Medicaid and CHIP cover nearly half of all births each year and have critical roles to play to ensure access to postpartum care that supports the lifelong health of mother and baby together. The Helping MOMS Act, passed with a bipartisan majority voice vote in the U.S. House of Representatives this week, would give states a clearer path to ensure that Medicaid and CHIP support women in the postpartum year as they build an essential bond with their child, setting the family on a healthy path.
The bill would give states the option to cover women in pregnancy-related Medicaid and CHIP coverage for one year after delivery, extending their coverage well beyond the current cutoff of 60 days after the end of the pregnancy. Introduced by Reps. Robin Kelly (D-IL), Michael Burgess (R-TX), Lauren Underwood (D-IL), Cathy McMorris Rodgers (R-WA), Ayanna Pressley (D-MA), and Buddy Carter (R-GA), the bill unanimously passed the U.S. House of Representatives.
Currently, states can only receive federal matching funds to extend postpartum coverage beyond 60 days through a Section 1115 waiver. Three states (Illinois, New Jersey, Missouri) have applied for some version of a postpartum coverage extension waiver, but no state has been approved by CMS. Even more states– more than 20— are on a path to do the same. Still other states, notably California and Texas, are using state-only funds to offer more limited benefits to a subset of postpartum women.
Instead of a waiver application, the bill allows states to submit a Medicaid and CHIP State Plan Amendment (SPA) if they choose to extend coverage for the full postpartum year. States that opt to extend postpartum coverage to women in Medicaid must extend coverage to pregnant women covered in CHIP as well.
After the current 60 day postpartum period ends, states could either offer the current Medicaid benefit package that all mandatory populations in the state receive (which for mothers under age 21 would include the EPSDT benefit), or a benefit package determined by the HHS Secretary to be “substantially similar.” The original bill language included a five percentage point increase in the federal matching rate (FMAP) to incentivize states to take up the option, but that language was dropped from the version that passed.
In addition to coverage, there’s also an effort to close some research gaps in the search for better birth outcomes for women in Medicaid and CHIP. The legislation directs the Medicaid and CHIP Payment and Access Commission (MACPAC) to publish a report on state Medicaid coverage of doula services and make recommendations for increasing access to doula services in Medicaid. GAO too must publish, two years after enactment, a report on gaps in coverage for pregnant and postpartum women in Medicaid and CHIP and to compare rates of insurance churn and mortality and morbidity in the states that elect the postpartum coverage extension and the states that do not.
The bipartisan bill, which now moves to the Senate, responds to the alarming maternal mortality crisis in the U.S., the only developed country in the world where the rate of maternal death is continuing to rise. About 700 women die each year due to pregnancy-related complications. According to the Centers for Disease Control and Prevention (CDC), about 31 percent occur during pregnancy, 36 percent happen during delivery or the week after, and 33 percent of the deaths occur one week to one year after delivery. When Medicaid and CHIP coverage ends at 60 days postpartum, many women become uninsured and miss out on critical access to treatment. Cardiomyopathy, or a weakened heart muscle, is the leading cause of death for women nationally in the week to one year after delivery. About three out of five pregnancy-related deaths are preventable, the CDC reported.
Black women and American Indian/Alaska Native women bear the brunt of the disparity. Nationally, Black women and American Indian/Alaska Native women are two to three times more likely to die from a pregnancy-related cause than white women. In some states the disparity is even wider — in Illinois, for instance, non-Hispanic Black women in the state have a shocking rate of maternal mortality six times higher than non-Hispanic White women.
Postpartum coverage extension is one important step to address this alarming trend. CCF and a coalition of 279 national, state, and local partners called on HHS Secretary Alex Azar this summer to approve the pending Medicaid waiver applications to extend postpartum coverage, both to support health equity and test whether extending Medicaid coverage can reduce the maternal death rate for populations at highest risk, including women with low incomes and communities of color.
This bill is one small piece of a larger national call for improvements in Medicaid coverage for pregnant and postpartum people, including a package of bills known as the “Momnibus” that includes significant improvements in the maternal health care system, such as investments in research, innovative payment models, and specific funding to community-based organizations that are working to improve maternal health outcomes for Black women.
For years, advocates, including the National Birth Equity Collaborative, Black Mammas Matter Alliance, American College of Obstetrics and Gynecology, March of Dimes, and other maternal health groups have called for improvements in Medicaid to address maternal health equity, coverage extensions that expand access, and better data to understand the causes and prevention of maternal deaths.