2021

A continuation of our series highlighting the issues affecting the low-income moms gaining access to quality health care.

By Lindsey Hill, Intern

Access to affordable health care is a basic human need yet in the United States, the future of a vital safety net remains uncertain. A report from 2018 revealed that 1 in 10 Arlington adults are living without health insurance. Given how affluent the Arlington community is, it’s a concerning statistic that 11% of Arlington residents do not have insurance. Thankfully there is a safety net for the uninsured – Medicaid. Medicaid covers essential health benefits, including pregnancy, maternity, pediatric care, chronic disease management, breastfeeding support, contraception, mental health and other behavioral health services.

Medicaid is a joint federal and state program that currently provides health coverage to 1 in 5 Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States, with Virginia Medicaid offering low-cost and no-cost health coverage programs for citizens and legal immigrants based on financial status. 

Close to 50% of all U.S. births are covered by Medicaid, along with a large number of maternal, infant, and child health visits. Serving millions of U.S. pregnant women living in poverty, Medicaid expansion has increased access to coverage and services associated with improving the lives of mothers and infants. 

While there are multiple coverage options in the state of Virginia for children and pregnant women, more can be done for these frequent users of needed medical services. Medicaid expansion can and will continue to help low-income populations, specifically helping mothers in need to ensure healthy pregnancies and births. The Governor of Virginia, Ralph Northam, has prioritized Medicaid expansion and in our next Medicaid blog, we will detail how this expansion can have a positive impact for the moms and babies we serve.

Patient Profile: Julie

This post is part of a series where we highlight the lives of the moms we serve. Specifically we want to bring a face to the complex issues we have begun addressing in this blog – such as care in the first trimester.

All stories are compilations from conversations with actual patients and additional research. To protect identities, we have used stock photos.
By Lindsey Hill, Intern

We have talked about the importance of first trimester care and today will highlight the amazing story of an Arlington mom, Julie, whose complicated third pregnancy was made easier through the help of JB-LF and those who contribute to the foundation.

Julie was pregnant with her third child – an exciting addition to the family. In previous pregnancies, she had been diagnosed with gestational diabetes, which is a condition where blood sugar levels become high during pregnancy and requires daily blood sugar monitoring. Gestational diabetes affects up to 10% of women who are pregnant in the U.S. each year. Julie also suffered from chronic hypertension (high blood pressure) prior to pregnancy – a condition that increases the risks for heart attack, stroke, heart failure, or kidney disease.

Julie obviously had her own health concerns, but knew that a healthy outcome was possible with monitoring. That feeling changed during an appointment in her first trimester when doctors discovered Julie’s pregnancy would add on to her already serious health issues. In addition, doctors detected that Julie’s baby had a serious anatomical defect, which was treatable, but would require her baby to be in intensive care for a long period after the delivery. This news was devastating to Julie, who on top of her own health challenges became fixated on what to do for her baby.

Needing a lot of support for both herself and her baby, Julie was at a loss for what to do. She would have almost weekly appointments, need follow-up ultrasounds and tests, and ways to monitor blood pressure and blood sugar. As if this all wasn’t hard enough, the situation was made harder by Julie having no health insurance, no paid time off from work, no car, and no reliable child care for her other children. How was Julie going to make this all work?

Enter the Jennifer Bush-Lawson Foundation and it’s partners, who alongside its contributors, could help Julie in her pregnancy.

Through JBLF’s grant to help fund a telemedicine pilot program, the Virginia Hospital Center clinic could offer Julie telemedicine appointments where Julie’s doctors could connect with her to check blood sugar and blood pressure readings, as well as discuss changes to Julie’s diet, exercise, and medications. We also provided Julie with a home blood pressure monitor and transportation vouchers to get to and from doctors visits. In preparation for her newborn baby’s arrival home, we gave Julie a pack-n-play.

Today, Julie and her baby are alive and well, thanks to all who contribute to the Jennifer Bush-Lawson Foundation. Julie’s story is one of the many that illustrates the importance of early intervention.

4 Questions with Jennifer Myers

This post is part of a series where we pose questions on issues related to maternal and infant care for vulnerable populations to health professionals, community advocates, mothers, JBLF volunteers and other important voices. 

