More States Extend Postpartum Medicaid Coverage as Three States Fall Behind

Just this month, Missouri and Alaska joined the growing list of states where their legislatures approved extending postpartum Medicaid coverage from 60 days to 12  months, following Mississippi, Wyoming, Montana, South Dakota, and other states that have acted this year. CMS is expected to approve the extensions after the states submit their state plan amendment applications.

Only three states–Arkansas, Idaho, and Iowa–adjourned their 2023 legislative sessions without taking action to extend postpartum Medicaid coverage. This will leave about 15,000 new moms each year without a full year of coverage after the end of pregnancy–roughly 6,000 new moms in Arkansas, 3,000 new moms in Idaho, and 6,000 in Iowa.

New mothers in these states already face significant challenges. Arkansas has the nation’s highest maternal mortality rate. Idaho lawmakers this year disbanded its maternal mortality review committee and passed several restrictive abortion laws which are driving maternity care providers out of the state. Iowa has lost more than a quarter of its labor and delivery units–about 41 locations– since 2000.

Due to lawmakers’ inaction, postpartum moms in these states will revert back to a 60-day postpartum coverage period in Medicaid as their states return to regular renewals after the end of COVID-19 pandemic’s continuous coverage protections. Research shows this could have dangerous consequences: before the pandemic, about half of all people covered by Medicaid for pregnancy lost coverage after the 60 days postpartum period and national data showed that about one-third of pregnancy related deaths occur between 43-365 days postpartum, after many have lost Medicaid coverage.

State legislators in Nebraska, Nevada, New Hampshire, Texas and Wisconsin continue to debate extending 12 months of postpartum Medicaid coverage as their sessions come to a close in June.

The vast majority of states have used the state plan amendment pathway, which requires states to offer continuous eligibility for full benefits for anyone eligible for Medicaid or CHIP during pregnancy, ending 12 months after the end of pregnancy. A smaller subset of states have used an 1115 waiver to lengthen the postpartum coverage period, and in some cases, attempted to limit the population of people or cover a shorter duration than the state plan amendment requires.

If all states adopt the coverage extension, an estimated 720,000 additional people each year would gain access to a full year of postpartum health coverage who might have otherwise lost coverage just two months after the end of pregnancy, according to recent HHS ASPE estimates.. The researchers noted that gains in postpartum eligibility are likely to be largest for individuals with incomes between 138-250 percent of the federal poverty level, whose incomes are generally too high to qualify for Medicaid as parents in most states.

The rapid uptake of the option since it was created in the American Rescue Plan Act of 2021 shows the wide range of support for leveraging Medicaid to support maternal health.The evidence for leveraging Medicaid to support maternal health is clear, and it is essential for states to seize this opportunity to improve outcomes for families.