Feds Let Illinois Extend Postpartum Medicaid Coverage

HHS Encourages Other States to Follow Suit

Alicia Ault

April 12, 2021

The federal government has approved a request by Illinois to extend postpartum Medicaid coverage to a full year from the current standard of 60 days.

Health and Human Services Secretary Xavier Becerra announced the approval at a press briefing today, noting that it was occurring during Black Maternal Health Week. The coverage extension is aimed at decreasing maternal morbidity and mortality, particularly among women of color.

Black women are two times more likely to die from a pregnancy-related cause than White women, according to HHS. Becerra noted that in the United States, 52% of pregnancy-related deaths take place up to one year postpartum, and that in Illinois, the figure is 80%.

"The continuity of coverage available through this action will help new mothers manage chronic conditions like hypertension and diabetes, and it will provide access to behavioral health and other mental health care services," he said.

Continuing Medicaid coverage for new mothers has been backed by the American Medical Association, is a priority of the American College of Obstetricians and Gynecologists, and has been promoted by Republicans and Democrats in Congress and state legislatures.

Illinois is the first state to seek and win approval to extend its Medicaid coverage from the current 60-days postbirth requirement. The program was granted through an existing section 1115 waiver program. It begins today and is authorized through December 31, 2025. The state estimates that some 2500 women with incomes up to 208% of the federal poverty level will receive the year of continuous Medicaid coverage. Illinois will evaluate whether the extension improves women's health and if it benefits the Medicaid program overall.

However, the recently passed coronavirus rescue package creates a new process that lets states more easily expand postpartum coverage, but they must act by April 2022. Becerra said the federal government is encouraging more states to follow Illinois' lead in extending postpartum eligibility by taking advantage of the new process.

States won’t get extra money — they will receive the regular per-capita based federal match if they extend Medicaid coverage through this pathway. Even so, Becerra said there has been much interest.

"I hope that we begin to see states not only express interest but actually submit their proposals on how they would do this," Becerra said.

Medicaid has become one of the key providers of maternal health care in the US, as it covers 4 in 10 births, according to the Kaiser Family Foundation. But postpartum coverage after the 60-day federal requirement is a patchwork. In 38 states (plus Washington, DC) that have expanded Medicaid under the Affordable Care Act, mothers who earn up to 138% of the federal poverty level can continue on Medicaid; for those who earn more than that, they can get coverage through the ACA.

In the 12 states that did not expand Medicaid, new mothers have to seek Medicaid coverage after 60 days as parents, and the income limits are strict. In Texas, for example, a married mother with a newborn loses Medicaid coverage 2 months after giving birth if she and her partner have an annual income above $3733, reports the Kaiser Family Foundation.

Coverage disruptions are harmful to mothers, said Becerra. HHS data shows that more than half of pregnant women in Medicaid experienced a coverage gap in the first 6 months postpartum and that disruptions in coverage often lead to delayed care and less preventive care, he said.

Becerra also announced that the Health Resources and Services Administration will make $12 million available over 4 years for the Rural Maternity and Obstetrics Management Strategies (RMOMS) program. Applicants for the new funds will be required to focus on populations that have historically suffered from poorer health outcomes, health disparities, and other inequities.

Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.

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