Jennifer Myers served as the Jennifer Bush-Lawson Foundation Executive Director from 2017 to 2020 and now serves as Treasurer of the Board of Directors.

1. You were JBLF Executive Director for 3 years, what are you proudest of?

It was really exciting to start expanding JBLF’s work. Our relationship with Virginia Hospital Center to support low-income moms and babies in Arlington has been extremely special and impactful, but so much need still remains in our county and region. I was glad to have the board’s support to explore other ways that JBLF could work in our community to lift up our most vulnerable members. While I was executive director, we launched a Prize for Prenatal Innovation, we held our first thought-leader event at Duke University’s DC offices, and we began making plans for research projects that have the potential to lead to better solutions. It was a groundbreaking time to be at the helm of JBLF and I can’t wait to see where our work goes under our current executive director. 

2. What JBLF program has surprised you the most

Our thought-leader event exploring innovative solutions to solve the maternal mortality crisis blew me away. The panelists spoke before a packed, engaged audience that included participants from the Arlington County board, DC government, nonprofits, foundations, businesses and more. When you launch a new program, in some ways it’s always a leap of faith. Seeing the interest by so many in such varied fields, all wanting to help moms in need, made it clear that JBLF was on the right path. 

3. What are you most excited about for 2021?

I can’t wait to have a normal 5K again in November! It’s hard to match the community love that I sense each and every year at that event. It’s wonderful to see so many faces coming back, and I’m always excited about the new people who join us after hearing about our mission. 

4. What are people surprised to find out about you?

I’m not a runner! The annual 5K is one of JBLF’s largest fundraisers and it’s an event I love, so I think most people assumed when I was the executive director that I was an avid runner. Thanks to two back surgeries, running is not in the mix for me (you can catch me at the pool swimming laps, though!). But JBLF’s mission and the community spirit at the 5K pulled me in.

First trimester care: A problematic start to pregnancy

1 in 3 babies in Arlington does not get seen by a healthcare provider during the first trimester of pregnancy.
By Lindsey Hill, Intern

This earliest phase of pregnancy contains the highest number of essential developmental milestones for both mother and baby. During this period, the baby’s organ systems and body structure develop, even tiny miracles as small as fingernail growth occur. As you can imagine, prenatal care, especially in the first trimester, is vital to both the pregnant mother and the development of a healthy baby.

According to the Virginia Department of Health, the percentage of women in Arlington seeking a healthcare professional in their first trimester remains relatively low. In 2018, only around 60% of expectant mothers in Arlington sought care in this critical period. While low-income pregnant women face the difficulties of being underinsured and finding or qualifying for healthcare programs, they also experience obstacles to care including transportation issues, lack of providers, language barriers, childcare needs, and the consequences of missed work. As much as these moms want to get the best possible care for their babies, countless roadblocks often stand in their way.

Why is needing care in the first trimester of pregnancy so important? Healthcare appointments in the earliest stage of pregnancy include physical exams and prenatal tests for mom and screenings to assess the health of the baby. These appointments help determine, find, and if necessary, prevent any foreseen problems or complications with the pregnancy. Expectant mothers also learn crucial information about their pregnancy as well as have the opportunity to ask their provider any questions they may have. Increasing the number of women who receive these early stages of care can reduce the likelihood of complications during pregnancy and childbirth, but the longer this care is prolonged, the more health risks the mother and unborn baby face.

The Jennifer Bush-Lawson foundation strives to serve the economically vulnerable mothers and infants of Arlington by giving them a fair start at life through access to quality pre and postnatal healthcare and support. We envision a community where every mother and newborn child receives the support they need to thrive– regardless of race, color, creed, or economic status. This is accomplished through innovative programs such as the tele-health project that increased monitoring access for pregnant women who do not have the option to take time off work or travel for frequent medical appointments. 

Care in the first trimester is critical for expectant mothers. The Jennifer Bush-Lawson Foundation is driven to provide women with more access to first trimester care as well as education about their pregnancies. Affordable healthcare is not always easily accessible, but coming to better understand the various barriers mothers face, we hope to better serve the community.

4 Questions with Lindsey Hill

This post is part of a series where we pose questions on issues related to maternal and infant care for vulnerable populations to health professionals, community advocates, mothers, JBLF volunteers and other important voices. 

Lindsey is the summer intern for JB-LF through her college, Marymount University.

