States Care for Pregnant Mothers by Extending Medicaid Postpartum Coverage

With the overturning of Roe v. Wade, state legislatures are grappling to implement initiatives to improve maternal health care both during and after pregnancy. Extending Medicaid health care coverage for pregnant women up to 12 months after they give birth or miscarry is one of the measures states are taking to ensure women have access to quality maternal care.

“Medicaid is a social safety net provided by federal and state governments working together to ensure that low-income and disabled individuals in America are not denied health care coverage,” explained Connor Semelsberger, director of Federal Affairs at Family Research Council. “Since it was established decades ago, Medicaid has had an emphasis on providing health care coverage for pregnant and postpartum women as well as young children. But over the years this has been de-emphasized.”

Under the Affordable Care Act, Medicaid finances four in 10 births nationwide. But that health care coverage lasts 60 only days. 

Losing health insurance shortly after giving birth increases a woman’s chances of dying from pregnancy-related complications such as severe bleeding, infections, heart disease, and mental illness. 

According to the Centers for Disease Control and Prevention, 700 women die annually from pregnancy-related complications with 33% percent of these deaths occurring between one week to one year postpartum. With timely diagnosis and quality care, the CDC estimates that two-thirds of these pregnancy-related deaths could be prevented. 

“Why wouldn’t we want to manage those chronic conditions for that first year postpartum so that they [mothers] can focus on getting healthy and getting back to work and ensuring their kid has what they need to succeed? It just seems like a no-brainer,” Diana Forester, director of Health Care Policy at Texans Care for Children, told the Texas Tribune. 

In April 2021, President Joe Biden announced that qualifying pregnant and postpartum mothers across the United States would have Medicaid and Children’s Health Insurance Program (CHIP) coverage for a full 12 months after giving birth. In this program, known as the American Rescue Plan, as many as 720,000 women nationwide would qualify for life-saving, affordable postpartum care.

Varying Responses to the American Rescue Plan 

Semelsberger explained that the Medicaid extension initiative is one states can opt in or out of depending on their legislatures. 

Louisiana was the first state to join the American Rescue Plan extending health care coverage from 60 days to 12 months. This program has benefited an estimated 14,000 pregnant and postpartum women. Illinois, New Jersey, and Virginia quickly followed providing a full year of postpartum coverage to all Medicaid and CHIP beneficiaries. 

“There is a real value in extending Medicaid coverage,” emphasized Semelsberger. “It's very key to keep both mom and baby healthy. There are all sorts of additional costs that come with giving birth such as childcare, formula, and clothes. The least of their worries should be paying tons of out-of-pocket expenses for health issues related to the pregnancy.”

At the moment, 33 states and the District of Columbia have enacted the American Rescue Plan, including 11 led by Republican governors. The states increasing health care coverage for women postpartum for 12 months are as politically diverse as California, Oregon, Kentucky, and Ohio. 

Last year, the Texas House passed a measure that would lengthen Medicaid health coverage to 12 months. But during the last days of the legislative session, the time was time period was halved to 6 months. 

Republican state Rep. Debbie Wood of Alabama supported legislation that would permanently extend postpartum coverage from 60 days to a full year. The bill did not pass, although lawmakers did allocate $4 million in the state budget for a pilot program instead. 

“There are those that absolutely do not want to expand Medicaid in any form or fashion in the state,” Wood said in a U.S. News & World Report interview.

Wyoming, Oklahoma, Montana, and Mississippi have taken no action to join the American Rescue Plan despite all enacting pro-life laws to protect the unborn. 

“We’ve been very clear we’re just not for Medicaid expansion,” Mississippi House Speaker Philip Gunn (R) recently told Mississippi Public Broadcasting. “This is arguably Medicaid expansion, certainly expanding coverage.”

Each birth under Medicaid costs approximately $18,865 and with the CDC estimating that more than 150,000 extra births annually because of the Dobbs decision, there will certainly be more spending. 

Semelsberger said, “Reforms of Medicaid are so complex. I hate to say, ‘This is definitely the best solution’ because it does cost taxpayers more money. But we do need to take care of women postpartum, whether that’s by states expanding Medicaid or a broader reform of health insurance.” 

Georgia state Rep. Sharon Cooper (R) has been advocating for the extension of postpartum coverage for years and is glad to see it finally take effect. 

In an interview with U.S. News & World Report Cooper, who chairs a House health care committee said, “In a perfect world, everybody would have some form of health insurance one way or the other. But this is not a perfect world. And if a year is what I've got, I'll take a year.”

Looking Forward 

The American Rescue Plan is currently available to states only until March 31, 2027. 

“In my experience working with federal programs, it's always good to review and revisit and adjust programs as necessary,” Semelsberger explained

He proceeded to explain that this program, which expires after a five-year window, will allow Congress to assess whether it was effective or not and adjust it accordingly. 

“I think states are now being faced with a new reality, some states are seeking to protect unborn life and others are wanting to continue to allow legal abortions through all nine months,” Semelsberger said.

He hopes that all states will one day realize that not only are unborn children worthy of protection, but mothers need support. 

“We need to ensure that every mother should not have to choose her job over her children,” said Semelsberger. “We need to ensure that every life can be brought into this world, even into the suffering in this world in a loving way. And the state, the civil society, and the church will be there to support them.”