Congress made several improvements to maternal health policy in the year-end Consolidated Appropriations Act of 2022, signed by President Biden on December 29, which both solidify eligibility for extended Medicaid postpartum coverage and bolster the health system’s capacity to serve new mothers.
These policy changes come alongside other Medicaid and CHIP provisions in the Omnibus bill, including mandatory 12-month continuous eligibility for children, Medicaid funding for mental health, Medicaid funding for Puerto Rico and the Territories, and changes to the COVID-19 Medicaid coverage protections. (All links go to other CCF blogs on these topics).
Permanent 12-Month Postpartum Medicaid Coverage Option
On the coverage side, Congress made the 12-month extended postpartum coverage option permanent. The option, which was created by the American Rescue Plan Act of 2021, previously expired in 2027. Making the option permanent puts to rest any state concerns about the option going away, and gives states certainty that once they take up the option to lengthen the postpartum coverage period from its current 60-day duration to 12 months after the end of pregnancy, they will continue to receive federal matching funds.
So far, more than 30 states have elected the option, and even more are expected to take it this year. Several more states have extended postpartum Medicaid coverage via a Section 1115 waiver. Taken together, this signals one of the fastest adoptions of an optional Medicaid policy in recent memory.
Still, by keeping the 12 months of postpartum coverage optional–instead of mandatory as many advocates pushed for–there will undoubtedly be new mothers left behind. There are 15 states that have not yet acted to extend 12 months of postpartum coverage: Alaska, Arkansas, Idaho, Iowa, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, South Dakota, Texas, Utah, Wisconsin, Wyoming. While there are strong advocacy efforts in some of these states heading into the 2023 legislative sessions, there will continue to be places where pregnant people lose coverage just 60 days after the end of pregnancy.
We know that coverage cliff has consequences. Data from the Centers for Disease Control and Prevention shows that about 53 percent of maternal deaths happen between 7-365 days postpartum, and loss of health coverage is cited as one of the reasons many women do not seek postpartum care.
During the COVID-19 public health emergency’s continuous coverage protection, the pregnant women eligibility group saw the greatest percentage increase in enrollment of any category, with roughly 64% more (652,000) beneficiaries in the pregnant eligibility group in April 2022 as compared to February 2020. The pace of growth signals that the continuous enrollment protection has filled a gap for postpartum women, and at the same time, puts their health coverage at risk as states return to normal operations when Medicaid’s continuous coverage provision expires in April 2023. Unless state policymakers take up the extended postpartum coverage option, it will be these low-income new moms who will again lose coverage just two months after delivery.
Maternal Health Infrastructure
Alongside the permanent postpartum coverage option, Congressional lawmakers made significant investments to support the health of new moms both inside and outside the health care systems. Among the health policy provisions are increased support for maternal mental health screening programs (previously known as the Into the LIght Act), increased funding for the maternal mental health hotline, and the creation of a new federal interagency task force coordinate efforts to address maternal mental health, and to create a national strategic plan including recommendations to state governors, House and Senate Committees, and relevant federal agencies to support and improve maternal mental health in the U.S (previously known as the TRIUMPH For New Moms Act).
The bill also included additional funding for quality improvement, data collection, and workforce development, including a $50 million investment in community health worker workforce training which my colleague Natalie Lawson will explain in greater detail in a future blog. All of these investments will help create a maternity care infrastructure that better meets the needs of pregnant and postpartum people.
Additionally, the Omnibus included the Pregnant Workers Fairness Act, which requires employers to provide reasonable accommodations for pregnant workers to protect the health of their pregnancy, and the PUMP for Nursing Mothers Act, which expands workplace protections for breastfeeding mothers. Many of these changes also push forward the Biden Administration’s White House Blueprint for Addressing the Maternal Health Crisis.
As the nation continues to face a worsening maternal health crisis, these investments are an important step forward towards making the country a safer place to give birth. There are many more things left for lawmakers to do to address the maternal health crisis: notably, Congress did not act on many of the Momnibus bills which are specifically targeted to address the Black maternal health crisis. However, the coverage and infrastructure investments are an important step forward in maternal health policy, and will help turn the tide of maternal mortality and morbidity that has consistently increased in recent years, with Black and Brown communities bearing the greatest burden.
[The bipartisan spending plan was approved by Congress and signed into law by the President on December 29, 2022. Read CCF’s brief to learn more.]