The maternal mortality rates in the United States are on the rise and are comparatively higher than other countries with similar economic status. Medicaid coverage is a significant contributor to maternal health, as it covers almost half of all births in the country. According to recent data, a considerable number of maternal deaths occur between 43 and 365 days postpartum, despite the historical limit of Medicaid coverage at 60 days postpartum.
“In the U.S., health insurance is really a necessary prerequisite to get high quality care,” said senior author Lindsay Admon, M.D., M.Sc., an assistant professor of obstetrics and gynecology at the University of Michigan Medical School and obstetrician-gynecologist at U-M Health Von Voigtlander Women’s Hospital. “It’s not the only step, but it’s a critical first step because without it, it’s hard to get a foot in the door.”
In March 2020, the Families First Coronavirus Response Act (FFCRA) was introduced. Admon notes that under this act, Medicaid programs were not allowed to remove people from Medicaid during the public health emergency. This was the first time that pregnancy-related Medicaid coverage was extended past 60 days after giving birth. The American Rescue Plan Act (ARPA) was passed in 2021, which provides states with federal funding to extend Medicaid coverage through the first year postpartum now that the pandemic has ended.
Admon and her colleagues have analyzed data to investigate the impact of the FFCRA on postpartum coverage and care during the pandemic. They found that for individuals who had Medicaid when they gave birth, the policy allowed for significant increases in postpartum Medicaid enrollment and a 40% reduction in postpartum uninsurance, according to their study in JAMA Health Forum.
“As of March 2024, almost all states either have implemented or plan to implement extensions of pregnancy Medicaid coverage through the first year postpartum,” said lead author Jamie Daw, Ph.D., an assistant professor of health policy and management at the Columbia University Mailman School of Public Health. “The results from our study are very encouraging, suggesting that those extensions are likely to significantly increase continued Medicaid enrollment and decrease uninsurance during the postpartum year.”
Nearly half of U.S. births are covered by Medicaid. Yet, once an individual gives birth, it can be more difficult to remain covered by Medicaid, Admon says, leaving postpartum people in a potentially dangerous position.
“A lot of postpartum maternal deaths are occurring in the late postpartum period, or beyond 43 days postpartum, which is actually around the time Medicaid coverage has historically ended,” Admon said. “We know some of the leading causes of maternal deaths from the late postpartum period are things like behavioral health conditions, and it is difficult to remain in treatment without insurance coverage.”
According to a recent study, the enrollment of postpartum Medicaid increased when recipients were not allowed to be disenrolled. However, the study found no connection between postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms. The lack of these findings could be attributed to the COVID-19 pandemic, as stay-at-home orders were in effect across the country. Additionally, the study only followed individuals for a few months postpartum, rather than the entire postpartum year.
“States can learn from this national experiment during the pandemic and apply these findings to consider the potential impact of adopting an ongoing extension of pregnancy-related Medicaid coverage through the first year postpartum,” Admon said.
