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2019 HSR&D/QUERI National Conference Abstract

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1042 — The VA's 7-Day Newborn Care Policy: Is 7 Days Enough?

Lead/Presenter: Rebecca Kinney
All Authors: Kinney RL (CWMVA ), Mattocks, KM (VA Central Western Massachusetts),

Objectives:
In May 2010, Public Law (PL) 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act amended the VHA's medical benefits package to include up to 7 days of medical care for newborns delivered by women veterans who are receiving VHA maternity care benefits. At the conclusion of this 7-day period, women Veterans must find other insurance options for their newborns. However, this policy has never been evaluated to determine whether 7 days provides sufficient coverage for newborns of women Veterans. Therefore, the goal of this study was to examine infant outcomes in the first seven days of life.

Methods:
We conducted a retrospective analysis of data collected from Veteran mothers enrolled in the COMFORT (Center for Maternal and Infant Outcomes Research in Translation) study between 2016-2018. Data collection was comprised of two semi-structured telephone interviews conducted at 20 weeks of pregnancy and 6-8 weeks postpartum. Women Veterans reported on infant outcomes following birth, including gestation, birthweight, ICU admissions, infant illness, and health insurance within in the first 7 days of coverage.

Results:
During the study period, 543 infants were born to 530 Veterans enrolled in VA care. Overall, 94% of infants were reported to be in "excellent health" by their mothers. Average gestation for the infants was 38.6 weeks; 11% of the newborn cohort were of low birth weight (less 5.8 pounds at birth.). Eighteen percent of the infants were admitted to the neonatal intensive care unit at birth, yet 90% of all infants were discharged from the hospital within the seven days after delivery. After hospital discharge, 40% of infants required follow-up care for non-routine health conditions. Overall, 90% of women had secured health insurance for their infants at the time of hospital discharge.

Implications:
During the two-year study period, a substantial majority of infants were discharged from the hospital within the 7-day VA coverage period. Though some infants experienced low birthweight or early complications requiring brief visits to the NICU, most infants were rated by their mothers as being in excellent health. Overall, the 7-day infant coverage period appears to be an effective strategy to ensure the newborns of women Veterans have costs associated with delivery and hospitalization covered by the VA, thereby reducing the risk of financial hardship to women Veterans who may not have secured health insurance for their infants prior to delivery.

Impacts:
Public Law (PL) 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act appears to be an effective policy in ensuring infants of women Veterans are provided with health insurance coverage in the first days of life, thereby reducing risk of financial loss among women Veterans without other forms of insurance for their infants. Further research should examine costs associated with extending insurance coverage to 14 days or longer, and how many additional women would be able to secure other forms of insurance in this time.