States Extend Medicaid Postpartum Coverage To Support Maternal Health

• Most pregnancy-related deaths in the U.S. are preventable.
• The White House recently released an executive summary on plans for change.
• Many states are implementing legislation to extend Medicaid coverage for postpartum care.

With rising maternal mortality rates, the Biden-Harris Administration announced a plan to support maternal health. Explore the details of the maternal health crisis and new legislation to address the issue.

The Maternal Health Crisis in the U.S.

Pregnancy-related deaths are rising each year. Women in the U.S. are dying from pregnancy-related causes at a rate higher than any other developed nation. According to the Centers for Disease Control and Prevention (CDC), the maternal mortality rate (MMR) in the U.S. was 32.9 per 100,000 live births in 2021 compared to 23.8 in 2020 and 20.1 in 2019.

According to the World Health Organization, the top cause of pregnancy-related death worldwide is hemorrhage, with infections coming in second. In the U.S., mental health conditions were at the top of the list, followed by hemorrhage, according to CDC data from 2017-2019.

Racial and ethnic disparities also play a role in defining the crisis. According to a 2021 National Institutes of Health report, 41.7% of African American women die from pregnancy-related causes, compared to 14.4% of White women and 28.3% of American Indian and Alaska Native women.

Over 80% of maternal deaths in the U.S. are preventable. While many countries have seen a stark decline in maternal mortality from 2000-2020, rates have increased in many Western countries — including the U.S.

How the Government Is Addressing Maternal Health Concerns

The maternal health crisis has prompted the need for a national improvement plan. The White House issued a report outlining plans to address racial disparities and improve maternal health outcomes. Part of the plan for addressing the maternal health crisis includes:

• Training more family medicine and obstetric providers in underserved settings and expanding access to doulas, licensed midwives, and freestanding birth centers
• Expanding and diversifying the number of nurses and certified midwives in underserved areas
• Training providers on implicit biases, culturally and linguistically appropriate care and behavioral health needs of pregnant and postpartum women
• Reducing the stigma of postpartum depression and other behavioral health conditions through a media campaign to raise awareness
• Working to ensure pregnant and postpartum women have comprehensive, continuous health insurance coverage

Approximately 1 in 4 births in the U.S. are covered under Medicaid. Initially, coverage lasted up to 60 days after the end of pregnancy. Yet, most maternal deaths occur in the late postpartum period (43-365 days postpartum), according to the CDC.

Recent federal legislation has established an extension of postpartum health care coverage for up to one year after pregnancy ends.

Medicaid Postpartum Coverage Extensions by State

Most states have implemented coverage extensions supporting maternal health. Among the first states were Maryland, New Mexico, and Washington.

Sources: KFF, Georgetown

*Utah limitation: Only women whose pregnancy ends in birth, miscarriage, stillbirth, or adoption due to rape, incest, or life endangerment are eligible for extended coverage.

What Extended Postpartum Coverage Means for Nurses and Healthcare Providers

The recent change in legislation may affect nurses and providers who work in a variety of specialties, including maternal health, primary, mental health, and emergency care. Clinicians might expect to see significant changes moving forward.

Increase in Mental Health Consultations

Maternal health clinicians might expect a rise in patient consultations and lengthier working relationships with mental health professionals. Similarly, mental health nurses might anticipate a rise in admissions of postpartum patients.

Katherine Yoder, vice president of government relations for Texas’ Parkland Health System, spoke with Kera News regarding the recent legislation.

She addressed the length of treatment needed for postpartum depression or substance use disorders. “It can last a lot longer than 60 days. It doesn’t turn off at 60 days.”

Modifications in Postpartum Safety Screenings and Training

Nurses and providers might see changes in safety screening protocols. Alaska’s Department of Health proposed extended screenings for mental health conditions, substance use, and intimate partner violence. The state documented drug and alcohol or substance use disorders in 72% of pregnancy-related deaths.

Nurses might expect extended training in how to screen for postpartum depression, particularly nurses working in maternal health, primary care, and emergency care settings.

Maternal Health Provider Shortages

Maternal health clinicians could see an increase in the provider-to-patient ratio. This could mean longer patient wait times and heavier workloads for nurse clinicians working in obstetric/gynecology clinics and emergency rooms.

Yoder addressed the care gaps that may persist after legislation.“Even with this extension of Medicaid, there's not always enough doctors that are willing to see women for maternal care,” she said. “In the rural areas, that has become more and more difficult.”

Despite unforeseen hurdles, the Biden-Harris Administration envisions a brighter future.

“Our vision for the future is that the United States will be considered the best country in the world to have a baby.” “We imagine a future where every person in this country can have a safe, dignified pregnancy and birth and where equitable access to health care before, during and after pregnancy is assured.”