A growing number of GOP-led states are expanding Medicaid coverage to new moms at the same time as they seek to ban or limit access to abortions.
Florida, Tennessee and South Carolina are among the states that are temporarily allowing low-income women to remain enrolled in Medicaid for up to 12 months after childbirth, instead of only the 60 days that federal law requires. They are taking advantage of a measure in the American Rescue Plan Act, which Congress passed in March 2021, that provides federal matching funds for the extended coverage for five years and makes it easier to apply for federal approval to offer it.
They are also among the 12 states that have yet to expand Medicaid to all low-income adults under the Affordable Care Act.
Other states – including Democrat-led California, Oregon and Kentucky – are also extending Medicaid enrollment for new moms. An estimated 164,000 women in these six states will benefit from the longer coverage period, according to the Centers for Medicare and Medicaid Services.
So far, 11 states have extended postpartum coverage to 12 months, and the agency is working with several other states.
If all states do so, as many as 720,000 women could be guaranteed postpartum health insurance for 12 months. Medicaid, which is generally available to pregnant women with somewhat higher incomes than other adults, covers 42% of births.
Addressing maternal mortality
The extended coverage seeks to reduce maternal mortality in the US, which suffers from the highest rate in the developed world, according to a Commonwealth Fund analysis. And the rate has been rising in recent years.
Black women were nearly three times more likely to die during pregnancy or childbirth than White women in 2020, according to the US Centers for Disease Control and Prevention.
Roughly 24% of maternal deaths happen six or more weeks after giving birth, said Maggie Clark, senior state health policy analyst at Georgetown University’s Center for Children and Families. Many of the women who die don’t have access to care.
New mothers are particularly at risk for cardiac conditions, including high blood pressure and cardiomyopathy, and mental health issues, including depression and substance abuse. Extending Medicaid coverage provides continuity of care that makes it easier for women to address their health problems.
“More than half of pregnancy-related deaths occur in the 12-month postpartum period, many of which are preventable,” said Maureen Corcoran, director of the Medicaid department in Ohio, which started offering a full year of coverage in April and expects to receive CMS approval soon. “Women who have recently given birth have health needs that continue for a full year, and high-risk pregnancy-related complications such as preeclampsia, blood clots and heart problems may not appear until months after delivery.”
Covering the postpartum year also relieves new mothers’ stress about being able to find care, Clark said. And it helps support the healthy development of the children as well as their mothers.
Limiting access to abortion
Several of the states that have extended postpartum coverage or are looking to do so also plan to ban or curtail access to abortion. Some health experts worry that further abortion restrictions could worsen maternal mortality.
A draft Supreme Court opinion leaked last month shows that a majority of justices planned to vote to overturn Roe v. Wade’s holding of a federal constitutional right to an abortion. If that turns out to be the final opinion, it would be left up to states to determine their abortion policies – 22 states have laws that could be used to restrict abortions, according to the Guttmacher Institute, which supports abortion access.
Some states see the Medicaid extension measure as an option to help women after they give birth.
Tennessee Gov. Bill Lee, a Republican, said last month that there is a way to protect unborn children and provide aid to new mothers.
“It’s also important that we recognize that women in crisis need support and assistance through this process. For example, that’s why we’ve expanded our postpartum coverage for women in TennCare,” Lee said in a May news conference, referring to the state Medicaid program.
States likely have a variety of motivations behind extending coverage, said Sarah Gordon, assistant professor at Boston University’s School of Public Health and co-director of the BU Medicaid Policy Lab. It only requires adding 10 months of enrollment for five years to a relatively low-cost group of residents.
“The American Rescue Plan provides a good deal for state budgets due to the availability of federal matching funds to cover the postpartum population,” she said. “And historically, it has proven easier to garner political support for expansions of coverage to pregnant and postpartum women compared to other populations, such as low-income adults under traditional Medicaid expansion.”