State Medicaid and CHIP Options Can Help Address Maternal Health Crisis and Eliminate Racial Health Inequities

Two Say Ahh! blogs published during Black Maternal Health Week this April–one from Marquita Little Numan reflecting on her personal birth story and another by Tanesha Mondestin on the Black Mamas Matter Alliance policy agenda – underscored the need for significant policy change to address the ongoing maternal health crisis facing our country, where Black women are three to four times more likely to die of pregnancy-related causes.

These disparities are not inevitable. As the blog authors–and our new brief–make clear, Medicaid policy change should be central to the solution. Medicaid finances roughly two-thirds of births to Black and Hispanic mothers, giving it an unparalleled ability to impact pregnant people, infants and new families in need of support. While coverage alone will not solve the maternal health crisis our country faces, state Medicaid and CHIP policy options provide states with significant opportunities to advance health equity and more effectively serve mothers of color.

The maternal health crisis is serious and complex: Racial inequities in maternal health outcomes have been exacerbated by the COVID-19 pandemic, and access to maternity care continues to worsen, particularly in the wake of the Supreme Courts’ Dobbs decision last June allowing  states restrict or even  ban abortion. Research suggests that states restricting access to abortion after the decision already had fewer maternity care resources and higher maternal and infant mortality rates. Experts predict the abortion restrictions will only make things worse.

At the federal level, President Biden signed into law nearly $1 billion in funding for maternal health priorities as part of the Consolidated Appropriations Act of 2022, and the administration continues to approve more states to extend the Medicaid postpartum period from 60 days to 12 months after the end of pregnancy–at last count, it was up to 32 states and D.C. with approved coverage extensions and more on the way.

Our new brief highlights state uptake of Medicaid and CHIP eligibility options and the research supporting their benefit, such as Medicaid expansion, income eligibility expansions, extending the duration of postpartum Medicaid coverage to 12 months following the end of pregnancy, using state-based marketplaces to enroll more uninsured pregnant people, and removing immigration-related barriers to health coverage.

Thanks to the work of our colleagues at CCF and the Kaiser Family Foundation on the 50-state annual eligibility and enrollment survey, who collected much of the data included in our report tables, we can see that a steady number of states each year continue to elect these options to promote greater access to care for pregnant people, and where opportunities remain.

Our brief also includes newly-analyzed Census data that shows the tremendous role that Medicaid expansion plays for reducing uninsured rates for women of childbearing age. Data from 2021 shows that women age 18-44 living in states that have expanded Medicaid coverage to all low-income adults earning up to 138% of the federal poverty level (FPL), or about $30,000 per year for a family of three, were nearly twice as likely to have coverage as those in in non-expansion states (note that the data only reflects states that had expanded Medicaid as of January 1, 2021). This trend extended across all racial and ethnic groups, our analysis shows.

This underscores the research findings which  show that having stable coverage before, during and after pregnancy improves maternal and infant health outcomes, and foreshadows the maternal health gains that states which recently approved expansion, including South Dakota and North Carolina, are likely to experience as they roll out Medicaid expansion in the coming months.

State eligibility is but one element of Medicaid and CHIP policy, and this brief builds on an earlier CCF report looking at the potential for state Medicaid policy levers to drive systemic changes that promote improved maternal health outcomes for enrolled beneficiaries: benefits, quality improvement and greater accountability for maternal health data and outcomes in Medicaid managed care. Taken together, these eligibility, enrollment, benefits, and quality strategies point to the significant potential for Medicaid and CHIP to play a role in combating maternal mortality and eliminating racial inequities in health outcomes.

As evidenced by the large swath of organizations and policymakers lifting their voices during Black Maternal Health Week earlier this month, the nation’s attention is more focused on Black maternal health and improving outcomes for new mothers than at any time in recent memory. Medicaid and CHIP programs have a crucial role to play in reaching families who are most in need of support and advancing systemic policy changes that help address the root causes of health disparities.