Rates of mortality and serious complications during pregnancy and childbirth are rising in the United States — particularly for women of color. Members of Congress are motivated to find solutions. Just this week, the House Energy and Commerce committee advanced two bipartisan bills to address the issue. One bill gives states the option to extend Medicaid coverage for a full year after birth, and the other promotes maternal health care quality improvements.
It is particularly encouraging that policymakers are recognizing the importance of two key aspects of this challenging crisis — the outsize potential of Medicaid to address maternal mortality and morbidity and the critical role continuous health insurance coverage plays in keeping women healthy during and after pregnancy. Postdelivery — the first 100 days after birth, often referred to as the fourth trimester — is an especially critical time for women to have access to health care because it is when most complications occur.
Unfortunately, many women lack consistent insurance coverage. Before states had the option to expand Medicaid to adults with income up to 138 percent of the poverty level (about $23,000 for a family of two), roughly half of women experienced a gap in coverage within six months of giving birth — making continuous care difficult if not impossible. Medicaid eligibility levels for pregnant women vary across states — from 138 percent of poverty to 380 percent (about $62,000 for a family of two) — and coverage ends 60 days after birth. While research shows higher uninsured rates for postpartum women in nonexpansion states, which have lower eligibility levels for parents, women in expansion states may also experience a gap in coverage.
When coverage lapses or people lose and regain coverage over a relatively short span of time — a phenomenon known as churning — the disruption can lead to delays in identifying pressing health challenges. These disruptions are deeply troubling given what we know about the postpartum period. Moms who struggle with new or chronic conditions, such as depression or high blood pressure, are left unsupported and may not be able to seek help. Gaps in health insurance coverage during this critical time, the fourth trimester through the first year, can prevent health care providers from identifying and treating complications that occur after the birth, contributing to rising maternal morbidity and mortality rates.
Comprehensive care and continuous coverage during the postpartum period are essential, especially for women with chronic medical or mental health conditions. Medicaid is well positioned to provide this kind of coverage and care. It has broad reach — it covered around 42 percent of births in the United States in 2018. And it is making a difference: in Medicaid expansion states, maternal mortality dropped by 1.6 deaths per 100,000 women.
Extending Medicaid coverage for pregnant women in every state for a full year after birth is a first step to eliminating disparities and improving outcomes. We are already seeing the effects of increasing coverage on health outcomes, with decreasing maternal mortality rates in Medicaid expansion states. The impact could be even greater if all Medicaid-covered pregnant women were able to keep their coverage for a longer period, a move that would support the transformation of maternity care.