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Newborn feet held in the palms of hands

New Mexico Medicaid Team Provides Prenatal Outreach to High-Risk Mothers

Birth plans for Alondra Carrillo’s son drastically changed after doctors discovered he had DiGeorge syndrome, a genetic condition requiring highly specialized care unavailable in New Mexico. Three months before giving birth, Alondra was hospitalized at Children’s Hospital of Colorado — more than 470 miles away from her home in Los Lunas, New Mexico.

After Carrillo’s son was delivered, the infant had the first of several surgeries he may need to address a variety of conditions. Her husband traveled back and forth to visit until their son was discharged.

Behind the scenes, Celeste Salcido, a medical management specialist for Blue Cross and Blue Shield of New Mexico, helped arrange for Carrillo and her son to get the care they needed, as well as pay Carrillo’s expenses during the months she and her son spent in Denver.

Carrillo says she continues to refer to information and resources Salcido has provided. “I feel like I could count on her,” Carrillo says of Salcido, a nurse and specialist in transitioning babies from neonatal intensive care. “She did all the phone calls for me, and she would check on me after every appointment. She relieved a lot of stress.”

Factors such as poverty, geography, and lack of health resources can make accessing adequate maternal care difficult for many of New Mexico’s new mothers. The stakes are especially high for women of color.

Statewide, little more than half of Native American women and nearly 58% of Black women receive the early and regular prenatal care recommended to reduce pregnancy complications and improve their chances of having a full-term, healthy baby, according to a New Mexico Department of Health report. By contrast, almost 71% of white women get that level of care, which still is below the national rate, the report states.

With about a third of New Mexico’s women and girls living in low-income, rural areas, many of them don’t see a health care provider until they give birth. More than 32,000 live in areas described as maternal care deserts — counties with little or no maternity health services — requiring travel as far as Lubbock and Corpus Christi in Texas or Colorado for specialty care. 

“A lot of our members want education and support,” says Cristin Weldon, manager of Special Beginnings®, a Blue Cross and Blue Shield of New Mexico maternity program for Medicaid members. “But they don’t know how to access it.”

Weldon and her team of medical management specialists and care coordinators attempt to fill care gaps and lower preterm births by identifying and reaching out to members at risk of having pregnancy complications. Each month, they try contacting more than 400 members facing health conditions and social issues that put them at higher risk — obesity, hypertension, preeclampsia, substance use disorders, diabetes, as well as lack of housing, transportation and food.

Care coordinators help members access care and find resources to help them reach full-term pregnancy, while helping reducing neonatal intensive care unit costs. After a baby’s birth, they continue their postpartum follow-up with mothers and newborns up to one year.

The team also collaborates with in-home care providers statewide such as Parents as Teachers and Nurse Family Partnership to offer support and resources for mothers, babies and their families.

“The communication has to be very good,” says Weldon, adding members sometimes suspect the outreach will lead to termination of their parental rights. “We’re working with a tough population and in a state that’s geographically tough. There are nooks and crannies with people all over the place.”

In 2023, the team served more than 1,500 high-risk families statewide through its care coordination and NICU transition programs.

“There are so many different issues and concerns to address even before a baby’s birth, and the Special Beginnings team is right there for the families,” says Dr. Cynthia Casteel, a medical director for BCBSNM. “The team helps keep these babies, especially the ones who are high risk for hospital readmissions, healthy and strong.”

Helping members overcome obstacles

The United States has the highest rate of maternal deaths in the industrialized world, The Commonwealth Fund states. About 1,200 women dying every year because of pregnancy-related problems, according to the Centers for Disease Control and Prevention. Receiving prenatal care late in a pregnancy or not at all increases risk of pregnancy complications and maternal deaths, the March of Dimes says.

In New Mexico, one in 10 births is preterm, according to the CDC.

Despite the state’s challenges, Weldon says her team’s outreach makes a difference for members. 

“We’re reaching out to our members as many times as we can, Weldon says. “I have a history of high-risk pregnancy myself. I can’t imagine going through it without resources.”

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association