The 2022 state legislative season is nearing its end in the coming weeks, and this year we’ve continued to see significant efforts in a broad range of states working to extend the Medicaid postpartum coverage from the current cutoff of just 60 days to a full 12 months after the end of the pregnancy.

Regular Say Ahhh! readers will recall that as part of the American Rescue Plan Act passed last year, Congress created a Medicaid and CHIP state plan option that allows states to receive federal matching funds to cover an additional 10 months of postpartum coverage for people covered by Medicaid or CHIP during pregnancy. When the bill passed last March, several states acted quickly to allocate the state share of funds before their legislative sessions ended. Since then, we’ve seen a steady stream of state legislative and administrative work to allocate funds to extend postpartum coverage and take advantage of the new state plan option when it officially becomes available next month on April 1, 2022.

See the table below for states where legislation to seek federal approval to extend postpartum coverage has either passed in at least one state legislative chamber or been included in the governor’s budget. Importantly, this current burst of activity is in addition to the 20 states that passed legislation last year to seek a state plan amendment or waiver to extend postpartum coverage on April 1, and the five states that have received 1115 waiver approvals to extend postpartum coverage already. Please let us know if we’ve missed any updates- this is a rapidly changing landscape!

*Georgia received an 1115 waiver approval last year to extend postpartum coverage for 6 months after the end of pregnancy, but this legislation would direct the state to instead seek a state plan amendment to provide coverage for 12 months postpartum.
Sources
1) “Medicaid After Pregnancy: State-Level Implications of Expanding Postpartum Coverage,” Gordon S, Sugar S, Chen L, Peters C, De Lew, N, and Sommers, BD. (Issue Brief No. HP-2021-28) Office of the
Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. December 2021. Accessed at: https://aspe.hhs.gov/sites/default/files/documents/cf9a715be16234b80054f14e9c9c0d13/medicaid-postpartum-coverage-ib%20.pdf ”
2) Kaiser Family Foundation analysis of approved and pending 1115 waivers, state legislation, and Medicaid state plan amendments. Accessed at https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/#note-0-10
3) Georgetown University Center for Children and Families analysis of approved and pending 1115 waivers, state legislation, and Medicaid state plan amendments

The need for action is clear: the latest data from the CDC shows that maternal death rates increased in 2020 for the second year in a row, and Black women continue to have a mortality rate twice as high as the national average.^[1] Maternal morbidity, which is defined as a “near-miss” that could have resulted in death, unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health, or serious illnesses that occur during pregnancy or postpartum period, such as cardiomyopathy, also disproportionately affects women of color and women living in low income communities. Medicaid is the source of coverage for about two thirds of births among Black women, so policy changes in Medicaid would be especially impactful for the women most at risk of mortality and other serious, life-altering complications.

Women of color are also more likely than their White peers to experience a coverage disruption during pregnancy, which can cut off their access to ongoing prenatal and postpartum care, access to medications or other support they need to manage their own health, which will support their health of their infant. About one third of pregnancy-related deaths occur between one week and one year after the end of the pregnancy, and as state maternal mortality review committees in dozens of states have shown, these deaths are often preventable. This suggests that improving access to care during this critical period could be lifesaving for new mothers.

If all states were to extend postpartum coverage for one year after the end of pregnancy, there would be about 720,000 more people each year who would experience 12 months of postpartum coverage. This would be the impact of the mandatory postpartum coverage extension passed by the House in the Build Back Better Act last fall.

In addition to the longer coverage period, we’re also watching to see how states use the longer timeline as an opportunity to make significant improvements in access and quality of care for postpartum people, such as adding coverage for care provided by doulas, and adopting women-centered models of care, such as maternal health homes or group prenatal care.

We plan to keep a close watch in the coming months as states begin submitting their state plan amendments to CMS for approval. Stay tuned!

^[1]Editor’s Note: To maintain accuracy, CCF uses the term ‘pregnant women’ when referencing statute, regulations, research, or other data sources that use the term “pregnant women” to define or count people who are pregnant. Where possible, we use more inclusive terms in recognition that not all individuals who become pregnant and give birth identify as women.