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States push to extend postpartum Medicaid benefits to save lives

Michael Ollove, Stateline.org on

Published in News & Features

The easier bureaucratic pathway in this year’s American Rescue Plan won’t be available to states until next year. For the moment, however, no matter where they live, new mothers on Medicaid don’t have to worry about losing benefits after 60 days. That’s because the COVID-19 relief bill that former President Donald Trump signed last year prohibited the states from dropping anyone from Medicaid during the public health emergency.

Although new mothers with low incomes are already covered beyond 60 days in states that expanded Medicaid, states could increase the number of women who would be covered. That’s what Illinois has done.

Previously in Illinois, only women whose income was less than 138% of the federal poverty line qualified for the extended time on Medicaid. The state’s waiver now ensures new mothers up to 213% of the poverty line can continue on Medicaid after 60 days as well.

“We determined that over two-thirds of pregnancy-related deaths were potentially preventable, and that one-third of pregnancy-related deaths occurred more than 60 days postpartum,” said Dr. Robin Jones, an OB-GYN who chairs the state’s Maternal Mortality Review Committee, which had become alarmed after digging into the data and asked Illinois’ lawmakers to approve the waiver application.

Most states and some cities now have appointed maternal mortality review committees comprising medical experts who delve into the cause of each maternal death with an eye toward identifying medical and procedural improvements.

Some states that didn’t expand Medicaid benefits under the Affordable Care Act do provide Medicaid coverage for parents, but the income thresholds are usually extremely low, meaning only the poorest residents qualify.

 

For example, Texas parents only qualify for Medicaid if their incomes are 17% of the poverty line or less. For a family of three, that would mean an annual income of up to $3,733.

The movement to extend Medicaid’s postpartum benefits gained traction after the CDC published alarming findings about maternal deaths in 2019. The report revealed that 11.7% of pregnancy-reported deaths occurred from the 43rd day of pregnancy to one year after delivery. That figure likely represents an undercount, maternal health experts say, because it doesn’t include deaths related to overdoses and suicides, which might be partly driven by the mental stresses associated with maternity.

The CDC data also underscores the gaping disparity in maternal mortality between White and Black women. The number of pregnancy-related deaths per 100,000 live births for White women is 13; for Black women, it’s more than three times higher, at nearly 43.

The leading causes of deaths immediately after the end of pregnancy also were different than those occurring months later, the CDC analysis revealed. For women who died between the seventh and 42nd day after pregnancy, strokes and infection were among the leading causes of death. Women who died later were more likely to succumb to cardiomyopathy, a disease of the heart muscle that can lead to heart failure. Other prevalent causes at that stage were embolisms and other cardiovascular conditions.

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