Update: On April 12, HHS announced that Illinois was approved to extend Medicaid postpartum coverage for 12 months using a waiver. The option under the American Rescue Plan will come into effect next year.

By Suzanne Wikle 

April 11-17 is Black Maternal Health Week, a time for reflection and action to address large disparities in maternal health experienced by Black women. Racial inequities in health care access and health outcomes cross all sectors of our health system, but maternal and infant health outcomes present some of the starkest disparities. Black women die from pregnancy-related causes at a rate of 40.8 per 100,000 live births, more than three times the rate for white women (12.7 per 100,000).  Many factors contribute to this horrifying disparity, including chronic stress caused by racism, providers who fail to take Black women’s health concerns seriously, and the lack of providers who come from communities of color.  Fixing this will take comprehensive efforts to change both our health care system and the broader society. But one contributing factor that policymakers can address quickly is the lack of a health care safety net for postpartum women who receive health insurance from Medicaid.

Medicaid plays a huge role in prenatal care and financing of births in this country. In fact, about half of all births are paid for by Medicaid. In some states it’s higher, and across the country Black and Hispanic births are more likely to be financed by Medicaid (68 percent and 60 percent, respectfully). While access to insurance alone won’t eliminate disparities in maternal health outcomes, insurance must be part of the overall solution. Medicaid has a role to play here – a significant role that can quickly leverage existing systems to provide needed health care in the postpartum period.  

After a child is born, however, new mothers who received prenatal care through Medicaid are only entitled to 60 days of postpartum Medicaid coverage – not nearly enough time to provide comprehensive postpartum care. Many pregnancy-related complications and deaths occur after the arbitrary 60-day Medicaid cutoff.  Additionally, postpartum depression, mood, and anxiety disorders can last for months, if not years after delivery. This limited coverage is particularly harmful in states that haven’t expanded Medicaid coverage because many women in those states will become uninsured after their limited postpartum coverage. Women in non-expansion states are more likely to be uninsured following their 60-day postpartum coverage compared to women in expansion states. And the uninsurance rate of new mothers in the postpartum period for Black and Hispanic moms is nearly double what it is for white moms. 

Recognizing how much greater of a role Medicaid can and should play in improving postpartum outcomes and literally keeping women alive, the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended that Congress mandate 12 months of postpartum coverage and that the federal government pay for 100 percent of the costs. If every state were required to provide 12 months of postpartum coverage, about two-thirds of the individuals who would be eligible for this new coverage are concentrated in five states: Texas, Florida, Georgia, Missouri and North Carolina. It is no coincidence that these five states have not expanded Medicaid (Missouri is in the process of implementing Medicaid expansion, but is classified as a non-expansion state for the data used here). This is a racial equity issue. People of color – particularly Blacks – are more likely to be uninsured, especially in non-expansion states. 

The American Rescue Plan passed by Congress in March and signed by President Biden included an option for states to expand postpartum Medicaid eligibility to 12 months beginning April 2022. This is a large step in the right direction, and we’re already hearing that states are eager to adopt this new option. However, as we’ve seen in the past, when a policy decision is left as a state option rather than mandated, many states won’t adopt the policy. In this case, postpartum women – including a lot of Black postpartum women – will be left without care. This option also leaves out others, including some immigrant women and women whose coverage is technically covering the fetus and not the woman. 

While the new state option is an important step forward, it’s a minimum that we should build upon. A national mandate that all states extend postpartum coverage is a better way to address maternal health disparities. Combining postpartum coverage extension with Medicaid expansion in the remaining hold-out states would be the best way to address maternal health disparities.