An important policy change to advance maternal health equity secured a spot in the Build Back Better Act, the budget reconciliation legislation currently under consideration in Congress. Pregnant people covered by Medicaid and CHIP would receive a full year of postpartum coverage, regardless of which state they live in. The bill requires that all states extend full-benefit Medicaid and CHIP postpartum coverage to one year after the end of pregnancy by redefining the postpartum period in statute from 60 days after the end of pregnancy to 12 months after the end of pregnancy.

Creating a new, nationwide standard of 12 months of postpartum Medicaid coverage is an important step towards achieving health equity and building a foundation of support for women and babies during the critical months immediately after childbirth. Extending postpartum coverage can also help to reduce racial disparities in health outcomes for moms and babies. However, with recent news that the size of the budget reconciliation bill is likely to shrink significantly due to ongoing negotiations between the Administration and Congress, it is critical that this policy and other important investments for maternal and child health be retained in any final legislation.

Dropping the mandatory postpartum coverage provision would run against the considerable interest from states, on a bipartisan basis, in expanding postpartum coverage. Regular Say Ahhh! readers will recognize the details of this proposal, as it makes mandatory the current state plan option to extend postpartum coverage for 12 months passed under the American Rescue Plan Act this past spring. Already, there are 19 states taking steps to adopt the option when it becomes available in April 2022. Additionally, several states have requested 1115 waivers for some type of postpartum coverage extension, and three states– Illinois, Georgia, and Missouri– have so far been approved.  But mandatory postpartum coverage would dramatically accelerate takeup among the states and ensure equity for low-income pregnant women across the states.

The policy details of the mandatory 12 month postpartum coverage extension are generally the same as those in the state plan amendment option:

• The 12 months of postpartum coverage would be required for all states in Medicaid and those states that cover pregnant women in CHIP (currently six states do this)
• Postpartum people must receive the full Medicaid benefit package during this period
• The state would receive its Medicaid and CHIP matching rates for the extended postpartum period
• The requirement would take effect on the first day of the first fiscal year quarter that begins one year after date of enactment.

Lawmakers are considering the mandatory 12 months of postpartum to better support parents in the months after giving birth, and the need is great: about 45 percent of women covered by Medicaid and CHIP for pregnancy become uninsured when the coverage ends at 60 days postpartum, a previous estimate the Congressional Budget Office has found. Many of these women eventually re-enroll in Medicaid or private coverage, but the lapses in coverage cause gaps that can cause women to delay seeking care in emergencies.

As my colleague Joan Alker recently blogged, there are many other critical health programs included in the bill draft under consideration, including a fix to the “coverage gap,” which as readers of SayAhhh! know well, exists for people below the poverty line in the twelve remaining states that have refused to expand Medicaid. For children, the bill would require 12 months of continuous eligibility in Medicaid and CHIP, a change that keeps children covered without gaps and has the biggest benefit for children of color.  It would also permanently provide federal funding for the CHIP program and ensure that states do not roll back children’s eligibility for Medicaid and CHIP or make it harder for eligible children to enroll over the long term.

This bill also makes significant investments in growing and diversifying the perinatal workforce, education and anti-bias training for healthcare providers, and support for data infrastructure to better support and track maternal health outcomes for women of color. Many of these investment opportunities were driven by the Black Maternal Health Momnibus, a package of several bills designed to comprehensively address all dimensions of the nation’s maternal health crisis. While all of these provisions were included in the version of the bill reported by the House Energy and Commerce Committee, the shrinking price tag of the overall reconciliation bill means that these important but relatively modest cost changes could end up on the chopping block though advocates are working hard to keep them included.

Requiring all states to provide 12 months of postpartum coverage is an investment that moves the nation closer to health equity by ensuring that all mothers, no matter where they live, have access to the health care they need to take care of themselves and their growing families during a critical time.

Editor’s note: To maintain accuracy, CCF uses the term “women” when referencing statute, regulations, research, or other data sources that use the term “women” to define or count people who are pregnant or give birth. This includes self-reported data collected by the U.S. Census Bureau. Where possible, we use more inclusive terms in recognition that not all individuals who become pregnant and give birth identify as women.