Each year, Medicaid pays for nearly half of all births in the United States, including a greater share of births in rural areas, among young women, and women of color. Medicaid and CHIP also cover close to half of the nation’s children under age 3, making it the largest source of coverage for infants and toddlers.

As the attention of policymakers shifts to this important period of prenatal, infant, and early childhood development, we’re glad to publish this brief on Medicaid and CHIP coverage for pregnant women in an effort to explain what options states have available to them right now to cover pregnant women and highlight opportunities where state and federal policy can improve outcomes for mothers and babies.

Designed for child advocates and others familiar with Medicaid policy generally, we hope this primer will be useful when thinking about pregnancy coverage policies alone and in combination with other eligibility groups, particularly children. In a future paper, we plan to look forward and envision what future Medicaid and CHIP pregnancy coverage policies could do to fully maximize Medicaid’s potential to support the healthy development of children and parents together.

The primer walks through the current coverage pathways and levers available to states to get more pregnant women and new mothers covered. For example, most states have opted to increase Medicaid and CHIP eligibility levels beyond the minimum income level of 138% FPL, though there are two states—Idaho and South Dakota—that have not. Many states also provide full Medicaid and CHIP benefit packages to women covered for pregnancy, but again, there are exceptions.

Though states are facing tremendous budget challenges in the face of the COVID-19 pandemic, we know that state and federal policymakers and advocates are continuing to work to take advantage of options already available to expand pregnancy coverage eligibility, while at the same time looking toward future options to cover postpartum women for 6 or 12 months after the end of their pregnancy. Importantly, these coverage extensions are most effective when paired with Medicaid expansion for all low-income adults, which provides consistent coverage before, during and after pregnancy.

The need for greater focus on Medicaid and CHIP pregnancy and postpartum coverage is critical. More than 700 women die every year from pregnancy related causes, and nationally, Black and American Indian/Alaska Native women are two to three times more likely to die of a pregnancy related cause than White women. In some states the disparity makes it so that Black women are up to six times more likely to die of pregnancy-related causes than White women. Women living in rural areas also experience maternal mortality and morbidity at higher rates than women in urban areas, are more likely to give birth without coverage, and have to travel long distances to reach a maternity care provider.

Looking at Figure 2 in our primer, you can see that the gaps in Medicaid and CHIP coverage for postpartum women are wide and need focused attention. About 24 percent of the pregnancy-related deaths occur between 43 and 365 days after the end of the pregnancy, which is well after Medicaid and CHIP pregnancy coverage ends.

We know from other research that as many as one in three women lose coverage for at least some time between the month before conception and six month postpartum. This is especially alarming given the postpartum physical and mental health challenges that new mothers face, such as weakened heart muscles and postpartum depression, which, according to new research from the National Institutes of Health, can persist for up to three years after the birth of a child.

For many years, national and state 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 been calling for improvements in Medicaid pregnancy coverage that advance maternal health equity, expand access, and produce better data to understand the causes and prevention of maternal deaths.

Policymakers at the state and federal level are poised for action. In addition to many state efforts, there are currently several bills moving through Congress to address these disparities, including the “Momnibus”, which is a compilation of bills to promote innovative maternity care payment models, diversify the perinatal workforce, improve data collection and quality measures, invest in community-based organizations, and support maternal mental health and women’s social needs. A separate bill recently passed by the U.S. House would give states an option to extend postpartum coverage to cover women for one year after the end of the pregnancy.

We hope that by laying out the federal minimums and state options in Medicaid and CHIP as they are today, and envision more inclusive coverage policies for the future, we can add to the conversation about how to improve Medicaid and CHIP coverage for pregnant women so that all families have the supports they need to thrive.

[Information on Congressional legislation was collected by Johnson Consulting Group.]

[To check eligibility levels for pregnant women in your states, visit CCF’s interactive state data hub.]