1. If you could tell us one thing, what would it be?
So far, one of the best parts about this internship has been researching the many topics I have been charged with writing about. I have learned so much, not only from the research, but also from JB-LF’s Executive Director, Kelly Garrity, and from the various webinars I have virtually attended. There’s a wealth of information out there about maternal health and how systemic changes can be made to improve the lives of pregnant women and new mothers. I’ve become so engrossed with the material I interact with that I sometimes have to stop myself from babbling when talking to others about how awesome this internship is.

2. What has surprised you the most in this internship?
What has surprised me the most in this internship is how many challenges and hurdles many mothers face. So much goes into ensuring our communities and mothers get taken care of, from family planning, to preconception, to prenatal and postnatal care. Yet many mothers are unfortunately not given the access to care that they need and deserve, and it’s organizations like JB-LF that invest in maternal health who are changing the playing field.

3. What are you most excited about for the future of JBLF?
I am most excited for the future of JB-LF as the foundation continues to conduct research and fund cutting-edge programs that will increase access to care. Making an impact in the community through serving families, raising awareness, covering basic needs, and so much more, JB-LF is spearheading important initiatives. Working collaboratively with other organizations, health care providers, and the families of Arlington County, I have the utmost confidence that real change is taking place for the futures of our mothers and their babies.

4. What are people most surprised to find out about you?
Most people I meet are surprised to find out how introverted I am. I can be a social butterfly, but truthfully only recharge my batteries when I’m by myself. At an early age I discovered my love for reading and writing, and always knew I wanted to study literature. My writing background has served me well in this role as an intern for JB-LF and I have enjoyed drafting up blog posts for the foundation.

4 Questions with Colleen Borelli

This post is part of a series where we pose questions on issues related to maternal and infant care for vulnerable populations to health professionals, community advocates, mothers and other important voices. Colleen Borelli joined the JB-LF board in 2019.

1. You are a local OB provider, how did you choose that career path?
 My Master of Public Health focused on Women and Infant Health which has always been a special interest of mine. Then when I went to medical school I found that OBGYN was really my passion within medicine. I love being able to care for women of all different ages and be part of some of the most important moments of their lives. I enjoy both the surgical and medical aspects of this specialty and really could not imagine doing anything else. It was really just a natural fit for me.

2. You joined the JBLF Board in 2019, what has surprised you the most?
What has surprised me most is our ability to accomplish quite a lot within a relatively small non-profit. The community involvement and support is really inspiring. It is great to see how an efficient and well run organization can make a very big impact with relatively less resources than large non-profits.

3. What are you most excited about for 2021?
I am most excited about finally travelling to see my family on the west coast who I have not yet seen in a year and a half. I am very grateful for the science behind the vaccines in getting us to this point.

4. What are people surprised to find out about you?
I may be one of the few Americans who doesn’t like ketchup….my kids always taunt me with it when they are eating their french fries!

5 Questions with: Kelly Garrity

This post is part of a series where we pose five questions on issues related to maternal and infant care for vulnerable populations to health professionals, community advocates, mothers and other important voices. Kelly Garrity joined as JB-LF Executive Director in March 2020.

1. How did you end up in the nonprofit sector and fundraising?

Accidentally! After a brief stint with Tech Start Up and Law Firms, a recruiter sent me a nonprofit position. I got the job and spent the next decade plus working with a nonprofit that focused on systemic health policy issues at the federal level. This ranged from the familiar Affordable Care Act to wonky topics such as value assessment.

I led the team responsible for recruiting nonprofit/business members and administering their associated benefits. In addition, I did fundraising for all of our advocacy and program work, a role that grew organically from the need to expand.

2. Why JBLF?

The intersection of professional growth and personal passions. I knew how important our work was to a vulnernable population from my experience as an infertility patient/advocate, with high-risk pregnancies covered by insurance, and stillbirth. In addition, the position provided me an opportunity to build on my professional experience at the Federal level to benefit my local community.

3. What has surprised you the most in your first year?

The community! After spending so much time focused on federal issues and the larger picture, it was an adjustment transitioning to a more local organization. I have been blown away by the wonderful volunteers, donors, partners, and moms/babies that I’ve gotten to work with this year. The strength of the network that JBLF has developed over just 6 years is amzing.

