Getty
California, Florida, Kentucky and Oregon are all expanding postpartum Medicaid coverage in a big way. The U.S. Department of Health and Human Services (HHS) has approved the four states to join South Carolina, Tennessee, Michigan, Louisiana, Virginia, New Jersey and Illinois in offering one year of postpartum Medicaid coverage, up from the 60-day period states are required to provide under federal law.
“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 statement.
The pathway for the expansion stems from a provision in the American Rescue Plan Act of 2021 that gives states the option of extending coverage to pregnant individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). It went into effect in April of this year and is currently limited to a five-year period.
Today, roughly two out of every three women enrolled in Medicaid today fall into the reproductive age category. When it comes to pregnancy, Medicaid plays a huge role as the largest single-payer of all pregnancy-related services. Currently, 42% of all U.S. births are financed by Medicaid.
HHS estimates that the four new states expanding coverage will mean 126,000 families could be impacted. California and Florida, in particular, will likely see a big impact as the states claim the number two and three spots by population size on the national list with estimated increases at 57,000 and 52,000, respectively.
Complications during the postpartum period are common and can be deadly. The expanded coverage could have a big impact on rising U.S. maternal mortality rates, as one out of three pregnancy-related deaths occurs within one week to one year postpartum. Within the data lies persistent and stark racial disparities, and historically, Medicaid has paid for a greater share of Hispanic, African American, and American Indian and Alaska Native women’s births compared to private coverage.
Beyond mortality, there’s increasing attention in obstetrics and gynecology on the importance of the weeks following birth for long-term maternal health, with physicians calling for ongoing, individualized care for patients as the standard of practice. Without expanded postpartum coverage, new mothers with Medicaid don’t necessarily have that option, even while some pregnancy-related health conditions are already known to be more prevalent in this patient population group. Postpartum depression, for instance, affects one in eight mothers nationally, and the rates are even higher among those with Medicaid at delivery compared to privately-insured patients.
Chiquita Brooks-LaSure, a health care policy official and administrator of the Centers for Medicare & Medicaid Services (CMS), is hopeful that states signing on to this expanded coverage will make a real difference in the data to come.
“As CMS Administrator—and also as a mother—I applaud California, Florida, Kentucky, and Oregon for joining a cadre of states in giving families one of the greatest gifts we can: The peace of mind of health coverage, particularly in the critical postpartum period,” she said in a statement. “The American Rescue Plan gives all states an easier pathway to extend postpartum coverage beyond the critical first weeks for a new family, which can put all our communities—particularly those hard hit by health disparities—on a better course toward health and well-being.”
Nine additional states, as well as the District of Columbia, are currently working with CMS to extend postpartum Medicaid coverage for one year after pregnancy. If all U.S. states were to adopt the policy, HHS estimates that approximately 720,000 people would experience expanded coverage annually.
