2021.3.5.Week Ending

Dr. Douglas Anderson, Chair of the Health Work Group of the Eastern Panhandle Family Resource Network, makes the case for extending postpartum coverage from 2 to 12 months for women on Medicaid and CHIP who do not otherwise qualify for these programs.

Now is the Time to Extend Medicaid Postpartum Coverage to 12 Months!

Introduction

West Virginia (WV) has enjoyed national attention on COVID-19 vaccination rates. A testament to "can-do" spirit, partnerships, and transparent planning. Why not do the same to prevent and reduce maternal and infant mortality deaths?

More than ever, WV legislators must address why 60 days of postpartum health coverage not enough to keep women healthy, decrease death, and reduce costs. Approximately three in five pregnancy-related deaths are preventable. Legislators can be a national leader by extending Medicaid postpartum coverage to 12 months and improving new mothers' quality of life!

Awareness

WV is not alone. US maternal mortality rates and pregnancy-related complications during and after childbirth are rising, particularly for women of color.  In 2018, the US infant mortality rate was 5.7 deaths per 1,000 live births. In West Virginia, the rate is 7.1 deaths per 1000 live births. Women with low incomes are likely to face health problems after birth.

Extending Medicaid postpartum coverage improves pregnancy-related outcomes by increasing access to care. Moms are more likely to delay treatment of chronic conditions and may not seek help due to lack of coverage. About one-third of US pregnancy-related deaths occur one week to one year after pregnancy ends. Black women are especially at risk. They are three to four times more likely to die from a pregnancy-related complication than non-Hispanic white women.

In 2019, West Virginia took important steps to extend Medicaid coverage to uninsured pregnant women up to 300 percent of the federal poverty level.  Unified bi-partisan support ensured no woman went without prenatal care, and every family had a healthy start. While we made progress, Medicaid only provides two months of postpartum coverage. That is not enough.

Benefits

Continuous postpartum coverage for 12 months is essential. The Centers for Disease Control and Prevention reports one-third of pregnancy-related deaths occur one week to one year after pregnancy ends. In Illinois, 56 percent of pregnancy-associated deaths occurred between 43 and 364 days. Recently, the American College of Obstetricians and Gynecologists (ACOG) stated more than half of pregnancy-related deaths occur in the postpartum period; 12 percent after the six-week postpartum visit up to a year.

Consistent coverage improves a mom’s well-being. According to studies, one in three women experiences a disruption in coverage before, during, or after pregnancy. When coverage lapses or mothers lose and regain coverage over short periods, the disruption leads to adverse consequences such as delays in earlier identification or addressing health challenges, even death. 

The Medical Expenditure Panel Survey revealed nearly 60 percent of the insurance disruptions included gaps in coverage.  These gaps prevent providers from identifying and treating complications occurring after birth, contribute to rising maternal morbidity and mortality rates, increase costs, and take a toll on families.

Momentum

Alignment, timing, and facts are on West Virginia’s side. Several US Congressional bipartisan bills related to maternal healthcare coverage, access, and quality have gained momentum. Provisions include Medicaid postpartum coverage to 12 months, coverage of doulas, broader provider networks in rural areas, and health equity training.

State maternal mortality review committees tout the benefits of Medicaid extending maternal health coverage. For example, five states have recommended 12 months of continuous coverage.

The American Medical Association supports extending postpartum coverage. For example, Illinois and New Jersey have proposals to provide a year of postpartum coverage for moms and babies with incomes above 138 percent of the federal poverty line who will lose Medicaid eligibility 60 days after birth.

West Virginia has an opportunity to be the nation’s leader. In February, the state legislature will consider a bill to extend Medicaid postpartum coverage from 2 to 12 months. The bill is an opportunity to show the nation how bi-partisan unification will work together to do the right thing by making smart investments in our families' health. We can act on ACOG’s guidance and congressional intent for at least 12 months of postpartum coverage.

Call to Action

West Virginia Medicaid is well-positioned to provide this coverage. With the number of health complications and maternal deaths in the postpartum period, keeping women covered through Medicaid is critically important. Extending access to Medicaid and coverage for 12 months improves health outcomes and saves the state money. While Congress is expected to make it easier for states to provide 12 months of postpartum Medicaid coverage, West Virginia can move forward now and make this happen.

