Analysis: New Mothers Gained Health Coverage During Pandemic-Era Coverage Protections, But 1 in 10 Still Uninsured

The Families First Coronavirus Response Act (FFCRA) required states to maintain uninterrupted coverage for all Medicaid beneficiaries in exchange for additional federal funding. This continuous coverage protection also extended to pregnant women in Medicaid beyond the previous 60-day postpartum cutoff that most states have now moved to extend to 12 months postpartum. A new analysis from Urban Institute, New Mother’s Coverage Improved during the Public Health Emergency showed potential impacts of the extended coverage period for new mothers using data from the American Community Survey (ACS), underscoring the need to ensure all new mothers enroll and remain enrolled in Medicaid as long as they remain eligible.

Uninsurance for new mothers improved by 14 percent between 2019 and 2021 after years of relatively steady coverage rates– a strong rise in health coverage during the high-stakes months for maternal mortality and morbidity during an already-stressful time of family change following a birth. Authors suggested a strong link between the Medicaid continuous coverage protections, noting a comparable rise in Medicaid/CHIP coverage as uninsurance dropped.

Even with the coverage gains, 1 in 10 new mothers still remained uninsured in 2021. Coverage disparities between new mothers persisted by age, income, race, ethnicity, and citizenship status. Hispanic and American Indian/Alaska Native new mothers still experienced the highest uninsurance rates by race/ethnicity in 2021 (20.5 and 21.0 percentage points). Young (ages 19-14) and undocumented new mothers were also more likely to be uninsured.

Where new mothers live also makes a difference. Coverage gains among new mothers between 2019 and 2021 were greatest for new mothers living in non-expansion states. North Carolina (-8.3%) and Mississippi (-8.0%) saw the greatest percentage point drops among states with available data (p. 13). Yet, despite gains, the uninsurance rate in 2021 among new mothers in non-expansion states as a whole was more than twice that of their counterparts in expansion states. This underscores once again the importance of the postpartum extension and how it builds on a foundation of Medicaid expansion that helps women get the care they need before, during and after pregnancy. More than half (57.2%) of uninsured new mothers live in the South.

These data show again what’s at stake for postpartum women during the unwinding. While the postpartum extension has been fully adopted in most states, the potential for this coverage to be unused is high as states disenroll high percentages of Medicaid beneficiaries for procedural reasons and evidence is mounting that systems are not equipped to work as intended to keep eligible family members enrolled– children and pregnant women are at the center of the risk, but we can’t fully quantify the extent of unwinding’s impact on postpartum based on the numbers reported by states. But that doesn’t put them at lower risk for coverage losses. Last month a whistleblower in Texas highlighted pregnant women among the groups unnecessarily losing coverage in unwinding. The extended postpartum coverage is only as good as the systems designed to keep eligible women enrolled and accessing the care they need.

To that end, the new report offers important policy recommendations to ensure new mothers are not only able to access needed coverage but also able to get high-quality care and services during the postpartum period:

  • Careful Unwinding of Pandemic Protections
  • Broad and Successful Implementation of Postpartum Extension (see CCF’s piece on this here)
  • Expanding Eligibility for Public Coverage Outside of Pregnancy
  • Targeted Efforts to Connect Subgroups of New Mothers More Likely to Be Uninsured to Other Coverage
  • Ensure Coverage Translates into Access to High Quality, Culturally Effective Care

We couldn’t agree more. As states take steps to address the maternal health crisis, they need to start now by ensuring new parents aren’t erroneously dropped from coverage.