Until last year, Georgia’s Medicaid coverage for low-income new mothers lasted 60 days.
This means that many women have expired Medicaid benefits before being referred to other medical providers for help with their serious health problems, says Dr. Keila Brown, an OB-GYN from Atlanta. “If they had to follow up on other postpartum issues, it would have been much harder to get them in that limited time,” said Brown, who works at Georgia’s Family Health Center, a group of community health centers.
Georgia’s lawmakers have acknowledged the state’s high rate of pregnancy-related deaths. In 2021, Georgia extended the Medicaid coverage window to six months after delivery. And, now, the state plans to extend that benefit to one year.
Georgia is one of a dozen states that have decided not to fully expand Medicaid – the federal-state health insurance program for low-income or people with disabilities – under the Affordable Care Act. But nine of these states, mostly in the south, have tried or planned to increase postpartum Medicaid coverage, in many cases up to a full year after birth.
Some have taken advantage of a provision in the American Rescue Plan Act that allows states to increase coverage using a Medicaid state plan amendment, an easier way than to apply for a federal waiver. The option is currently only available in states until March 31, 2027.
Extensions have political overtones. Some maternal health advocates say the new postpartum benefits could open the door to Medicaid expansion in some states. But other advocates say the extensions provide cover for lawmakers who do not want to fully expand Medicaid, which would provide long-term insurance coverage for these low-income women and others.
Lawmakers, physicians and patient advocates point to the high maternal mortality rate as the reason for increasing maternity coverage – as well as the fact that it can generally have a positive effect on women’s health.
Maternal health policy is on the minds of analysts, physicians and lawyers as the US Supreme Court appears ready to uphold a nationwide abortion policy. States across the country, many of them in the south, plan to limit access to abortion if the court annulled its 1973 ruling. Rowe vs. Wade Decision, which established the right to an abortion. The new restrictions on abortion access could mean an increase in the number of women continuing their pregnancies and in need of postpartum care.
According to the Center for Disease Control and Prevention, 2 out of 3 pregnancy-related deaths are preventable, and 1 in 3 occur one week to one year after delivery. Many of these deaths are associated with chronic health conditions, and black and indigenous women are more likely to die than white women.
Medicaid pays for approximately 42% of births in the United States, so health advocates suggest that expanding the insurance program to reach more mothers would improve maternal health and save more lives.
A recent report on maternal mortality from the Tennessee Department of Health linked many maternal deaths to substance abuse disorders, mental health conditions and heart disease. One year of uninterrupted Medicaid coverage can help mothers solve those problems, says Dr. Nicki Jite, an OB-GYN from Knoxville.
The one-year extension of state coverage from 60 days officially began April 1.
“You can’t solve all the problems in one year, but I think you can have a better sense of control over some of these problems in one year than six to eight weeks – especially when those six to eight weeks were pretty much more than caring for a new baby. Dominance, ”Zite said.
Policy experts say the one-year transfer of postpartum Medicaid coverage, though important, solves only a fraction of the maternal health puzzle.
“Many of these conditions – for example, hypertension, cardiovascular conditions – need to be addressed before a woman can become pregnant,” said Joan Alker, a research professor at Georgetown University’s McCourt School of Public Policy.
And women, whether they are pregnant or new mothers, can get more easily treated for this condition in the Medicaid extension state, Alker says. A 2020 study found that maternal health outcomes were better in non-expansion states than in states where Medicaid coverage was extended.
The spread of Medicaid also reduces the demand for abortion, said Dr. Bonjo Reddick, a family practice doctor in Savannah, Georgia. “How you can prevent a lot of miscarriages is by making contraceptives available to people,” she said.
For now, states must continue Medicaid coverage until the covid-related public health emergency is over, so that currently enrolled women do not fall through the cracks.
In a summary of the 2021 issue, federal health researchers say that approximately 20% of people, including pregnancy-related Medicaids, become uninsured within six months of birth, including states where Medicaid has fully expanded. The percentage is almost double in non-expansion states.
Due to this drop-off of coverage, politically diverse states like California, Oregon, Kentucky, Ohio and Louisiana – all of which have expanded Medicaid – have launched 12-month maternity coverage. According to a federal estimate, 720,000 women nationwide would be eligible if all states received longer coverage.
There is talk that postpartum extensions may lead non-expansion states to take the next step. Taylor Platt, a health policy researcher at the American College of Obstetricians and Gynecologists, said: “States that have adopted extensions are creating political will and momentum to reach the point of expansion of Medicaid.”
But some health care officials are wary of reading too much about the popularity of benefit extensions.
“Postpartum mothers are a group that is going to be interested in supporting politicians of any stripe,” said Christian Sora, executive vice president of the South Carolina Hospitals Association. Extending postpartum coverage could complicate South Carolina lawmakers’ efforts to fully expand Medicaid, Saura said. Throwing out a small, controversial group for a coverage extension exposes “least politically sympathetic” groups.
Republican lawmakers who pushed for postpartum extensions in other states say they have faced considerable resistance from some members of their party.
Alabama Republican State Republican Debbie Wood says, “There are some who don’t want to expand Medicaid in the state in any way or fashion. Wood said he supported legislation that would permanently increase postpartum coverage in Alabama from 60 days to a full year. The bill was not passed, but lawmakers instead set aside 4 4 million in the state budget for a pilot program.
In Georgia, there has been years of work to increase postpartum coverage and lobbying behind the scenes of fellow Republicans, said state Republican Sharon Cooper, who pushed for change. “In a perfect world, everyone will have some form of health insurance, one way or another. But it’s not a perfect world, “said Cooper, chairman of the House Health Care Committee.” And if I had one year, I’d take one.
Some states that have not expanded Medicaid – such as Wyoming, South Dakota and Mississippi – have no political will to expand postpartum care. “We have made it very clear that we are not for the expansion of Medicaid,” Mississippi House Speaker Philip Gunn told Mississippi Public Broadcasting recently. “It’s logically Medicaid expansion, of course expanding coverage.”
More work needs to be done for postnatal coverage of maternity leave, maternal health advocates say. They want to see the fast-track extension option become available after 2027, and one-year coverage for new mothers has become a permanent requirement for all states.
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