Why Medicaid should give moms full year of coverage post-pregnancy

Kevin B. O'Reilly , Senior News Editor

What’s the news: The AMA and hundreds of other organizations are urging the Centers for Medicare & Medicaid Services (CMS) to swiftly approve demonstration projects that would extend the coverage period for people who enroll in Medicaid while pregnant to a full year after the pregnancy ends.

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About 700 pregnancy-related deaths happen in the U.S. annually, with 60% of them being preventable, according to the Centers for Disease Control and Prevention. There “are stark racial inequities in maternal mortality,” and the pandemic “risks exacerbating the maternal health crisis,” says the letter sent by hundreds of national, state and local organizations, including the American College of Obstetricians and Gynecologists.

There are pending section 1115 Medicaid demonstration projects that should be approved as soon as possible. “The Biden administration has a unique opportunity to elevate maternal health among its Medicaid priorities” by doing so, the letter says.

Learn more with the AMA about why inequities in maternal mortality must be attacked head on.

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Why it’s important: The U.S. is the only industrialized nation where maternal deaths are on the upswing, with Black women three times likelier to die from a pregnancy-related complication than white women. Indigenous women, meanwhile, are more than twice as likely to die from such a complication in comparison with white women.

“Continuous access to Medicaid is crucial to addressing our nation’s rising rate of maternal mortality,” says the letter to leaders at CMS and the Department of Health and Human Services. “Under current law, women who are eligible for Medicaid based on the fact that they are pregnant become ineligible for coverage 60 days after the end of pregnancy. While some women are able to successfully transition to other sources of coverage at this time, many are left in the untenable position of being uninsured shortly after a major medical event. Insurance coverage disruptions are one of many factors that contribute to high rates of maternal mortality among the Medicaid-eligible population.”

Of all U.S. births in 2018, 43% were paid for by Medicaid. More than three in five births to Black or Latina women were covered by Medicaid. About half of all Black women experienced an interruption in coverage from before pregnancy to postpartum, research shows.

“There are major risks to becoming uninsured shortly after experiencing pregnancy,” the letter says. “For example, one in seven women experience symptoms of postpartum depression in the year after giving birth.”

Nearly 20% of “women who lost Medicaid coverage and became uninsured in the postpartum period reported either gestational diabetes or pregnancy-related hypertension—both conditions that would benefit from ongoing monitoring and treatment after the end of pregnancy,” the letter notes.

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Learn more: AMA policy encourages state and county health departments to develop a maternal mortality surveillance system, identify barriers and develop strategies to implement evidence-based practices to reduce poor obstetric outcomes in racial and ethnic minorities.

The AMA also has policy that supports establishing government-funded maternal mortality review committees.

Find out why more new moms are dying in the U.S. and how to arrest the trend.