The momentum for extending postpartum Medicaid and CHIP coverage accelerated last week, with the Medicaid and CHIP Payment and Access Commission (MACPAC) giving a strong endorsement of the policy.
MACPAC voted to recommend that Congress act to guarantee 12 months of postpartum coverage for pregnant individuals in Medicaid, and to align the policy in states that expand CHIP coverage to pregnant women (as six states currently do). Moreover, the commission will urge Congress to provide a 100% federal matching rate (FMAP) for the extended postpartum period in Medicaid. They also recommended that all pregnant individuals in Medicaid receive the full Medicaid benefit package throughout their pregnancy and postpartum period. This would mean that the four states (Arkansas, New Mexico, North Carolina, and South Dakota) that currently limit benefits to pregnancy-related services for some pregnant women in Medicaid, will need to provide full benefits if Congress acts on the MACPAC recommendation.
These broad recommendations are the result of the commission’s study of the policy over the past several years, hearing from many state officials, researchers, advocates and other experts to examine the policy from all sides, with a particular emphasis on the pervasive racial and ethnic disparities in outcomes for pregnant people covered by Medicaid. Among Medicaid beneficiaries, women of color and women living in rural areas are at the greatest risk of experiencing severe maternal morbidity, such as stroke or hemorrhage. Black and Indigenous women were two to three times more likely to die of a pregnancy-related cause as White women, regardless of their insurance coverage at the time of delivery. A significant portion of pregnancy-related deaths occur more than two months after the end of the pregnancy, after pregnancy Medicaid coverage has expired for many pregnant women.
The clear evidence of racial inequities, alongside compelling stories from those in the Medicaid postpartum coverage gap, helped convince the commission to make the strongest recommendation to cover as many women as possible with the fewest barriers. In public comments, Donna Kreuzer from Texas shared how her daughter lost her battle with severe postpartum depression after the birth of her first child in 2010, and how she now advocates for extending postpartum Medicaid coverage so that all women with postpartum depression can access the lifesaving care they need, when they need it.
Advocates from New Jersey shared how many of the women they serve have maternal depression and anxiety, yet they lose access to critical medication when their Medicaid coverage ends 60 days after giving birth. Reapplying for coverage often means an hours-long, in-person visit to a local benefits office, a serious barrier to a new mother managing their newborn’s unpredictable schedule and their own physical recovery after delivery.
While commissioners were initially split on whether to recommend 90 or 100 percent federal funding, maternal and child health advocates helped solidify the commission’s final vote as a both a recognition of the importance of the policy to improving maternal health and of the fiscal challenges states are facing due to the COVID 19 pandemic. Even a minimal state match could be hard to justify in the current budget environment, commissioners said, and the policy is too important to let the current budget crisis stall action. Several advocates commented that while their states were still committed to extending postpartum coverage, the policy change has been put on hold during the pandemic. The estimated federal cost of extending coverage is between $30-40 billion over 10 years.
MACPAC’s recommendations will be part of the commission’s March report to Congress, which is already contemplating an extension of postpartum coverage. Last fall, the House passed a bipartisan bill to give states the option to cover women in pregnancy-related Medicaid and CHIP coverage for one year after delivery and receive federal matching funds, extending their coverage well beyond the current cutoff of 60 days after the end of the pregnancy. A bipartisan group of senators also support the policy, but the bill did not make it through the chamber in 2020.
On a parallel track, several states have submitted 1115 waiver applications to CMS to receive federal matching funds for an extended postpartum coverage period for at least some pregnant women. None of the applications were approved by the Trump Administration, and they are now being considered by the Biden Administration.
MACPAC’s strong recommendation is the latest in a growing call for action on maternal and infant health, a call that has only grown louder during the COVID-19 pandemic when families are facing unrelenting stress. Extending Medicaid postpartum coverage can be a powerful tool to ensure that families get their healthiest start.