Rural Health Policy Project

Solution to Maternal Health Crisis Must Center on Medicaid

Earlier this month, CCF submitted comments to the Senate Finance Committee with recommendations to reduce maternal mortality and morbidity and help mothers and babies thrive together.  At the heart of our comments was this: Medicaid must be at the center of any efforts to solve to this crisis.

Here’s why. Medicaid paid for nearly half (43 percent) of all births in the United States, and covered a greater share of births in rural areas, among young women, women of color and women with lower levels of educational attainment. Because Medicaid serves a lower income population with greater underlying health risks, Medicaid beneficiaries have an 82 percent greater chance of severe maternal mortality and morbidity than privately insured women.

Among Medicaid beneficiaries, there are wide geographic and racial disparities in outcomes. Women of color and women living in rural areas are at greater risk of mortality and morbidity. In some states, maternal mortality rates for black women are nearly four times as high as those for white women, regardless of coverage source.

As the largest purchaser of maternity care in most states, Medicaid has the power to drive system-wide quality improvements, such as holding health plans and systems accountable for poor prenatal and birth outcomes and incentivizing higher value care.

Research consistently shows that more than any other policy decision, Medicaid expansion has been proven to lower maternal and infant mortality and support women’s health before, during and after pregnancy.  Lack of health insurance among women of childbearing age is nearly twice as high in states that have not expanded Medicaid under the ACA.

A new study published in the Women’s Health Issues journal showed Medicaid expansion was significantly associated with lower maternal mortality.  The effects were greatest for non-Hispanic black women, the racial group with the highest rates of maternal mortality. Effects were also greater for the period beginning 60 days after birth, when Medicaid pregnancy coverage currently ends. This suggests that, “sustained insurance coverage after childbirth as well as improved preconception coverage could be contributing to decreasing maternal mortality.”

So far, policymakers in at least a dozen states are pursing some extension of postpartum coverage beyond 60 days after birth, and the Urban Institute estimates that extending postpartum Medicaid coverage to one year after delivery for new moms has the potential to help at least 200,000 low-income uninsured mothers gain needed coverage.

Adopting expansion would also reduce disruptions in coverage experienced by women during their pregnancies and in the months following.  About one third of women nationally experience some disruption in coverage between the month before they become pregnant and the sixth month after delivery, including losing coverage altogether.  In some states, including Texas, Oklahoma and Georgia, more than one-third of women are uninsured between preconception and postpartum. Women of color are also more likely to lose coverage at some point during their pregnancy than are white women, contributing to their greater risk of maternal mortality and morbidity.

Particularly during the COVID-19 pandemic, leaders should stop any effort to undermine Medicaid coverage, such as adding work requirements, coverage lockouts or other barriers that keep pregnant women or any other beneficiaries for accessing care.

Finally, Medicaid can do more to support maternal and child health by financing models of care that treat mothers and babies together, such as using the well child visit to address caregiver depression or connect families to social supports. For instance, the Healthy Steps model, an evidence-based model overseen by ZERO TO THREE, leverages pediatric primary care by incorporating family specialists in the primary care office who conduct screenings, provide referrals and connect families to services.

We applaud Senate Finance Committee Chairman Chuck Grassley and Ranking Member Ron Wyden for their interest in solving our nation’s maternal health crisis. Prioritizing and protecting Medicaid is the right place to start.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.