At least eight states this year have decided to seek federal approval to expand postpartum Medicaid coverage, leaving only a handful of states that have opted out of guaranteeing at least a year of health care for women during this critical period after pregnancy.
New states on the list include Montana, where lawmakers in the recently concluded legislative session voted for a state budget that contains $6.2 million in state and federal funds over the next two years to expand the Postpartum eligibility continues from 60 days to 12 months after pregnancy. This would provide coverage for between 1,000 and 2,000 additional parents in the state each year, according to federal and state estimates.
Maggie Clark, program director at the Center for Children and Families at Georgetown University, tracked state bills to expand postpartum coverage under Medicaid, the state health insurance program. federal state for low-income people. What’s driving the wave is recognition by policymakers of all political affiliations that the United States is in a maternal health crisis, she said. Maternal mortality rates have increased during the pandemic, especially among non-Hispanic black women, according to the Centers for Disease Control and Prevention.
“Whether you’re conservative, liberal, or somewhere in between, people are really supportive of maternal health and helping moms and babies get off to a good start,” Clark said.
More than 4 in 10 births in the United States are covered by Medicaid. But the default postpartum coverage period is 60 days.
State by state, momentum has been building to ensure medical care for new mothers is not interrupted by the loss of health care coverage. The American Rescue Plan Act made it easier for states to expand postpartum Medicaid coverage by allowing them to simply modify their Medicaid plans instead of requesting a full waiver from the Centers for Medicare & Medicaid Services.
Besides Montana, lawmakers in Alaska, Mississippi, Missouri, Texas, Utah and Wyoming passed measures this year to expand postpartum Medicaid coverage from 60 days to one year. States must submit changes to their Medicaid plans to federal authorities for approval. South Dakota officials submitted a proposed amendment to the state’s Medicaid plan in March.
This amendment is pending with CMS, which has approved 12-month postpartum coverage plans for 33 states and Washington, DC, as of May 30. New York and Vermont also have pending applications, and states with newly enacted measures should submit theirs. Soon. It typically takes a few months for CMS to approve changes to the state Medicaid plan to expand postpartum coverage, Clark said.
Lawmakers in Nebraska, Nevada, New Hampshire and Wisconsin are considering moves to extend postpartum Medicaid coverage to 12 months.
Three other states considered but failed to pass legislation this year that would have allowed 12 months of postpartum Medicaid coverage: Idaho; Iowa; and Arkansas, which has the highest maternal mortality rate in the country, according to the CDC.
Support in state houses for such measures has been mostly bipartisan at a time of polarizing debate over reproductive health policy since the U.S. Supreme Court struck down Roe v. Wade last year.
Abortion has crept into the debate in some cases. The Texas House, for example, passed a 12-month postpartum coverage bill in April, only to see the measure amended in the state Senate to ban coverage for women after abortions. After negotiations, the bill passed stated that “Medicaid coverage is extended to mothers whose pregnancies end in childbirth or end in natural loss of the child,” leading some fear that the federal authorities will approve the amendment to the state plan.
The bill is directed at Republican Gov. Greg Abbott, who has said he supports the measure.
Expanded postpartum coverage allows new parents to build a relationship with their health care provider and manage their care and chronic conditions without interruption to insurance coverage. Ongoing care is especially important during the first year after birth, when patients face an increased risk of post-pregnancy complications and a significant number of maternal deaths are due to suicide and substance use. said Annie Glover, senior researcher at the University of Montana. Rural Institute for Inclusive Communities.
“The year after giving birth is a very vulnerable year for the pregnant person,” Glover said. “They have a new baby in their family, and this is a time when they probably need health care more than ever.”
Providing access to mental health and addictions treatment is especially important, said Stephanie Morton, director of programs and impact for the nonprofit Healthy Mothers, Healthy Babies: the Montana Coalition. “We know that suicide and overdose combined is one of the leading causes of death among new mothers,” she said.
Republican Montana Gov. Greg Gianforte included expanding postpartum coverage in his initial budget proposal last fall. But a moment of confusion occurred on May 22 when Gianforte vetoed a bill that would have directed the implementation of certain provisions of the state budget, including the extension of post- partum. State health officials and the bill’s sponsor, Republican Representative Bob Keenan, said the veto does not affect the state’s ability to expand postpartum Medicaid coverage.
“Supporting new mothers and infants by extending Medicaid coverage up to 12 months postpartum was a top priority for the governor and his administration this session,” said the director of the Department of Public Health and Human Services. state social workers, Charlie Brereton, in an emailed statement. “We are grateful for the support of the Legislative Assembly.”
States weren’t allowed to remove most beneficiaries from their programs during the covid-19 pandemic, so parents losing their Medicaid coverage after the birth of a child wasn’t an issue. But states are revising their Medicaid roles now that the public health emergency is over. The Biden administration has estimated that 15 million people could lose Medicaid as a result.
This could include some people who would be eligible for postpartum coverage in states with pending approval for expansion. But state agencies have a lot of discretion in how they redetermine Medicaid enrollment, and Clark said she expects them to do what they can to make sure New parents don’t lose their coverage under what’s called the Medicaid denouement.
“We hope state agencies will honor the wishes of the legislature,” she said.