HHS Secretary Becerra Approves Illinois Waiver Request to Extend Postpartum Medicaid Coverage

New mothers in Illinois will now be able to stay eligible for Medicaid and CHIP coverage for one year after delivery under a Medicaid Section 1115 waiver approved today by the Centers for Medicare and Medicaid.

The approval allows Illinois to receive federal matching funds for providing an additional 10 months of pregnancy-related Medicaid and CHIP coverage for a total of one year after the end of pregnancy, extending coverage well beyond the current cutoff of 60 days postpartum. CMS also approved the state’s request to provide continuous eligibility for a woman during the entire postpartum period, ensuring continuity of coverage.

(There are a few more pieces in the approval, so stay tuned for a future blog. But for now, we’ll stick to the extended postpartum Medicaid coverage news.)

In the approval letter, CMS wrote that the approval allows the state to test the effects of extending postpartum coverage, and that the amendment, “…aims to increase and strengthen overall coverage and improve the health of certain mothers in Illinois, as well as reduce the rate of maternal morbidity and mortality in the state by addressing continuity of care for women postpartum.”

Illinois was the first state to apply to CMS to extend postpartum coverage, in large part due to the state’s extreme racial disparities in maternal mortality. Illinois’ Maternal Morbidity and Mortality Report released in October 2018 found that non-Hispanic black women are six times as likely to die of a pregnancy-related condition as non-Hispanic white women in the state. Nationally, Black women and Indigenous women have the highest maternal mortality rates, and are more than two to three times more likely to die from a pregnancy-related cause than are White women.

Coverage churn in the postpartum period is also a major reason why more than half women covered by Medicaid during their pregnancy experienced a coverage gap in the first six months postpartum, and struggled with unmet health needs, such as postpartum depression or cardiovascular conditions.

The Illinois approval letter also noted that the comments the agency received on Illinois’s  application—including the letter submitted by Georgetown University CCF and a sign-on letter from many other national organizations—highlighted the benefit of extended postpartum coverage on children as well. When mothers are covered and able to be healthy themselves, they can better bond with their children and support the early brain development that is so critical for long term child health. Children whose parents have health coverage are more likely to receive regular well visits and live in families experiencing greater financial security.

Several other states have applied for Section 1115 waivers to extend postpartum coverage, and the recently-passed American Rescue Plan created a new state plan amendment pathway for states to extend postpartum coverage receive federal matching funds beginning April 1, 2022. My colleague Joan Alker recently blogged about the differences in these two approaches and will likely have more to say in a future blog. We also outlined steps states and CMS can take now to prepare for the smooth implementation of the new SPA option next year and leverage other funds from the American Rescue Plan to support new parents and their infants.

We anticipate more action on this front, as the momentum for extending postpartum Medicaid coverage continues to grow. Secretary Becerra today strongly encouraged other states to use the new SPA option to extend postpartum coverage, and highlighted coverage extension as a way to improve health equity and save mothers’ lives. Becerra was joined at the press conference by Illinois congressional leaders, and connected the announcement to Black Maternal Health Week, organized by the Black Mamas Matter Alliance, the National Birth Equity Collaborative and other maternal health and reproductive advocates from across the country during the week of April 12-16.

We applaud the approval of Illinois’ postpartum coverage extension and will keep a close watch on other activity as more states consider how they can use Medicaid to ensure that every family has a healthy start.

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