Until last year, Georgia’s Medicaid coverage for low-income new moms was 60 days.
That meant many women’s Medicaid benefits expired before they could be referred to other medical providers for help with serious health issues, said Dr. Keila Brown, OB -GYN in Atlanta. “If they needed other postpartum issues tracked, it was kind of hard to get them into that limited time frame,” said Brown, who works at Family Health Centers of Georgia, a group of health centers community.
Georgia lawmakers, recognizing the high rate of pregnancy-related deaths in the state, have taken action. In 2021, Georgia extended the Medicaid coverage window to six months postpartum. And now the state plans to extend that benefit period to one year.
Georgia is one of twelve states that opted out of fully expanding Medicaid — the federal state health insurance program for people with low incomes or disabilities — under the Affordable Care Act. But nine of those states, mostly in the South, have requested or plan to request an extension of postpartum Medicaid coverage, in many cases to a full year after a birth.
Some have taken advantage of a provision in the American Rescue Plan Act that allows states to expand coverage using a state Medicaid plan amendment, an easier path than seeking a federal waiver. The option is currently available for states only until March 31, 2027.
Extensions have political overtones. Some maternal health advocates say the new postpartum benefits could open the door for Medicaid expansion in some states. But other advocates say the extensions provide coverage for lawmakers who don’t want to fully expand Medicaid, which would give longer-lasting insurance coverage to these low-income women and others.
Lawmakers, doctors and patient advocates cite high rates of maternal mortality as a reason to expand maternity coverage – as well as the positive impacts this could have on women’s health in general.
Maternal health is on the minds of policy analysts, doctors and advocates because the United States Supreme Court appears poised to upend abortion policy nationwide. States across the country, many of them in the South, plan to restrict abortion access if the court overturns its 1973 ruling Roe vs. Wade decision, which established the right to abortion. New limits on access to abortion could mean an increase in the number of women who continue their pregnancies and need postpartum care.
Nearly 2 in 3 pregnancy-related deaths are preventable, and 1 in 3 occur a week to a year after childbirth, according to the Centers for Disease Control and Prevention. 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 about 42% of births in the United States, so health advocates suggest expanding the insurance program to reach more mothers for longer 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 use disorders, mental health problems and heart disease. A year of continued Medicaid coverage could help mothers deal with these issues, said Dr. Nikki Zite, an obstetrician-gynecologist in Knoxville.
The extension of state coverage from 60 days to one year officially began on April 1.
“You can’t solve all the problems in a year, but I think you can have a much better grip on some of these problems in a year than you could in six to eight weeks – especially when those six to eight weeks were pretty much dominated by new infant care,” Zite said.
Policy experts say moving to one year of postpartum Medicaid coverage, while important, only solves part of the maternal health puzzle.
“Many of these are conditions — for example, hypertension, cardiovascular disease — that need to be treated before a woman becomes pregnant,” said Joan Alker, a research professor at Georgetown University McCourt School of Medicine. Public Policy.
And women, whether pregnant or new mothers, can more easily get treatment for these conditions in Medicaid expansion states, Alker said. A 2020 study found that mothers in states that had expanded Medicaid coverage had better health outcomes than those in states without expansion.
Dr. Bonzo Reddick, a family physician in Savannah, Georgia, said Medicaid expansion is also reducing the demand for abortions. “To prevent many abortions, you have to make contraception available to people,” he said.
For now, states must continue Medicaid coverage until the covid-related public health emergency ends, so currently enrolled women don’t fall through the cracks.
In a 2021 briefing note, federal health researchers said 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 double in non-expanding states.
This decline in coverage is why states as politically diverse as California, Oregon, Kentucky, Ohio, and Louisiana—all states that have expanded Medicaid—instituted maternal coverage expansion. of 12 months. According to a federal estimate, as many as 720,000 women across the country would be eligible if all states adopted the longer coverage.
There are rumors that postpartum extensions may cause non-expanding states to take the next step. “In states that have enacted expansion, you’re building the political will and momentum to reach a point of Medicaid expansion,” said Taylor Platt, health policy researcher at the American College of Obstetricians and Gynecologists.
But some health officials are hesitant to interpret the popularity of extended benefits too much.
“Postpartum moms are a group that politicians on all sides will do well to support,” said Christian Soura, executive vice president of the South Carolina Hospital Association. Expanding postpartum coverage could complicate efforts to get South Carolina lawmakers to fully expand Medicaid, Soura said. Peeling off a small, non-controversial group for extended coverage leaves what he called the “least politically sympathetic” groups exposed.
Republican lawmakers in states who have pushed for the postpartum extension in other states say they have encountered considerable resistance from some members of their party.
“There are those who absolutely do not want to expand Medicaid in any form or fashion in the state,” said Republican state Rep. Debbie Wood of Alabama. Wood said she supports legislation that would have permanently extended postpartum coverage in Alabama from 60 days to a full year. The bill didn’t pass, but lawmakers ended up investing $4 million in the state budget for a pilot program.
In Georgia, expanding postpartum coverage has taken years of behind-the-scenes work and lobbying by fellow Republicans, said state Rep. Sharon Cooper, who has been pushing for change. “In a perfect world, everyone would have some form of health insurance in one way or another. But it’s not a perfect world,” said Cooper, who chairs a health care committee of the House “And if a year is what I have, I’ll take a year.”
Some states that haven’t expanded Medicaid — like Wyoming, South Dakota, and Mississippi — lack the political will to expand postpartum care. “We’ve been very clear that we’re just not for Medicaid expansion,” Mississippi House Speaker Philip Gunn told Mississippi Public Broadcasting recently. “It’s arguably an extension of Medicaid, certainly an extension of coverage.”
More work needs to be done to boost coverage in the postpartum period, maternal health advocates said. They would like the expedited extension option to be available beyond 2027 and for one year of coverage for new moms to become a permanent requirement for all states.
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