Policymakers Have More Work to Do to Address the Black Maternal Health Crisis

By Maggie Clark and Kay Johnson

Last month, policymakers and advocates marked the fifth-annual Black Maternal Health Week and called attention to the policy changes that can help put an end to the country’s increasing and unacceptably high rates of maternal mortality, especially for Black women who die from pregnancy-related causes at a rate more than twice the national average.

One critical change has recently taken effect: As of April 1, 2022, states can use a state plan amendment (SPA) to extend postpartum Medicaid coverage to one year after the end of pregnancy. CMS has announced that it’s working with more than a dozen states to make this important change allowed by the American Rescue Plan, and even more states are working to take up the option.

But beyond this coverage change, other legislative and administrative efforts to improve maternal health outcomes have been scattered through the recently enacted FY 2022 Appropriations Bill, the House-passed Build Back Better Act—which included nearly all the provisions of the comprehensive Black Maternal Health Momnibus suite of bills—and President Biden’s budget recommendations released earlier this month.

The table below summarizes provisions, as well as funding committed and proposed, and compares the most comprehensive approach of the Black Maternal Health Momnibus to other recent activity. The gaps between the proposals and the enacted policy changes show the work still left to be done to make the systemic changes and investments needed to create a supportive infrastructure of maternal health coverage and care across the country.

A country’s maternal mortality rate is a key measure of how we’re doing as a society on health. And the alarming U.S. rate—higher than any other industrialized nation and still climbing—shows that the country is not doing well. In particular, federal data show excess mortality and morbidity for Black and Indigenous women. Improving maternal health will require increased coverage, improvements in the perinatal workforce, and changes in the health care delivery and financing system.

Policy changes and investments such as those shown above are designed to tackle the challenges broadly.  It will take sustained, structural changes, such as the Build Back Better Act’s two-track approach of mandatory 12-month Medicaid postpartum coverage extension, alongside public health investments in growing and diversifying the perinatal workforce and supporting a more robust data infrastructure to better track and improve maternal health outcomes for women of color, to address the full magnitude of this crisis.

*Note that much of the funding in the Appropriations bill and President’s Budget Proposal go to MCHB HRSA. The Budget-in-Brief notes: “$276 million across HRSA to improve maternal health and specifically reduce maternal mortality and morbidity, $202 million above FY 2022 enacted. HRSA will expand current initiatives.”  These are noted here in red when they are distinct from what was in the Momnibus or the Build Back Better Act.

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