One-year postpartum Medicaid coverage: Are states ready to offer  it soon?

Photo by Toshimasa Ishibashi via Flickr.

April 1 marks the kickoff date for a federal option that makes it easier for states to extend postpartum Medicaid coverage to one year after childbirth from the current 60-day standard.

Journalists can now find out how well their states have prepared to take advantage of this Medicaid-expansion pathway, which Congress created as part of last year’s American Rescue Plan legislation. Here are several good websites to track the progress states have made in winning needed Centers for Medicare and Medicaid Services (CMS) permission for the one-year postpartum coverage.

  • The National Academy for State Health Policy (NASHP) has a website dedicated to tracking efforts to expand postpartum Medicaid coverage. It offers detailed summaries of the status of efforts within state legislatures to make the needed legal changes for the coverage expansion.
  • Kaiser Family Foundation (KFF): It’s always a good idea to check the website of the nonprofit Kaiser Family Foundation (KFF) when covering a Medicaid issue. KFF is keeping tabs on state efforts as well through its Medicaid Postpartum Coverage Extension Tracker.
  • American College of Obstetricians and Gynecologists (ACOG) : ACOG is advocating for wide use of the new pathway, calling “critical” as many states as possible implement the required state plan amendment for the April 1 start date, ACOG said on a webpage dedicated to building support for a permanent expansion.

There’s been significant interest in recent years in addressing the reasons why U.S. maternal mortality rates have risen, running counter to global trends of falling rates — at least in the years before the pandemic.

“No mother should have to fight for her coverage or care during pregnancy or while caring for a newborn,” CMS Administrator Chiquita Brooks-LaSure said in a Dec. 7 statement, noting that unnecessary postpartum illnesses and deaths “disproportionately harm people of color.”

The U.S. maternal death rate rose from 12 per 100,000 live births in 1990 to 35 per 100,000 live births in 2020, while the global rate fell from 244 per 100,00 live births to 152 per 100,00 live births, according to data cited by the Bill and Melinda Gates Foundation.

“Maternal mortality rates have dropped around the world, but in the U.S. they have risen, leaving behind devastated families and children who will grow up never knowing their moms,” said Rep. Lauren Underwood (D-IL) in a speech last year on the House floor.

“And for Black moms and other women and birthing people of color, the crisis is even more severe,” added Underwood, who was a leader in efforts to expand Medicaid’s postpartum coverage.

Black and American Indian-Alaska Native people are up to five times more likely than white people to die from pregnancy-related complications and more likely to have a preventable death, said CMS officials in a Dec. 7 letter to state health officials. (CMS cited the CDC as the source of this estimate.)

Medicaid and motherhood

Medicaid can be viewed as something akin to the financial backbone of American obstetrics, at least in many states.

Medicaid paid for 43%, or about 1.65 million of 3.83 million, births in the United States in 2018, according to MACPAC, a federal advisory commission that studies the program.  Even in states where Medicaid coverage of births was lowest, it paid for at least one in four of them. Medicaid covered 25% of births in North Dakota and 26% in Utah. But it covered 63% of births in both Louisiana and Mississippi.

ACOG long has been advocating for expanded postpartum coverage, including an effort to make the extension granted in the American Rescue Plan permanent.

ACOG  posted a useful explainer article about the extension of postpartum Medicaid coverage included in the 2021 American Rescue Bill. It notes that Democrats have sought through their sweeping legislative proposal, known as the Build Back Better Act, to make Medicaid postpartum coverage mandatory and permanent.

States already could extend coverage with legislative action through a bill, executive action in a governor’s budget, or regulatory action by submitting what’s called a Section 1115 waiver request or a state plan amendment (SPA) to CMS. ACOG said. With the American Rescue Plan, “Congress has made available to states an additional and simpler pathway for five years in which to extend Medicaid coverage for pregnant people from 60 days to one year postpartum,” ACOG said.

Illinois moves first

Rep. Underwood’s home state was the first to take advantage of the new Medicaid offer. In April, CMS approved its application to use the new pathway to expand postpartum Medicaid coverage to one year. This approval is effective April 12, 2021 through Dec. 31, 2025, when, unless extended or otherwise amended by federal officials, this expanded postpartum Medicaid coverage expires, CMS said in the approval letter.

Illinois seized the chance to extend postpartum coverage under the new path in large part because of concerns about the state’s extreme racial disparities in maternal mortality, wrote Maggie Clark, a senior state health policy analyst at the Center for Children and Families (CCF) at Georgetown University. (Clark’s colleague, noted Medicaid expert Joan Alker, in an April blog wrote about how states already had been looking for ways to use section 1115 waivers to extend postpartum coverage for different lengths of time and for more limited groups of people or more limited benefits.)

By December 2021, the Biden administration approved Medicaid waivers to extend postpartum coverage in Illinois, Georgia, Missouri, New Jersey, and Virginia, Health and Human Services Secretary Xavier Becerra said in a speech.

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