To boost maternal health for low-income women, California, Florida, Kentucky and Oregon in May received approval from the federal government to extend Medicaid coverage for 12 months after childbirth.
Nationwide, pregnancy-related chronic illnesses such as diabetes, heart disease and high blood pressure, combined with mental health issues including suicides and drug overdoses, are contributing to an increase in deaths among women during pregnancy, childbirth and the first 12 months after delivery, according to the U.S. Centers for Disease Control and Prevention.
Three out of five of those deaths could be prevented with adequate medical attention, the CDC says.
In 2018, the American College of Obstetricians and Gynecologists issued new medical guidelines for postpartum care, saying that ongoing attention rather than a single encounter with a medical professional is urgently needed to “reduce severe maternal morbidity and mortality.”
But Medicaid pregnancy coverage, which pays for about 40% of all births in the United States, expires 60 days after childbirth, leaving many women without health insurance at one of the most vulnerable times in their lives.
After the 60 days, women can reapply as a parent, but the income limit is typically much lower, so thousands of women don’t qualify.
Expanding postpartum Medicaid benefits in the four states, along with an extension of the federal-state Children’s Health Insurance Program, is expected to improve the health and overall wellbeing of roughly 126,000 families, according to the U.S. Department of Health and Human Services, which shares the cost of Medicaid with states.
“The first year after giving birth is a critical period—and families deserve the peace of mind knowing they will be able to access the health care coverage they need, without interruption,” said HHS Secretary Xavier Becerra in a news release announcing the states' expanded coverage.
According to a 2019 CDC study, nearly 31% of maternal deaths occur during pregnancy, 36% during delivery or a week after and 33% one week to one year after delivery.
In the past, states had to file time-consuming paperwork with the federal government to receive a waiver of rules if they wanted to extend Medicaid coverage for a full year after childbirth. The Biden administration’s American Rescue Plan Act streamlined the process.
Seven states—Illinois, Louisiana, Michigan, New Jersey, South Carolina, Tennessee and Virginia—already have extended Medicaid from 60 days to 12 months postpartum.
The District of Columbia and nine other states—Connecticut, Indiana, Maine, Minnesota, New Mexico, North Carolina, Pennsylvania, Washington and West Virginia—have asked for federal permission to do the same.
In 2020, the maternal mortality rate was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019. For Black women, the rate was 55.3, nearly three times the rate for White women, according to the CDC.