4. What are you most excited about for 2021?

Holding our 7th annual 5K (and hopefully family fun day) and the research we plan to conduct with the low-income moms we serve. With this research we aim to make long term change by understanding the current process for accessing their care, why barriers may exist to timely initiation of prenatal care, and determining what other obstacles are present during pregnancy for this vulnerable population.

5. What are people surprised to find out about you?

There are a few things that come to mind.
– I am an Air Force child who only moved once.
– I am an ice skater who now coaches the sport.
– I have run a marathon.
– I have 4 tattoos.
– I consider my ADD as a superpower.

5 Questions with: Emily Hershenson

This post is part of a series where we pose five questions on issues related to maternal and infant care for vulnerable populations to health professionals, community advocates, mothers and other important voices. Emily Hershenson, an independently licensed clinical social worker who is in private practice as a psychotherapist in Dupont Circle in Washington, DC, shares thoughts on maternal mental health.

1. How did you join the health care field and what inspired you to focus on mental health and psychoanalysis?

I went to graduate school for social work after forays into two very different fields: politics and the performing arts. I loved working in both, but I knew I wanted to go to social work school and specifically become a psychotherapist because of my own life experiences. I think there are usually personal reasons we choose the work we do; that certainly is the case for me. But psychotherapy is such a hopeful endeavor. The therapist and patient work together to gain a greater understanding of the patient’s life with the goal of relieving suffering and making life ultimately more meaningful. It can be so transformative. It’s a privilege to do the work I do. 

2. What do you think are the major maternal mental health concerns that are affecting women of color and low-income women?

I think the biggest maternal mental health concern can be summed up with one phrase: access to care. As an example, there’s a higher incidence of Postpartum Depression (PPD) among low-income and minority women. Often, it’s not even diagnosed among these women. If it is correctly diagnosed, a realistic treatment plan cannot often be implemented. Why? Because of access to care. If you’ve got two kids at home already, a newborn and you’ve been diagnosed with PPD, when are you going to see a psychotherapist weekly? Who is going to watch your kids? How are you going to get to the therapist’s office? How are you going to pay your co-pay? (Or, a more accurate question: how can you find a therapist with availability who also accepts your insurance?)

Further complicating the situation are language and cultural barriers to care. In many communities, mothers feel ostracized if they’re having a tough time after the baby arrives. Regrettably, there is still such stigma around mental health challenges, especially for new mothers. Many moms who would benefit from PPD treatment don’t even know there is help out there. They may not even have a name for what they’re experiencing. 

3. What are some possible solutions that can help resolve these issues?

There are no easy solutions, of course. I think JB-LF is doing great work. It’s going be the efforts of organizations that are going to make a difference–whether through direct funding, community partnerships, or campaigns raising awareness about the issues. I think the more maternal mental health is discussed openly, the less shame moms will feel in reaching out for help.

I had very difficult postpartum experiences after each of my children was born. It was hard, but I was relieved when I met other moms who had similarly tough times. I was lucky. I had the resources and fantastic support to get the help I needed. I think if more people are willing to open up and share their stories, it can be powerful and de-stigmatizing. 

4. What are some ways that women can handle or deal with postpartum depression at home?

If you suspect you have PPD or are experiencing any changes in your mood, talk to your doctor or RN right away. Ask for their help in getting help. It can be too overwhelming to have to coordinate treatment on your own. If you can, go walk with your baby in a carrier or a stroller; breathe some fresh air. Eat well. Snack on peanut butter, cheese, apple slices. Drink lots of water. Keep in contact with friends and family. Don’t isolate yourself. Remember that you’re not alone.

5. What are some resources, outside of hospitals, that low-income women can utilize that can provide support?

Often times, health care providers tell moms that they’re not alone and that the mental health challenges they are facing are not their fault and that, with help, they can be well again. This may seem like an empty sentiment if you’re someone without access to resources.

Everyone should know about Postpartum Support International. It’s a very important resource for postpartum mothers and their families: The organization is dedicated to helping women suffering from perinatal mood and anxiety disorders (PPD is the most common one) and they offer reliable support and information for moms and families (and professionals too). They have a help line–which is not a crisis line–as well: 1-800-944-4473.  On their website, you can find everything from online support meetings and local resources. Every new mom should visit their website at least once. They are doing important work.