Limited Postpartum Medicaid Coverage Extensions are a Missed Opportunity

States are continuing to push for extending Medicaid coverage for postpartum women beyond the current federal cutoff of 60 days after the end of their pregnancy. Just in the last month, three more states submitted waiver applications to CMS: Indiana, Georgia, and Texas.

Before the end of the year, we submitted comments on Indiana’s limited plan. The federal comment periods for Georgia and Texas are still open, and we will have more to say about these proposals soon.

Unfortunately, Indiana’s proposal only extends postpartum coverage for 12 months to women with opioid use disorder (OUD), which the state estimates will cover only about 725 of the 5,500 women each year who lose coverage at 60 days after the end of their pregnancy. This, like the proposal from the Trump Administration to extend postpartum Medicaid coverage only to women with substance use disorder, does not go far enough to reduce maternal mortality rates and, as we pointed out in our comments, might end up widening racial disparities in birth outcomes.

We offered qualified support for Indiana’s plan since it builds on the state’s Medicaid expansion coverage foundation. But we urged CMS to take a more inclusive approach and work with the state to extend coverage to all postpartum women for 12 months to better support the health and wellbeing of new mothers and babies together and specifically support Black women who bear the brunt of the U.S. maternal mortality crisis.

Focusing on coverage for just women with OUD ignores the range of issues pregnant and postpartum women face, and does not match what the state’s maternal mortality data shows is the single leading cause of pregnancy-related death in the state: cardiovascular conditions. Cardiomyopathy and cardiovascular conditions were the two leading underlying causes of pregnancy-related deaths among non-Hispanic Black women, a Centers for Disease Control review of causes of maternal mortality found. In contrast, the leading underlying cause of death among non-Hispanic White women was mental health conditions.

Requiring women to first be diagnosed with OUD to become eligible for extended postpartum coverage also creates a red tape barrier for a mother who is recovering from childbirth and managing a newborn, and may be reluctant to self-identify as having an opioid addiction, much less be able to travel to appointments or schedule consultations with providers. According to a recent report from the Substance Abuse and Mental Health Services Administration, only 10 percent of people with a substance use disorder in the general population seek treatment, and “this is magnified in the Black/African American community where there is significant historical mistrust of the health care, social services, and the justice system.”

Limiting the 12-month postpartum coverage just to women with a specific diagnosis is a missed opportunity to address the root causes and persistent racial disparities in pregnancy related death, and better support mothers and babies in the first months of life.

But it is important to remember that while 12-month postpartum Medicaid coverage is an essential piece of the puzzle, it cannot solve the maternal mortality crisis in isolation. In addition to comprehensive and continuous coverage, states should consider new ways to leverage Medicaid financing to help build the necessary infrastructure for pregnancy and postpartum care coordination, perinatal case management, home visiting, standardized data collection, and development of a diverse and inclusive birth care workforce, among other essential elements of a robust maternal and child health care system.

Extending comprehensive postpartum Medicaid coverage for all pregnant women is an essential step, but not the only step, to set young families on a healthy path. Now is the time to fully leverage the program’s impact.

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