Kentucky gets a 'D' grade on second annual report card on maternal mental health, a bit worse than the national average

By Melissa Patrick
Kentucky Health News

Kentucky received a D grade on the second annual report from the Policy Center for Maternal Mental Health, moving up from a D-minus in last year's report card. The national grade was D-plus; D was the most common grade, and 23 states had grades higher than Kentucky's.

“Maternal mental health is core to the health and well-being of women and families. Our report cards provide state government and advocacy leaders with a tool for identifying areas of opportunity and the ability to track annual progress,” Joy Burkhard, executive director of the policy center, said in a news release from the Milken Institute School of Public Health at George Washington University, which supported creation of the report cards.

“We are particularly hopeful about one of the new measures added this year, which tracks how often women are being screened for these disorders,” Burkhard said. ”Asking about symptoms is the first step toward diagnosis and treatment.”

The report notes that two things changed in Kentucky to improved the state's grade, however slightly. The state now meets the recommended maternal-mental-health prescriber ratio for the perinatal population and has a perinatal quality collaborative that prioritizes maternal mental health (a new category).  

The 2024 report cards include 18 measures that are divided into three key domains: Providers and Programs, Screening and Screening Reimbursement, and  Insurance Coverage and Treatment Payment. 

Kentucky met six of the 18 measures on the report card, with most of them in the Insurance Coverage and Treatment Payment domain, for things like expanding Medicaid, extending Medicaid coverage to one year after birth, and the ability to submit claims to proivate insurers for pre- and post-birth maternal mental-health treatment.

Kentucky got a D for providers and programs, an F for screening and screening reimbursement, and a C for insurance coverage and treatment payment.

What's Kentucky doing? 

Kentucky has several groups working on this issue, including a mental-health initiative in the state Department for Public Health, called the Maternal Mental Health Collaborative, and the Kentucky Perinatal Quality Collaborative, an effort of hospitals, doctors, nurses, public-health experts and others.

Another group working on this issue is the Mind the Gap Kentucky Coalition, which includes Postpartum Support International along with a host of other members, led by Nikki Boyd, the director of maternal infant health initiatives with the March of Dimes. 

"One thing all the groups involved in maternal mental health are doing is being sure to work together, to share resources and reduce unnecessary duplication of effort across the board," Marcie Timmerman, executive director of Mental Health America Kentucky, said in an email. 

In 2023, the legislature passed Senate Bill 135 to require the Cabinet for Health and Family Services to make information on postpartum depression and a postpartum assessment tool available on its website. It also required the cabinet to develop and implement a collaborative program aimed at improving the quality of prevention and treatment of postpartum depression.

In 2024, legislators passed a multifaceted bill dubbed the "Momnibus" as part of Senate Bill 74. It was originally House Bill 10, sponsored by Rep. Kim Moser, D-Taylor Mill. The Momnibus portion of this bill came out of a working group of Republican and Democratic women in the House and the Senate. 

Among other things, the Momnibus ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period.

It also establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visitation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

"I'm not surprised by our report card here, but I am energized by the existence of more than one advocacy group, the commitment to improving maternal mental health by legislators who were involved in HB 10, which turned into SB 74, and by providers who are increasingly involved in this effort to improve and ultimately save lives," said Timmerman, of Mental Health America.

Boyd said the results of the report card drive a lot of work being done by the Mind the Gap Coalition and the state task force. 

"These are things that can't be done overnight," she said. "There's a lot of policy involved and a lot of across the aisle work that needs to happen for these to happen. . . . It's a good guide, a good metric to help us figure out what the needs are." 

Boyd said each measure on the report card needs to be considered related to the needs of the state. For example, the report card shows Kentucky does not have at least one inpatient maternal-mental-health treatment program, but does not consider that the state does not  have enough patient volume to support one. Places are available to provide this kind of care, but she said this is something the state should monitor. 

Boyd said she's excited that Kentucky is taking the reins on this issue. 

"Kentucky's really doing a good job around prioritizing this and doing small things to ensure that Kentuckians are getting access," she said. "So obviously, there's a long way to go, but  I think getting it started, it's a great, great start." 

National numbers and efforts

The national grade improved slightly from a D to a D+, with four states earning B grades, up from one in the 2023 report; 19 states receiving C grades, up from 10 in 2023; 24 states receiving D grades, down from 25 in 2023; and five states getting a failing grade, down from 15 in 2023.  

"The U.S. is failing mothers," says the report. 

On May 14, the U.S. Department of Health and Human Services released the Task Force on Maternal Mental Health's national strategy to address maternal mental health, calling it an "urgent public-health crisis." The news release said the U.S. has the highest maternal death rate among high-income countries and 22% of the deaths are related to suicide, drug overdose, mental-health issues and substance-use disorder. 

“Many of these tragic deaths can be prevented by eliminating health disparities and understanding the impact of mental health during pregnancy and in the first months as a parent,” said HHS Secretary Xavier Becerra. “We want to address the challenges people are facing, decrease stigma associated with these challenges, and improve access to support both inside and outside of the health-care system.”

The five pillars of the national strategy are: building a national infrastructure that prioritizes perinatal mental health and well-being, with a focus on reducing disparities; making care and services accessible, affordable, and equitable; using data and research to improve outcomes and accountability; promoting prevention and engaging, educating, and partnering with communities; and lifting up the voices of people with lived experience, according to the news release.