In the United States, the issue of maternal mortality is becoming more pressing. The USA has the highest maternal mortality rate in the developed world, and it’s been rising in recent years.
Many new mothers die from preventable causes such as overdose and suicide, and these deaths occur outside of the safety net of Medicaid coverage. New mothers who receive pregnancy-related Medicare coverage typically lose these benefits 60 days after giving birth.
To help ease the transition for new mothers during this critical time, some states are now expanding Medicaid coverage beyond the 60-day postpartum period. This expansion provides new mothers and babies with continuity of care, which is important for both their physical and mental health. In addition, it helps ensure they have access to necessary health services, including preventative care and treatment for postpartum depression.
Expanding Medicaid coverage for new mothers is a positive step that can help save lives and help tackle the maternal mortality crisis head-on.
What is Medicaid?
Medicaid is a jointly funded federal-state health insurance program for low-income individuals and families. Medicaid is the largest source of public funding for long-term care services in the United States.
In 2022, Medicaid covered nearly 88 million people, which equates to more than 1 in 4 Americans. Of this figure, around 7 million are enrolled in Children’s Health Insurance Programs (CHIP). CHIP is a program that provides health coverage to low-income children who do not qualify for Medicaid.
Eligibility for Medicaid is based on income and assets. It also considers other factors such as pregnancy, disability, age, and whether an individual is a parent or caretaker of a child younger than 18.
What is Medicaid expansion?
The Affordable Care Act (ACA), also known as Obamacare, was signed into law in March 2010.
It called for Medicaid expansion to provide coverage to more low-income individuals. Before the ACA, Medicaid was typically only available to older, disabled adults unless an individual was pregnant or had minor children. However, the income caps to qualify as a parental caregiver were extremely low.
The ACA revised the qualifying income level to include low-income individuals with incomes 133% of the federal poverty level (FPL) plus 5% income disregard. The FPL is currently around $13,600 for an individual. By expanding Medicaid, the ACA created a viable pathway to coverage for millions of low-income adults.
The expansion was enacted in 2014 and was implemented in states choosing to participate. As of June 2022, 39 states and the District of Columbia have adopted expanded Medicaid. However, there are still 12 states outstanding.
How Medicaid covers pregnancy
Medicaid covers the costs of around 4 in 10 births. Typically, states must provide pregnancy-related coverage for 60 days following the birth. Following this period, some people may continue to qualify for Medicaid through other eligibility criteria. However, many people lose their coverage, particularly if they live in a non-expansion state.
The American Rescue Plan Act of 2021 addressed the lack of healthcare coverage for new mothers. It provides federal matching funds for the extended coverage for up to 5 years. The act allowed states to temporarily extend postpartum coverage for up to 1 year through a pathway known as the state plan amendment (SPA).
Currently, 19 states, including DC, have implemented the 12-month extension, and a further 12 states are at the planning stage.
A growing number of Republican states are extending postpartum coverage to new mothers while simultaneously banning or limiting access to safe abortions.
States including Florida, Tennessee, and South Carolina temporarily allow low-income women the extended 12-month Medicare coverage following childbirth. The states are among the 12 that have yet to expand Medicare under ACA.
Why extended postpartum coverage matters
Despite being a developed nation and spending more on healthcare than any other country, the USA has one of the highest maternal mortality rates in the world. And yet, most maternal deaths are preventable.
In 2020, the maternal mortality was just under 24 deaths per 100,000 live births compared to a rate of 20.1 in 2019. This ratio is more than double the rate of most developed countries and higher than some developing nations.
Another worrying factor is the racial disparities. These death rates have dramatic variation by race and ethnicity. For example, black non-Hispanic women are more than twice as likely to die from pregnancy or childbirth-related conditions and complications than white women.
Pregnancy-related mortality is most commonly caused by hemorrhage, cardiovascular disease, infection, hypertension, and embolism.
Extended postpartum coverage can make a big difference for new mothers. It gives them time to recover and heal without worrying about losing their health insurance. It also gives them time to establish breastfeeding, which can benefit both mother and child significantly.
The Centers for Disease Control and Prevention (CDC) recommends mothers breastfeed for at least 6 months. However, less than half of US mothers are still breastfeeding at 6 months postpartum, which can sometimes have long-term health and nutrition consequences for the infant.
Extended postpartum coverage can help new mothers manage chronic conditions such as hypertension, cardiomyopathy, and diabetes. These conditions are common during pregnancy and can have serious consequences if not properly managed.
Besides physical health, postpartum mental health issues are also a major concern. As many as 1 in 7 women experience depression during pregnancy or in the first few weeks to months after childbirth.
Postpartum depression can significantly impact the mother-infant relationship and can lead to problems with bonding, attachment, and childcare. It can also increase suicide risk.
Extended postpartum coverage can help new mothers access mental health services and treatment. It can also provide much-needed support and resources during this challenging time.
While extended postpartum coverage is a step in the right direction, it is not a perfect solution. There are still some gaps in coverage, and as it’s only temporary, it doesn’t provide long-term security for new mothers. Once the coverage expires, people may be left without health insurance.