Today marks the end of Black Maternal Health Week, which is celebrated every year from April 11-17. This initiative was founded by the Black Mamas Matter Alliance (BMMA), which advocates for Black mothers and has goals of changing policy, cultivating research, advancing care, and shifting culture.  The week calls attention to the Black maternal health advocates working to eliminate disparities and the theme was “Our Bodies Belong to Us: Restoring Black Autonomy and Joy!”.

In addition to highlighting community-based advocates, health care providers and policymakers working for change, this year BMMA launched their comprehensive policy agenda which consists of six policy issues:

1. Structural and Social Determinants of Black Maternal Health
2. Full Spectrum Maternal, Sexual, and Reproductive Healthcare
3. Black Maternal, Reproductive, and Perinatal Workforce Development
4. Criminalization of Black Women, Birthing People, and Families
5. Research and Data Transformation
6. Black Women and Birthing People’s Leadership

The policy agenda reflects that changes across all sectors are needed to address the Black maternal health crisis. Medicaid policy changes are an important component, and among their Medicaid-specific recommendations, BMMA recommends:

• Establishing mandatory, permanent Medicaid postpartum coverage for 12 months
• Adopting the Affordable Care Act’s (ACA) Medicaid expansion to close the Medicaid coverage gap
• Increasing access to maternal mental health services by increasing the number of providers who accept Medicaid
• Require public and private insurance plans to have a robust network of birth justice-informed reproductive health, allied health, and perinatal health providers.
• Establish a demonstration project to test payment models for maternity care, including postpartum care, under Medicaid and the Children’s Health Insurance Program (CHIP).
• Develop strategies for ensuring continuity of health insurance coverage for pregnant and postpartum people, including presumptive eligibility for pregnant people and measures to prevent any disruptions in coverage during pregnancy, labor and delivery, and up to one year postpartum.

Medicaid policy changes are critical to addressing the maternal health crisis. Currently, over 40 percent of births in the United States are financed by Medicaid. In states like Louisiana and Mississippi, Medicaid finances more than 60 percent of births. At the same time, the United States has the highest maternal mortality rate compared to other high-income countries and the rates continue to worsen, especially for Black women.

According to a recent report by the Centers for Disease Control and Prevention, there were 1,205 maternal deaths in 2021. The maternal mortality rate for Black women was 69.9 deaths per 100,000 deaths compared to 26.6 deaths per 100,000 live births for White women. The CDC also reports that 53 percent of pregnancy-related deaths occur between one week and one year after childbirth.

Many of BMMA’s policy recommendations are included in pending federal legislation and state and federal policymakers are continuing to act. The Consolidated Appropriations Act of 2023 made permanent the option to extend postpartum Medicaid and CHIP coverage from 60 days to 12 months. Currently,  31 states and Washington, D.C. have implemented the 12 month Medicaid expansion, 6 additional states plan to implement the extension, and 3 other states have proposed more limited coverage extensions.

If all states decided to implement the 12 month postpartum Medicaid coverage option, the number of pregnant Medicaid beneficiaries who would remain eligible for Medicaid would by about 720,000 people per year. Individuals in non-expansion states would benefit the most from extended postpartum Medicaid eligibility according to a recent report from the HHS Assistant Secretary of Planning and Evaluation. Postpartum eligibility for Medicaid would increase by 65 percentage points, adding about 350,000 people. This would be life-changing for many families.

BMMA’s policy agenda also encourages Medicaid expansion for all low income adults, which has been associated with reductions in maternal and infant mortality, reductions in postpartum hospitalizations, and greater uptake of preconception, prenatal, and postpartum care. North Carolina just became the 41^st state, along with Washington, D.C. to adopt Medicaid expansion through the ACA.  There are 10 states that have not yet adopted Medicaid expansion.

Beyond eligibility, the policy agenda also calls out ways that Medicaid can support a more diverse perinatal workforce, including doulas and midwives, and use its financing structure to implement payment methodologies that incentivize high-quality maternal health care models and prioritize perinatal mental health care. Maternal mental health care is particularly important: postpartum depression impacts 1 in 5 women and research shows that undiagnosed and untreated mental health disorders can lead to an increased risk of developing hypertension, hemorrhaging, preterm birth, low birth weight, and suicide. Inequities in maternal mental health also disproportionately affect communities of color. Nearly 60% of Black and Latina mothers do not receive treatment for mental health conditions due to a lack of insurance coverage, stigma about mental health, and a lack of culturally sensitive and competent care.

These health policy changes are but one piece of the larger shift needed to ensure Black maternal health, rights and justice. As BMMA points out, policy issues, “…are not siloed in Black women and birthing people’s lives.”

To learn more about the BMMA, please visit their website.

​​Editor’s note: To maintain accuracy, Georgetown 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. Where possible, we use more inclusive terms in recognition that not all individuals who become pregnant and give birth identify as women.