Louisiana, once again, got a grade of F, this time for having too many premature births, according to an annual national survey by the March of Dimes, which was released Thursday.

While this year’s grade showed a slight improvement over last year’s, the state is far shy of the goal of lowering the U.S. preterm birth rate to 9.6 percent of live births by 2020.

Louisiana’s 2014 premature birth rate was 15.1 percent — down from 15.3 percent the prior year. A baby born before the pregnancy enters its 37th week is considered premature. A pregnancy reaches full term at 40 weeks.

But Louisiana remains in the cellar with Mississippi, Alabama and Puerto Rico. Neighboring states of Texas and Arkansas are among the states with a C grade — the average for the U.S.

California, Oregon, Maine, New Hampshire and Vermont got A’s.

“I’m not so much worried about the letter grade. What I look at is how we are doing,” state Department of Health and Hospitals Secretary Kathy Kliebert said. “We are moving in the right direction.”

Kliebert said policies the state has put in place, such as providing health care coverage to more pregnant women and refusing to pay for elective deliveries before 39 weeks, are working.

But she said some policies have only been fully in place not quite 18 months. “It’s going to take some time before we notice it on these report cards,” she said.

Babies born prematurely have medical problems that often continue impacting their quality of life, while dramatically driving health care costs up.

In Louisiana, preterm births cost Medicaid, the government insurance program for the poor, an extra $200 million annually, according to statistics released last year.

Louisiana Budget Project Executive Director Jan Moller said it is no coincidence that Louisiana is right there with Mississippi and Alabama in the premature birth rankings.

“Poor birth outcomes correlate with poverty. All the states that rank low have high rates of poverty,” Moller said. He said poor diets, smoking and other bad behaviors all make it more likely for premature births.

“There are limits to what a good health coverage system and doctors and hospitals can fix,” he said. “There are a lot of underlying contributing factors. … Ultimately, you need to deal with the roots of poverty.”

Moller said it is a very good thing that more women are being covered through Medicaid, the government health insurance program for the poor.

But women are not being covered leading up to pregnancy when a host of medical problems could be dealt with, he said.

Nationally, more than 450,000 babies are born too soon each year, one in nine of all deliveries, according to the March of Dimes.

In Louisiana, 9,563 babies were born prematurely in 2013, the year covered by the latest March of Dimes report. The premature birth rate was highest among black women at 20.1 percent.

The 2013 number is a decrease from 10,360 registered in 2006, state health officials said.

Kliebert said Medicaid payment changes were made in July 2014 ending the practice of reimbursing physicians for “unnecessary early elective deliveries,” she said.

Louisiana’s largest private insurer, Blue Cross Blue Shield of Louisiana, joined the state in enacting the policy in September.

All Louisiana hospitals committed to curb the practice of early deliveries, Kliebert said. She said independently verified Medicaid claims data indicates 18,700 fewer neonatal intensive care unit days between state fiscal year 2012 and 2013 for a 10 percent reduction.

Kliebert said there is also expanded coverage of family planning and treatment for men and women for such things as sexually transmitted diseases.

March of Dimes state director Frankie Robertson noted the stepped-up efforts underway including prevention programs and partnerships with state health officials and the Louisiana Hospital Association.

“We have put in place the necessary framework for the future of newborn health, and we expect to see better rates in the coming years,” Robertson said.

The March of Dimes funds research and programs as it works to end premature births, birth defects and infant mortality.

Follow Marsha Shuler on Twitter @MarshaShulerCNB. For more coverage of the state capitol, follow Louisiana Politics at http://blogs.theadvocate.com/politicsblog/