States are expanding Medicaid for new mothers – even when they reject wider expansion

Until last year, Medicaid coverage in Georgia for new low-income mothers lasted 60 days.

This means that the benefits of Medicaid for many women have expired before they can be referred to other health care providers for help with serious health problems, said Dr. Kayla Brown, an gynecologist in Atlanta. “If they needed to be tracked down by other postpartum problems, it was quite difficult to get them in that time frame,” said Brown, who works at Family Health Centers of Georgiagroup of public health centers.

Georgian lawmakers recognize those of the state high pregnancy-related deaths, have taken action. in 2021 Georgia extended the Medicaid coverage period of up to six months after birth. And now the state plans to extend the period of benefits to one year.

Georgia is one of a dozen states that have chosen not to fully expand Medicaid, the federal state health insurance program for low-income or disabled people, under the Affordable Care Act. ass nine of these countriesmainly in the south, have sought or plan to seek extension of Medicaid postpartum coverage, in many cases up to a year after birth.

Some have taken advantage of a provision in the U.S. Rescue Plan Act that allows states to extend coverage using an amendment to Medicaid’s state plan, an easier way than applying for a federal waiver. The option currently only available in states until March 31, 2027.

Enlargements have a political overtone. Some advocates of maternal health say new postpartum benefits may open the door to Medicaid expansion in some states. But other advocates say the extensions provide coverage for lawmakers who do not want to fully extend Medicaid, which would provide longer-term insurance coverage for these low-income women and others.

Legislators, doctors and advocates cite high maternal mortality rates as a reason for expanding the scope of maternity – as well as the positive effects it can have on women’s overall health.

Maternal health is on the minds of political analysts, doctors and advocates because the US Supreme Court seems ready to change abortion policy nationwide. states across the countrymany in the south plan to restrict access to abortion if the court overturns the 1973 ruling. Roe v. Wade a decision establishing the right to abortion. New restrictions on access to abortion could mean an increase in the number of women continuing their pregnancies and in need of postpartum care.

Almost 2 out of 3 pregnancy-related deaths are preventable and 1 in 3 occur one week to a year after birth, according to the Centers for Disease Control and Prevention. Many of these deaths are related to chronic health conditions, and black and indigenous women are more likely to die than white women.

Medicaid pays approximately 42% of births in the United Statesso health advocates suggest that expanding the insurance program to reach more mothers in the long run would improve maternal health and save more lives.

or a recent report on maternal mortality from the Tennessee Department of Health connects many deaths of mothers with substance use disorder, mental health conditions and heart disease. One year of continuous Medicaid coverage can help mothers deal with these problems, said Dr. Niki Ziteobstetrician-gynecologist in Knoxville.

The state extension of coverage from 60 days to one year officially launched on April 1.

“You can’t solve all the problems in one year, but I think you can get much better control over some of these problems in one year than you could in six to eight weeks – especially when those six to eight weeks were almost dominated by new baby care, ”Zite said.

Policy experts say that moving to one year of postpartum Medicaid coverage, while important, solves only one part of the maternal health puzzle.

“Many of these are conditions – such as hypertension, cardiovascular disease – that need to be addressed before a woman becomes pregnant,” he said. Joan Alkerresearch professor at the School of Public Policy at Georgetown McCourt University.

And women, whether pregnant or new mothers, can more easily receive treatment for these conditions in the Medicaid expansion states, Alker said. 2020 study found that mothers in the states that expanded Medicaid coverage had better health outcomes than those in non-enlargement countries.

dr Bonzo RedikA family doctor practicing in Savannah, Georgia, said expanding Medicaid also reduced the demand for abortion. “How you can prevent many abortions is by having contraception available to people,” he said.

For now, the states must continue to cover Medicaid until the covid-related public health emergency is overso the women currently enrolled do not fail.

In a brief reference for the 2021 edition, federal health researchers said that about 20% of people with pregnancy-related Medicaid become uninsured within six months of giving birth, including in states that have fully expanded Medicaid. The percentage is almost doubled in non-expanding states.

This drop in coverage is why states as politically diverse as California, Oregon, Kentucky, Ohio and Louisiana – all states that have expanded Medicaid – have introduced a 12-month extension of coverage for mothers. About 720,000 women across the country would qualify if all states accepted longer coverage, according to federal assessment.

It is said that enlargements after birth can lead countries to take the next step without enlargement. “In the states that have undertaken enlargement, you are building the political will and momentum to get to the point of expanding Medicaid,” said Taylor Platt, a health policy researcher at American College of Obstetricians and Gynecologists.

But some health professionals are wary of reading too much about the popularity of the benefit extension.

“Mothers after birth are a group that politicians of all kinds will have an interest in supporting,” said Christian Sura, executive vice president of South Carolina Hospital Association. Expanding coverage after birth could complicate efforts to get South Carolina lawmakers to fully expand Medicaid, Soura said. The removal of a small, consistent group to expand coverage leaves exposed groups he called “the least politically sympathetic.”

Republican lawmakers, who have called for an extension of the postpartum period in other states, say they have met with significant opposition from some members of their party.

“There are those who absolutely do not want to expand Medicaid in any form or way in the state,” said the Republican representative. Debbie Wood from Alabama. Wood said he supports legislation that will permanently extend Alabama’s postpartum coverage from 60 days a year. The bill was not passed, but deputies turned out invests $ 4 million in the state budget instead for a pilot program.

In Georgia, expanding postpartum coverage took years of work and behind-the-scenes lobbying of fellow Republicans, the state spokesman said. Sharon Cooperwho insisted on change. “In a perfect world, everyone would have some form of health insurance in one way or another. But this is not the perfect world, “said Cooper, who chairs the chamber’s health committee. “And if I have a year, I’ll take a year.”

Some states that have not expanded Medicaid – such as Wyoming, South Dakota and Mississippi – do not have the political will to expand postpartum care. “We were very clear that we were simply not in favor of expanding Medicaid,” said Philip Gunn, a spokeswoman for the Mississippi House of Representatives. recently told Mississippi Public Broadcasting. “This may be an extension of Medicaid, certainly an extension of coverage.”

More work needs to be done to support postpartum coverage, maternal health advocates said. They would like the option of a quick extension to be provided after 2027 and one year of new mother coverage to become a permanent requirement for all countries.

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