The pregnancy-related health care services provided under Medicaid vary significantly by state, a new survey has found.
The differences matter greatly because Medicaid finances over 40% of births in the United States—more in some states—and two-thirds of births by Black and Alaskan Native people. In recent years, policymakers have paid increasing attention to the higher rates of maternal mortality among those groups.
The Kaiser Family Foundation this month released the results of a survey of 41 states between June and October 2021 that shows which pregnancy-related services each state covers. The federal government requires all states to provide cost-free Medicaid coverage to pregnant women with incomes under 138% of the federal poverty line and for at least 60 days after delivery. States are free to broaden the benefits.
The federal government pays at least 50% of Medicaid’s costs, and more in states with lower per capita incomes.
The report found that of the 41 states that responded, 31 cover blood pressure monitors for pregnancy-related home use, but only nine states provide reimbursement for scales to monitor weight gain during pregnancy. Most states cover continuous glucose monitors and nutritional counseling for those with gestational diabetes.
More than half of the responding states cover home births under Medicaid, although several of those require some additional approvals or the presence of a doctor or midwife at the birth.
Fewer than half of responding states cover childbirth and parenting classes.
The survey found that most states cover home visiting services during and after pregnancy, although some of them limit those home visits for high-risk pregnancies.
Most states cover dental services for pregnant Medicaid enrollees, although some limit that benefit to emergency dental services and do not cover preventive dental care.
Three of the responding states—Indiana, New Jersey and Oregon—covered doula services as of July 1, 2021, and the report said that Minnesota, which did not respond to the survey, does as well. Some other states reported that they were considering adding doula services as a Medicaid benefit.
Most states cover treatment services for pregnant and postpartum women with substance use disorder beyond the minimum requirements from the federal government.
However, the survey found that most state Medicaid agencies don’t cover fertility assistance services. Eleven states do cover diagnostic testing related to fertility. States are required to cover most prescription medications under Medicaid, but not necessarily fertility medications. California, Illinois, New York and Wisconsin are the only states among those that responded that cover fertility medications.
About one-third of the state Medicaid programs cover the full array of breastfeeding services and supports—including classes, pumps and lactation consultations.
Most of the state Medicaid agencies, 35 of 41, place no limits on the number of postpartum visits they cover.