The United States has a maternal health crisis. Even before the COVID-19 pandemic, our maternal mortality rate exceeded all other developed nations. According to the National Center for Health Statistics, 1,205 pregnant women (including those who were pregnant or had been pregnant within the last 42 days) died in 2021, a 40 percent increase over 2020. And, according to the CDC, 84 percent of those deaths were preventable. Those life-saving interventions are often funded by Medicaid. And while a significant number of pregnancy-related deaths happen 6-12 months after the end of pregnancy, the federal government only mandates that Medicaid coverage extend for 60 days after the end of the pregnancy.
State policymakers are taking notice. In response to this deadly gap in coverage, a growing number—Democrat and Republican, urban and rural—are working to extend postpartum Medicaid coverage in their states. Thirty-one states and the District of Columbia (as of April 2023) have recently passed coverage extensions.
According to Maggie Clark, former program director at the Georgetown Center for Children and Families, it’s a decision that is pretty clear for policymakers across the political spectrum, once they see the research. CCF works with early childhood advocacy organizations across the country to provide that data—and the story it tells—on a state-by-state basis. “No matter the state and no matter the policymaker’s priorities or perspective, we’ve seen a lot of new interest in extending postpartum Medicaid coverage as a way to keep families and communities healthy, vibrant, and safe,” she says.
The list of states passing extensions recently is as diverse as it is long.
Kansas extended coverage in July 2022. “Our efforts to expand health care coverage have paid off,“ announced Governor Laura Kelly, “benefiting moms and giving babies a stronger start to life. This bipartisan work will reduce maternal mortality, improve child development, and save Kansans money on vital health care.”
Governor Mike DeWine signed Ohio’s extension a month later, observing at the time, “Maternal health is a strong predictor of a child’s health, so by extending health coverage for new moms, we are helping to provide the healthiest possible start in life for Ohio’s children.”
The Texas legislature also recently passed a bill extending postpartum Medicaid coverage to 12 months. Speaker Dade Phelan, a Republican, was a strong supporter of the bill, which was authored by Democrat Rep. Toni Rose.
Shifts like these are often fueled by behind-the-scenes, long-term advocacy. In Texas, for example, advocates have been pushing the extension for several years. “This took three legislative sessions to pass,” says Stephanie Rubin, CEO of Texans Care for Children. “It surely has been a lesson in staying strong and continuing to build momentum even in the face of setbacks.”
Part of this momentum has also likely been fueled by unprecedented attention to the maternal health crisis at the federal level, along with the aftermath of COVID-19. These factors heightened pregnancy-related health issues and fatalities and deepened longstanding maternal health racial disparities. In March 2021, Congress passed the American Rescue Plan Act of 2021, which created the now-permanent pathway for states to receive federal matching funds for extending the postpartum coverage period to 12 months after the end of pregnancy.
The Supreme Court decision to overturn Roe v. Wade also created a new urgency around postpartum care and sparked coalitions that would have previously been unlikely. Clark notes that in some politically conservative states, unlikley allies are joining forces to support an extension of postpartum Medicaid coverage. When Mississippi passed a postpartum Medicaid extension earlier this year, for example, Governor Tate Reeves did so in spite of a concern about the cost. “In a post-Dobbs world,” the governor wrote on social media, we may have to do things that make us ‘philosophically uncomfortable.”
“All policymakers want their states to be vibrant places where mothers and their newborns thrive,” says Helene Stebbins, executive director of the Alliance. “It’s hopeful to see advocates and policymakers working together on small policy changes that can have a huge impact on making that vision come true.”