OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID1 Babies, Business and the Bottom Line

Fewer preterm births Potential cost savings (in billions) Preterm birth rate (% of live births) 231, ,000 fewer babies born preterm $11.9 billion $11.9 billion saved Preterm Birth Reductions * Preliminary data Source: Preterm birth rates—National Center for Health Statistics, 2006 – 2012 final and 2013 preliminary natality data Fewer preterm births—calculated as the reduction in preterm birth rate since 2006 times the number of live births per year. Potential cost savings—based on estimated number of fewer preterm births and the average societal costs due to preterm birth from the Institute of Medicine, Prepared by March of Dimes Perinatal Data Center, June 2014.

Institute of Medicine Report, 2006 Annual Societal Economic Costs Associated with Preterm Birth, US 2005 Preterm is less than 37 completed weeks gestation. Source: Institute of Medicine, Preterm Birth: Causes, Consequences, and Prevention. National Academy Press, Washington, D.C. Published and unpublished analyses Prepared by the March of Dimes Perinatal Data Center, Total Costs = $26.2 billion annually Immediate Short Term Medical Care for Preterm Infants $16.9 billion (65%) Lost Household and Labor Market Productivity $5.7 billion (22%) Maternal Delivery $1.9 billion (7%) Special Education $1.1 billion (4%) Early Intervention $611 million (2%)

More than 12 times as much Costs per infant include all employer payments for newborn medical care during the first year of life. Source: Truven Health Analytics, Inc. Costs of Preterm Birth. Prepared for March of Dimes, Average Expense to Employer Newborn Care

Cost Drivers: Average Newborn Healthcare Utilization

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID6 Every week in Mississippi more than 744 babies are born. Of these babies: 127 babies are born premature 87 are born low birth weight under 3 lbs. 1 oz. 282 are born by cesarean section 7 babies die before their first birthday Estimated cost to be around $330,000,000 ( 6604 babies x $50,000 average cost) our challenge

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID7 To improve the health of babies by preventing birth defects, premature birth and infant mortality by: our purpose funding research providing education to help moms and health care professionals supporting families with direct care and support

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID8 David J. Dzielak Ph.D. MASI 8 th Annual Winter Conference February 26, 2015 Office of the Governor | Mississippi Division of Medicaid

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID9 Mississippi Division of Medicaid The Mississippi Division of Medicaid has over 900 employees located throughout one central office, 30 regional offices and over 90 outstations. We are charged with facilitating the Medicaid program for the state of Mississippi. Mission: The Mississippi Division of Medicaid responsibly provides access to quality health coverage for vulnerable Mississippians. Values: We are committed to accomplishing our mission by conducting operations with… Accountability * Consistency * Respect * * *

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID10 History of Medicaid Medicaid was created as part of the Social Security Amendments of 1965, to provide health coverage for certain eligible, low income populations Medicaid was enacted by the Mississippi State Legislature All 50 states, the District of Columbia, and five territories participate in the voluntary matching program.

Medicaid Overview Federal Medical Assistance Percentage (FMAP) Lowest match 50%, MS has highest match at 73.58% Eligibility determined by income and SSI status Based on the Federal Poverty Level (FPL) OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID11 Family Size 100%133%138%143%194%209% 111,77016,24816,24317,42423,42425, ,93021,98421,98323,58031,70434, ,09027,73227,72429,74839,98443, ,25033,46833,46535,89248,26451, Federal Poverty Level Guidelines

Who is Enrolled? 54.7% = Children 6.6% = Low Income Parents/Caretakers 17.6% = Disabled (Supplemental Security Income) 11.1% = Dually eligible 3.0% = Family Planning 1.9% = Pregnant Women OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID12 744,668 Medicaid beneficiaries 50,191 CHIP beneficiaries 794,859 Total enrollment As of January 31, 2015

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID13 Premature Birth in the U.S. 1 in 9 babies born premature (before 37 weeks) Leading cause of infant mortality Leading cause of long term childhood disabilities

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID14 By Definition Normal duration of pregnancy is weeks Preterm delivery – pregnancy duration of less than 37 weeks Low birth weight < 2,500 g. or 5.5 lbs. (range is 2,000 – 2,500 g or lbs.) Very low birth weight < 1,999 g or 4.3 lbs. (range is 1,500 – 1,999 g or lbs.) Extremely low birth weight < 1,499 g or 3.3 lbs.

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID15 Why Does This Matter ? Significant development of the brain in last six weeks of pregnancy Babies born before 39 weeks have an increased risk of learning disabilities and behavioral problems More likely to have breathing and swallowing problems. More likely to have apnea and SIDS

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID16 Interesting Statistics In 2013 Medicaid funded 60% of the deliveries in Mississippi 26.3 % of those were preterm deliveries Of the preterm deliveries 42% were admitted to the NICU. Cost of preterm delivery for Medicaid in 2013 was $56 million

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID17

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID18 Risk Factors for Preterm Delivery Race – African-American babies are 2X more likely to be low or very low birth weight Age - 40 increased risk Multiple births – twins 2X more likely to be low or very low birth weight Maternal Health – drugs, alcohol, and cigarette smoking during pregnancy Socioeconomic status

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID19 What Causes Preterm Delivery? Genetic patterns Low grade undiagnosed infections Environmental factors Physiologic signals to begin labor Placental dysfunction Structural changes in the uterus Socio-demographic factors

OFFICE OF THE GOVERNOR | MISSISSIPPI DIVISION OF MEDICAID20 More Research is Needed March of Dimes is very active in this arena Learn more at prematurityreseach.org

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