To help address the US maternal health crisis, more states are expanding Medicaid coverage after childbirth


Texas has joined a growing number of states that are extending the period that new mothers can qualify for Medicaid coverage after childbirth and are providing coverage beyond the required 60 days postpartum up to 12 months.

On Friday, Texas Gov. Greg Abbott signed House Bill 12 that extends the state’s postpartum Medicaid coverage to a full year, according to the Republican Bureau Condition Senator Lois Kolkhorst, sponsor of the bill.

The rate of severe maternal morbidity — or pregnancy and childbirth complications — has been rising in Texas.

“The Texas legislature has been instrumental in protecting the lives of mothers and their children. House Bill 12 is an important step in this continuum of caring for mothers in caring for their children; They can rest assured that they will receive the right care after birth,” Kolkhorst said in an email on Thursday. “In a post-Dobbs era, the Texas Senate and House of Representatives have poured significant resources into women’s, maternal and child health, with funding approaching $1 billion. HB 12 is one bill in a package of bills aimed at improving health and outcomes for women and their children.”

Abortions longer than six weeks are banned in Texas — one of the most restrictive abortion laws in the developed world — prompting lawmakers to debate the language used in HB 12, which ultimately included an amendment clarifying that the expanded Medicaid policy Health insurance “applies to mothers who are pregnant”. end with the delivery of the child or with the natural loss of the child. This does not apply to pregnancies that end in abortion.”

According to the nonprofit KFF, formerly known as the Kaiser Family Foundation, another 35 states and the District of Columbia have so far expanded their postpartum Medicaid coverage to a full year postpartum.

New York was the latest state to expand insurance coverage.

“New York’s efforts reflect growing support for putting families on a solid footing by extending postpartum coverage to a full year after pregnancy,” said Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, in a press release on Tuesday. “The Biden-Harris administration has made maternal health a priority and will continue to do so until all 50 states and every US territory can offer pregnant women and their families the lifeline that comes with health insurance ties.”

Maternal health advocates hope the extensions will play a small but crucial role in addressing the country’s maternal death crisis. According to the US Centers for Disease Control and Prevention, about one in three pregnancy-related deaths occurs about a week to a year after delivery.

“It’s really important that people have insurance before, during, after and outside of pregnancy, and we know that having such insurance improves your access to health care,” said Usha Ranji, deputy director of women’s health policy at KFF, of her team has done this Track how many states have expanded Medicaid coverage after childbirth.

“Medicaid actually pays for more than four out of every 10 births nationwide. When it comes to addressing maternal health issues, Medicaid is a major player and that is the real driver behind pursuing these guidelines,” she said. “For decades, pregnant Medicaid coverage has ended 60 days after childbirth. This has been federal policy for many years. And when the American bailout plan was passed, it gave states the option to extend the deadline to one year.”

To reduce maternal mortality and morbidity in the United States, the Biden-Harris administration last year encouraged states to expand Medicaid postpartum coverage requirements from two months after birth to a full 12 months.

In that announcement, the government called for ensuring that women giving birth are taken seriously when they raise concerns, diversifying the workforce of perinatal health workers, strengthening economic and social support for patients, advancing data collection and research, and access to mothers to improve health services that include behavioral health — all part of his blueprint plan for maternal health.

According to the KFF tracker, currently only three states have either not expanded Medicaid coverage after childbirth, have not proposed plans to do so, or have no pending legislation that has passed at least one chamber: Arkansas, Idaho, and Iowa.

“Some states just haven’t picked it up because they may not want to expand Medicaid benefits. However, it’s really important to remember that most states have now done so and have extended postpartum coverage by at least 12 months,” Ranji said. “And if you look at the map, it’s not just blue states. There are red states there too, some in the south.”

Expanding Medicaid coverage after childbirth differs from fully expanding Medicaid coverage in a state.

When it comes to pre-pregnancy coverage, Ranji says, states that have implemented full Medicaid expansion seem to have higher rates of pre-pregnancy coverage. According to KFF, as of the end of May, 41 states and DC have adopted full Medicaid expansion, but 10 states have not.

“Coverage and access to medical care before pregnancy are also important for a healthy pregnancy and postpartum period,” Ranji said.

For the sole purpose of expanding Medicaid coverage after childbirth, the process can take a long time for a state Measures by state legislators and a financial commitment from the state.

“A state’s decision to expand postnatal coverage may require state legislature approval, and will likely require the legislature to allocate additional federal resources to fund the expansion of coverage for this population,” Hemi Tewarson, executive director of the National Academy for State Health said in an email that the policy also tracks state efforts to expand Medicaid coverage after childbirth.

“Moving from 60 days postpartum to 12 months comes with costs that will vary from state to state as they depend on each state’s Federal Medical Assistance Percentage Rate (FMAP) and how many people are due to the pregnancy and their income are eligible for Medicaid. She wrote. “There may also be some state policymakers reluctant to expand federal insurance programs.”

The mortality rate of women in the United States from pregnancy or childbirth is increasing every year.

A National Center for Health Statistics report released in March found that the US maternal mortality rate for 2021 – the year for which the latest data is available – was 32.9 deaths per 100,000 live births, compared with rates of 20.1 in year 2019 and 23.8 in 2020.

The total number of women who died of maternal causes in the United States was 1,205 in 2021, an increase from previous years: 658 in 2018, 754 in 2019, and 861 in 2020.

“States are also using other Medicaid policy levers to address the maternal mortality crisis, such as reimbursement for doula and midwife services,” Tewarson said.

“Medicaid coverage from community-based providers like doulas and midwives can improve health outcomes for pregnant and postnatal people, especially low-income people and people of color,” she said. “Research shows that doula and midwifery care is associated with healthy birth outcomes, including lower cesarean rates, fewer obstetric procedures, fewer complications, less chance of preterm birth, and more.”

Tewarson added that ten states, including Washington DC, have introduced a Medicaid benefit for doulas and all states currently reimburse services provided by certified midwives.

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