Why Reimbursement Policies Alone Won’t Fix Postpartum Mental Health Care

The views and opinions expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of the Policy Center for Maternal Mental Health.

In 2025, Medicaid marks its 60th year as a cornerstone of U.S. maternal and child health coverage, financing more than 40% of all births nationally.¹ As maternal mental health continues to gain attention among payers, providers, and policymakers, Medicaid’s role in supporting equitable access to postpartum behavioral health services is more critical than ever.

Two recent studies examining Massachusetts Medicaid reforms provide important insights into how reimbursement policies affect postpartum mental health service delivery. One study, published in Health Services Research, evaluated the impact of separate reimbursement for perinatal depression screening. The other, published in the Journal of Womens’ Health, assessed the effects of payment parity for tele-mental health services. Together, these studies offer a clear message: while targeted Medicaid payment reforms may improve certain care processes, they are insufficient to drive meaningful system-wide improvements in postpartum mental health outcomes without accompanying structural support.

Two Medicaid Reforms, Two Different Results

Separate Reimbursement for Perinatal Depression Screening

In May 2016, Massachusetts Medicaid (MassHealth) implemented a policy to reimburse providers for conducting perinatal depression screening as a separate billable service. The analysis of this policy, using Massachusetts All-Payer Claims Database (MA APCD) from 2014-2020, found a significant increase in postpartum screening rates among Medicaid enrolled – rising from 1.9% pre-policy to 16.9% post-policy.² This increase in screening exceeded that seen among privately insured individuals during the same period.

Despite this improvement in screening rates, the policy did not result in a statistically significant increase in antidepressant treatment or depression diagnoses. These findings suggest that reimbursement for screening alone is insufficient to ensure follow-up care.

Tele-Mental Health Payment Parity 

In January 2019, Massachusetts became one of the first states to establish payment parity for tele-mental health visits in Medicaid, ensuring that telehealth services were reimbursed at the same rate as in-person visits. An evaluation of this policy, using MA APCD data from 2016-2020, found no significant increase in the use of tele-mental health services among Medicaid-enrolled postpartum individuals.³ Uptake remained extremely low: just 0.07% of the Medicaid enrollees used postpartum tele-mental health services in the pre-pandemic period.

The findings highlight that financial parity policies may be insufficient in isolation, particularly when systemic barriers to access remain unaddressed.

What Policymakers and Payers Need to Know

These studies reveal several key takeaways for those designing and implementing maternal mental health policy:

• Reimbursement can increase provider behavior, but not necessarily care outcomes. While  screening rates improved following the introduction of separate reimbursement for perinatal depression screening, there was no significant increase in diagnosis or antidepressant treatment.
• Parity in payment for tele-mental health services does not guarantee parity in access. Even when reimbursement rates are equal to in-person visits, structural inequities, such as digital access, provider availability, and care coordination capacity, may prevent meaningful uptake. 
• Systems change must go beyond reimbursement. Without addressing the full continuum of care – including referral, diagnosis, treatment and follow-up – payment reform alone is unlikely to reduce gaps in postpartum mental health care.

For meaningful change, policymakers and payers must go beyond payment reform and invest in the systems and structure that enable effective, coordinated care.

Why Payment Alone Falls Short

The limited success of these Medicaid payment policies reflects broader, well-documented barriers in the postpartum mental health care landscape:

• Provider shortages in behavioral/mental health specialists, particularly among providers who accept Medicaid
• Digital access gaps, including limited broadband access and low digital literacy among Medicaid enrollees
• Lack of behavioral health integration in obstetric care settings, where postpartum individuals are most likely to interact with the health system
• Weak referral and follow-up infrastructure, which leads to missed opportunities for treatment even when conditions are identified

These challenges require coordinated strategies that go beyond adjusting reimbursement policies for Medicaid enrollees.

System-level Actions for Payers and Policymakers

To improve postpartum mental health outcomes for Medicaid populations, reimbursement reforms must be paired with systemic changes. Recommended actions include: 

• Promote behavioral health integration in obstetric settings using evidence-based models
• Invest in digital infrastructure to ensure Medicaid enrollees can access telehealth services reliably and equitably
• Provide technical assistance and training to providers on billing procedures and screening best practices
• Strengthen the behavioral health workforce, particularly in underserved areas, through targeted recruitment, training incentives, and rate adjustments
• Establish robust care coordination mechanisms to ensure screening results lead to timely referrals and follow-up treatment

These interventions align Medicaid financing with the operational capabilities necessary to achieve lasting improvements in maternal mental health systems.

Conclusion: Investment Must Go Beyond Reimbursement

Medicaid’s 60th anniversary is a moment to reexamine how the program supports maternal mental health. Massachusetts’ experience shows that reimbursement policies alone are not enough. Screening may increase, but outcomes will remain stagnant unless structural barriers – such as provider shortages, digital divides, and fragmented care systems – are addressed.

To create meaningful change, financial incentives must be matched by system capacity. Effective maternal mental health care depends not just on paying for services, but on building the infrastructure that makes those services accessible and impactful.

Author’s Note

This blog post was supported by the National Institute for Health Care Management (NIHCM) Foundation. The content is solely the responsibility of the author and does not necessarily reflect the views of the NIHCM Foundation. The funder had no role in the design, analysis, or interpretation of the studies discussed, nor in the writing or review of this post.

Author Bio

Chanup Jeung, Ph.D. is an Assistant Professor in the Department of Health Policy, Management & Behavior at the University at Albany, State University of New York. His research focuses on Medicaid policy, maternal and child health, and mental health service delivery.