Optional 12 Months Postpartum Medicaid Coverage Leaves Opportunity to do More

Tucked inside the American Rescue Plan signed into law by President Biden last week is a Medicaid state plan option allowing states to offer pregnancy-related Medicaid and CHIP coverage for one year after the end of pregnancy, extending coverage well beyond the current cutoff of 60 days postpartum.

The option, which is the result of years of advocacy and devastating data showing high rates of maternal mortality in the year after pregnancy, especially for women of color, will become available to state Medicaid programs beginning April 1, 2022.

The creation of the extended postpartum Medicaid and CHIP coverage option is an important down payment to support maternal and infant health. But the work, both at the federal and state levels, is far from done. To improve maternal and infant health and help address the critical need for greater health equity and racial justice, Congress should consider the Medicaid and CHIP Payment and Access Commission (MACPAC) recommendation to make the extended coverage mandatory, permanent, and matched at 100% FMAP. This provision would help postpartum people, no matter where they live, access lifesaving care for one year after the end of pregnancy.

And for the 12 states that haven’t yet expanded Medicaid coverage, the American Rescue Plan includes generous incentives to cover all low-income adults, which reams of evidence shows will benefit parents and their newborns before, during and after pregnancy. Paired together, Medicaid expansion and extended postpartum coverage will undoubtedly save lives.

Once the postpartum coverage option becomes available next year, states can submit a Medicaid state plan amendment to receive federal matching funds to cover postpartum people for an additional 10 months after the end of the pregnancy in Medicaid and CHIP. States that take up the option must also apply the extended coverage to pregnant people they’ve opted to cover in CHIP. Currently, six states offer coverage to pregnant people in CHIP.

The new law is an essential, if incomplete, first step. It’s worth also noting the new law is:

  • Not permanent— the new option has a 5-year sunset
  • Not mandatory for states
  • Available at a state’s regular FMAP rate

As we said before, by making the extended postpartum coverage optional, there will be pregnant people who will not receive the benefit. CBO estimates that by 2024, about 25 percent of all pregnant people who would be expected to receive postpartum services from Medicaid will live in states that implement the 12-month option.

Say Ahhh! Readers will recall that MACPAC recently voted to recommend that Congress make extended postpartum coverage mandatory for all states, and provide a federal match of up to 100% FPL. The recommendation was formally reported to Congress yesterday.

The commission made such a strong recommendation after years of considering research that showed 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 postpartum Medicaid coverage has expired for many pregnant women.

The outcomes are also intertwined with a state’s decision to expand Medicaid to all low income adults. States without Medicaid expansion have the greatest share of uninsured postpartum women who would benefit from extended coverage. According to research from the Urban Institute, nearly two-thirds of uninsured new mothers who would likely gain eligibility reside in just five states: Florida, Georgia, Missouri, North Carolina, and Texas. Four of these states have not yet expanded Medicaid coverage to all low-income adults, and Missouri voters approved expansion via ballot initiative last year, but the state has not yet implemented it.

Congressional leaders have indicated they want to do more to solidify postpartum Medicaid and CHIP coverage. In committee hearings on the bill, several House members, including House Energy and Commerce Committee Chair Frank Pallone, said that they fully intend to make the option permanent, but that they were limited by the rules of the Senate budget reconciliation process used to pass the full bill. Under budget reconciliation bills, policies cannot increase deficit spending beyond the 10-year budget window.

It’s encouraging that they want to continue to strengthen coverage for new mothers. Extended Medicaid postpartum coverage that is permanent, mandatory for states, better financed, and paired with Medicaid expansion would go farther to achieve health equity and move closer toward racial justice for the next generation.

Stay tuned for more detailed analysis in the coming weeks on what stakeholders can do to make these policy options as successful as possible.

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