House of Representatives and U. Senate to support state efforts to extend postpartum coverage. Extending postpartum Medicaid coverage can be achieved through various pathways. More information on the new SPA option is available below.
The American Rescue Plan Act, signed into law on March 11, , makes available a new pathway states can use to extend Medicaid coverage for pregnant people from 60 days to one year postpartum. This pathway—known as a state plan amendment SPA —will become effective next year April 1, , but there is work to be done now.
Does the new federal law automatically extend Medicaid postpartum coverage in every state? What does this mean for state budgetary decisions and their financial commitment?
Importantly, obstetrician—gynecologist advocates may find themselves needing to explain to allies, legislators, and other stakeholders that the new law does not automatically extend Medicaid postpartum coverage. Instead, it makes available to states an additional and simpler pathway to achieve this coverage. In other words, there is still work to be done to achieve postpartum extension in your state! It is critical that we keep up the momentum and have as many states as possible ready to implement on April 1, To help advance this policy across states, ACOG has developed several advocacy tools.
Bulk pricing was not found for item. CBO estimates that by , about 25 percent of all pregnant people who would be expected to receive postpartum services from Medicaid will live in states that implement the month option.
Say Ahhh! The recommendation was formally reported to Congress yesterday. The commission made such a strong recommendation after years of considering research that showed pervasive racial and ethnic disparities in outcomes for pregnant people covered by Medicaid.
Among Medicaid beneficiaries, women of color and women living in rural areas are at the greatest risk of experiencing severe maternal morbidity , such as stroke or hemorrhage.
Black and Indigenous women were two to three times more likely to die of a pregnancy-related cause as White women, regardless of their insurance coverage at the time of delivery. A significant portion of pregnancy-related deaths occur more than two months after the end of the pregnancy, after postpartum Medicaid coverage has expired for many pregnant women. States without Medicaid expansion have the greatest share of uninsured postpartum women who would benefit from extended coverage.
According to research from the Urban Institute, nearly two-thirds of uninsured new mothers who would likely gain eligibility reside in just five states: Florida, Georgia, Missouri, North Carolina, and Texas.
Four of these states have not yet expanded Medicaid coverage to all low-income adults, and Missouri voters approved expansion via ballot initiative last year, but the state has not yet implemented it. Under a new interim final rule effective on November 2, states can move a pregnant woman from the pregnancy group to another eligibility pathway if eligible for another full benefit group, such as ACA expansion, and the benefit package for the new group is the same or more generous than the pregnant woman benefit package, move to new group.
However, if the pregnancy benefit package is more generous than another pathway or the person is ineligible for any other full benefit group, they would remain enrolled in pregnancy group.
In addition to changing eligibility for coverage, the coronavirus pandemic has changed the way pregnancy and postpartum care is provided. New mothers may be more isolated from postpartum support, such as family members or doulas and women may be accessing services such as lactation consultations or postpartum checkups via telehealth. Continuity of coverage may be even more valuable given the other disruptions in care that new parents may be facing during the pandemic.
Postpartum care encompasses a range of important health needs, including recovery from childbirth, follow up on pregnancy complications, management of chronic health conditions, access to family planning, and addressing mental health conditions. While postpartum care has traditionally centered around one clinical visit six to eight weeks after delivery, there has been a paradigm shift to emphasize that postpartum care is an ongoing process that typically requires multiple visits and follow up care that may last a year or even longer.
This is particularly important for those who experience pregnancy complications or have chronic conditions, such as hypertension or diabetes. Mental health is a major concern during and after pregnancy. Suicidality among pregnant and postpartum people has risen over the past decade.
At least one in ten women experience perinatal depression, and some studies suggest higher rates but poorer access to treatments among some communities of color and low-income women. ACOG recommends screening during the postpartum visit and initiation of treatment or referral to a mental health provider when a woman is identified with depression.
This kind of care may be provided over a long duration, often lasting beyond 60 days. Addressing pregnancy-related deaths typically defined as death within one year of pregnancy 5 , particularly the substantially higher rates among Black and American Indian and Alaska Native AIAN women, is an urgent health challenge.
Furthermore, a wide array of conditions that may present or persist through the postpartum period, including mental health challenges, intimate partner violence, and substance use, all play a role in maternal mortality and broader maternal health outcomes.
Assuring that low-income women have continuous coverage after pregnancy would support improvements in infant and maternal outcomes.
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