Improving Maternal Health Outcomes Isn’t That Complicated

Congress needs to mandate postpartum Medicaid coverage for at least one year. It would be just one step in addressing maternal health inequities.

Photo of Black woman breastfeeding baby
Health insurance during the postpartum period is critical because pregnancy-related health complications can occur until one year after labor and delivery, and they are often preventable. Getty Images

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As we approach Mother’s Day, many mothers across the country still lack access to the health insurance they need to care for themselves. A new federal policy, tucked into the Biden administration’s COVID-19 relief package, offers some help—but it also leaves too many new mothers out in the cold.

President Joe Biden signed the American Rescue Plan Act into law in March to provide relief during the ongoing COVID-19 pandemic. The bill includes many provisions to help small businesses, local governments, and individuals, ranging from extended unemployment benefits to child tax credits. The bill also grants state governments the option to extend Medicaid postpartum coverage from 60 days to 12 months. As people begin to see stimulus checks in their bank accounts, low-income postpartum people may also see their Medicaid coverage extended, though not immediately.

This optional extension is not enough, though. The United States has the worst maternal mortality rates when compared to other high-income nations, and Black and Indigenous people are two to three times more likely to die from pregnancy-related causes than white people, a disparity that increases with age. Allowing states to opt out of providing continuous coverage does not go far enough in addressing the maternal mortality crisis and creates an additional barrier for Black and Indigenous parents to access high-quality and affordable health insurance.

Medicaid is uniquely positioned to address the ongoing disparities in maternal health, as it pays for 43 percent of births in the United States. Per federal statute, Medicaid is required to cover pregnant women for 60 days postpartum, which can lead to unstable or even discontinued health-care coverage following the 60-day period. (Though not all people who become pregnant or give birth are women, that’s the language used in the federal statute.) When caring for a newborn baby, having to think about health-care coverage is an additional stressor, especially for new parents experiencing heightened barriers to resources and services.

Health insurance during the postpartum period is critical because pregnancy-related health complications can occur until one year after labor and delivery, and they are often preventable. Postpartum check-ups are a critical component to the recovery process, where mothers can be screened for postpartum health concerns such as depression, hemorrhage, blood clots, or infections. But for people who lose insurance after 60 days, postpartum care is inaccessible, and preventable health complications go undetected.

When new mothers lose Medicaid coverage, they may also lose access to trusted health-care providers they have a relationship with. Mandatory extension for one year postpartum would mean fewer disruptions to continuity of care and would encourage mothers to continue postpartum care visits. Continuous health insurance coverage is needed to ensure that people have access to necessary care before, during, and after pregnancy.

Optional extension does not go far enough because it does not mandate that states must provide the full 12 months of coverage. Southern states like Louisiana and Georgia experience high rates of maternal mortality, disproportionately affecting Black people, and can choose to keep policies the way they are, thus perpetuating disparities in maternal health outcomes. Historically, these states have been slow to adopt Medicaid policies targeted at eliminating disparities. States like Georgia, Mississippi, and Alabama are among the 12 states that have not adopted Medicaid expansion. While people who live in expansion states may be eligible for postpartum coverage under Medicaid and subsidies for the Affordable Care Act marketplace, those in non-expansion states are at risk of falling into the coverage gap, meaning their incomes make them ineligible for Medicaid, but private health insurance is still unaffordable.

Further, the option to extend postpartum coverage is only available to states for five years. While this may motivate states to quickly take action, it may deter states who decide past the five-year mark to extend coverage or who have a change in administrative priorities.

Optional extension is an example of the reproductive oppression Black and Indigenous women continue to experience. While the American Rescue Plan includes incentives for states to expand Medicaid coverage, there is no guarantee that these states will expand coverage, let alone extend the postpartum coverage period. While this policy has the potential to impact lives, there is no guarantee that it will. Optional postpartum coverage does not equate to mandatory, and this bill lacks the provisions necessary to hold states accountable for extending their Medicaid programs.

We recognize that mandatory Medicaid extension isn’t the only solution to improving birth outcomes, but it would be a step toward addressing maternal health inequities. This Mother’s Day, Congress should enact legislation that mandates Medicaid postpartum coverage for at least one year in order to address the ongoing maternal health crisis.