Confronting Maternal Mortality Crisis: New Resources Track State Progress on Extending Medicaid Postpartum Coverage

Before the COVID-19 pandemic, addressing the maternal mortality crisis was among the highest policy changes on the priority list for state lawmakers and health officials. COVID-19 has further exposed the fault lines that create health disparities between racial, ethnic, income, and other groups. As the virus has spread, it is communities of color, low-income communities and areas without access to health care that are increasingly bearing the brunt of the crisis. Similar patterns that we’ve already seen in maternal morbidity and mortality.

There is no one solution for this, but many. Though states are facing unprecedented budget shortfalls and cuts in the face of the pandemic, policymakers should not push aside the needs of mothers and babies who arguably need more support now than ever.

When it comes to Medicaid, one concrete action item that has come up time and time again is to extend the (arbitrary) end to coverage for pregnant women in Medicaid and CHIP beyond 60 days postpartum. Urban Institute researchers previously found that at least 200,000 women would benefit from such a coverage extension. The Urban Institute’s latest report, Uninsured New Mothers’ Health and Health Care Challenges Highlight the Benefits of Increasing Postpartum Medicaid Coverage, pulls health interview survey and health status outcome data to paint a fuller picture of the need. Three key findings (p. 1) bear repeating:

  • Approximately 11.5 percent of new mothers nationwide were uninsured from 2015 to 2018; just over half of those uninsured new mothers were Hispanic, and close to two-thirds lived in the South.
  • About 1 in 5 uninsured new moms reported at least one unmet need for medical care because of cost in the past year, and over half were very worried about paying their medical bills.
  • Roughly half of all uninsured new mothers reported that losing Medicaid or other coverage after pregnancy was the reason they were uninsured, suggesting that they would likely benefit from an extension of postpartum Medicaid coverage.[emphasis added]

Notably, right now, the Families First Act requires states to maintain coverage for pregnant women who enrolled in Medicaid as of March 24th through the end of the public health emergency. Unfortunately, no such broad-based disenrollment protection exists in CHIP.

Where are states on extending Medicaid postpartum coverage?

Beyond the emergency, states seeking Medicaid postpartum coverage extensions need to do so through an 1115 waiver, as states like Illinois and New Jersey have pursued. Another timely new resource from our friends at the National Academy of State Health Policy details the full list of proposed or enacted actions.  At least 20 states are seeking some type of postpartum coverage extensions and NASHP links to bill language, waiver proposals and related documents

This coverage extension for new moms is long overdue. Several bills pending in Congress in recent years have moved to make this a state option using a Medicaid state plan amendment. Yet amidst the current economic and public health crisis—and to date, there is no movement in sight on additional federal help—state budget shortfalls may take Medicaid coverage extension for postpartum women or other expansions off the table when they arguably need consistent coverage the most.


Elisabeth Wright Burak is a Senior Fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.