Improving Health Outcomes Through Access to Home Blood Pressure Monitoring

Improving Health Outcomes Through Access to Home Blood Pressure Monitoring

Hypertension in Pregnancy and Postpartum Risk 

Hypertensive disorders of pregnancy (HDP), including preeclampsia, are a leading cause of maternal morbidity and mortality in the United States, affecting approximately 4%–8% of pregnancies. Despite evidence that early detection and management of hypertension can improve outcomes, access to remote blood pressure monitoring (RPM) remains fragmented. Many Medicaid programs cover home blood pressure cuffs, yet coverage criteria, delivery methods, and provider workflows vary widely. In practice, perinatal individuals are often unable to access a cuff unless hospitals proactively order and stock them for real-time distribution, which typically is only accomplished using charitable fundings or funding sources outside of reimbursement from claims. For a service and device already covered by most payers, states should consider the opportunity to break down access barriers to this essential and life saving service.  

Clinical Best Practice 

The U.S. Preventive Services Task Force (USPSTF) recommends screening for preeclampsia throughout pregnancy using blood pressure measurements, citing strong evidence of reduced morbidity and mortality. Recent studies further affirm the benefits of remote monitoring: 

• • Home readings are accurate: Tucker et al. (2018) found that home BP readings during pregnancy align closely with clinic values and support timely identification of complications. 

• • Patients are compliant and engaged: In a French cohort, 87% of pregnant individuals reported home BP monitoring as easy to use, with software support improving confidence and adherence. 

• • Postpartum monitoring reduces readmissions: At Boston Medical Center (BMC), postpartum hypertension-related readmissions dropped by 19% after implementation of a cellular-enabled cuff program. 

When patients have early access to a cuff, it allows clinicians to distinguish between preeclampsia and chronic hypertension—an important differential for managing long-term cardiovascular risk. 

Evidence of Return on Investment and Improved Outcomes 

RPM programs have demonstrated cost effectiveness, even in studies limited to observing healthcare utilization in the 2-weeks after delivery. Programs like BMC’s remote monitoring initiative show that simple, scalable interventions can drive equity and improve outcomes. Their model includes: 

• • Cellular-connected cuffs that transmit readings without Wi-Fi 

• • Daily monitoring by nurses who intervene in real time 

• • Pharmacy partnerships for expedited medication delivery 

• • Intentional design to close racial gaps, with over 80% of participants identifying as Black or Hispanic 

Meanwhile, the Preeclampsia Foundation’s Cuff Kit program—funded in part through the Health Resource and Services Administration’s (HRSA’s) Healthy Start Innovation—has demonstrated early success in states like Missouri. These efforts reinforce that RPM is not only clinically effective, but also an equity-aligned, patient-preferred model of care. 

Medicaid Coverage Gaps and Other Barriers 

Most state Medicaid programs report covering blood pressure cuffs for pregnant individuals, but real-world implementation varies. A 2021 survey of Medicaid Directors by the Kaiser Family Foundation found: 

• • 35 states cover home blood pressure cuffs during pregnancy 

• • 29 states extend coverage into the postpartum period 

• • Fewer states reimburse for telemonitoring or technology-enabled RPM services 

Even in states with coverage, barriers persist: 

• • Accessing the cuff often requires patients to navigate specialty or mail-order pharmacies 

• • Providers must write prescriptions, with varying MCO formulary requirements 

• • Labor & Delivery units often lack stocked cuffs, missing the window to train patients at discharge 

• • Tech-enabled cuffs may not be covered, making it harder for nurses to remotely monitor patients’ readings and identifying high readings in real time.   

Reducing Barriers to Access 

To support equitable, high-value maternity care, states should consider adopting bundled RPM policies for hypertensive disorders of pregnancy, including: 

1. 1. Eligibility: All pregnant and postpartum Medicaid enrollees at risk of preeclampsia, with a pathway for presumptive eligibility based on clinical judgment. 
   2. Covered Services: Cuff distribution, remote monitoring, nurse follow-up, and pharmacy coordination. 
   3. Cuff Types: Include Bluetooth or cellular-enabled, clinically validated cuffs to support patients with limited digital access. 
   4. On-Site Distribution: Prospective funding to enable participating facilities to stock cuffs for real-time distribution at prenatal visits, labor and delivery, and postpartum follow-up. 
   5. Reimbursement Vehicles: 

• • • Medicaid State Plan Amendments (SPA) to clarify RPM coverage 
    • 1115 waivers to pilot equity-driven models like BMC’s 
    • ARPA and maternal health grants to fund infrastructure and evaluation 
    • Charitable funding