Illinois submitted its application in January 2020, but it didn’t receive approval until the new administration took office.
“There were multiple [waiver applications] during the Trump administration, and essentially CMS just sat on that,” said Jamie Daw, an assistant professor at Columbia University’s Mailman School of Public Health who has done extensive research on perinatal insurance coverage for low-income women. “We can infer that what wasn’t a priority for the Trump administration is for the Biden administration.”
Biden provided further encouragement to the states to extend postpartum Medicaid benefits. The American Rescue Plan, the president’s COVID-19 relief package, includes a provision that enables states to extend postpartum benefits through an administrative action that is much faster and less cumbersome than using the waiver process, which can take months or even years.
Many who work in maternal health applauded the move. “Our approach to the states is to say however you can get it done, just go for it because the federal government has signaled there’s no wrong door to achieving this policy change,” said Emily Eckert, manager of health policy at the American College of Obstetricians and Gynecologists.
U.S. Sen. Dick Durbin and Rep. Robin Kelly, both Democrats from Illinois, want to go further. They introduced measures in Congress this year that would require all state Medicaid agencies to provide a year of postpartum coverage. They also want the federal government to pick up all the costs rather than requiring states to pay a share, as is the case with most Medicaid expenses.
Although neither the administration nor Congress has yet gone that far, maternal health care practitioners are enthusiastic over the progress they have made.
“Of all the things I have worked on in 30 years as an advocate, this will be the most impactful for our patients,” said Dr. Maura Quinlan, an OB-GYN with Northwestern Medical Group in Chicago. “I literally every day see women dropping out of care,” when they hit the 60-day mark.
According to the federal Centers for Disease Control and Prevention, nearly 23% of pregnancy-related deaths after the day of delivery occur in the period between six weeks after delivery and the end of the first year.
Yet for most pregnant women who receive health coverage through Medicaid, those benefits end 60 days after delivery, leaving them without health insurance during a still precarious postpartum period.
“That 60-day cutoff is based on a false belief that pregnancy-related complications end then,” said Dr. Charlene Collier, an OB-GYN at the University of Mississippi Medical Center in Jackson, Mississippi, and chair of the state’s Mortality Review Committee, which tracks maternal deaths in the state. “Now we know those complications extend through the end of the first year.”