Moms, employers, and others affected by the current policy should speak out, tell their stories, and inform their legislative representatives of this opportunity. The situation, 60 days coverage, and gaps in insurance are costly and deadly. Twelve months of continuous coverage will decrease maternal mortality, enhance long-term family health and employability, and address racial disparities.  

About the Author: Douglas Anderson is a healthcare administrator with 35+ years of experience in military, international, and education domains.  As an executive coach, he helps community leaders integrate social services with healthcare delivery systems to create healthier individuals and families. He is co-author of Health Systems Thinking: A Primer. Specific citations to sources are available upon request. He lives in Martinsburg, WV. He can be contacted at [email protected]

SOURCES

Zephyrin L, Coleman, Akeiisa, Nuzum,,Rachel, Getachew, Yaphet Increasing Postpartum Medicaid Coverage Could Reduce Maternal Deaths and Improve Outcomes. To the Point. The Commonwealth Fund; 2019. doi:https://doi.org/10.26099/ejtb-tw04 https://www.commonwealthfund.org/blog/2019/increasing-postpartum-medicaid-coverage

Data from: Pregnancy Mortality Surveillance System: Trends in Pregnancy-Related Deaths (1987-2017). 2020. Atlanta, GA.

Xu JQ MS, Kochanek KD, Arias E. Data from: Mortality in the United States, 2018: NCHS Data Brief No. 355, January 2020. 2020. Hyattsville, MD: National Center for Health Statistics.

Eckert E. It’s Past Time To Provide Continuous Medicaid Coverage For One Year Postpartum. Health Affairs Blog blog. 2020. https://www.healthaffairs.org/do/10.1377/hblog20200203.639479/full/

Petersen EE DN, Goodman D, Cox S, Mayes N, Johnston E, Syverson C, Seed K, Shapiro-Mendoza CK, Callaghan WM, Barfield W. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. Vol. 68. 2019:423-429. Morbidity and Mortality Weekly Report (MMWR) file:///C:/Users/Owner.000/AppData/Local/Temp/mm6818e1-H.pdf

Katch H. State and Federal Policymakers Should Extend Postpartum Medicaid Coverage. Off the Charts: POLICY INSIGHT, BEYOND THE NUMBERS. Center on Budget and Policy Priorities; 2020. https://www.cbpp.org/blog/state-and-federal-policymakers-should-extend-postpartum-medicaid-coverage

Report to Congress on Medicaid and CHIP: Medicaid’s Role in Maternal Health. 2020. file:///C:/Users/Owner.000/AppData/Local/Temp/Chapter-5-Medicaid%25u2019s-Role-in-Maternal-Health-2.pdf

Data from: Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level. State Health Facts. 2019. San Francisco, CA.

Data from: Births Financed by Medicaid. State Health Facts. 2019. San Francisco, CA.

Fact Sheet: Medicaid’s Role in Financing Maternity Care. 2020. https://wonder.cdc.gov/natality.html.

Ranji U, Gomez, Ivette, Salganicoff, Alina Expanding Postpartum Medicaid Coverage. Expanding Postpartum Medicaid Coverage. Kasier Family Foundation (KFF); 2020. https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/

Illinois Maternal Morbidity and Mortality Report. 2018. https://reviewtoaction.org/sites/default/files/portal_resources/MaternalMorbidity_MortalityReport_2018.pdf

Laurie Zephyrin AC, Rachel Nuzum,Yaphet Getachew. Increasing Postpartum Medicaid Coverage Could Reduce Maternal Deaths and Improve Outcomes. 2019. https://www.commonwealthfund.org/blog/2019/increasing-postpartum-medicaid-coverage

Sommers B, et al. Insurance Churning Rates For Low Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many. Health Affairs 2016;35,(10)

Daw J, Kozhimannil, KB, Admon, LK High Rates Of Perinatal Insurance Churn Persist After The ACA. 2019. https://www.healthaffairs.org/do/10.1377/hblog20190913.387157/full/

Rohrbach K, Robinson, Walker, Bartlett, Ellington, Hanna, Hornbuckle, Kelly, Mandt, Pushkin. ARTICLE 5. MISCELLANEOUS PROVISIONS.  §9-5-12. Medicaid program; maternity and infant care; A BILL to amend and reenact §9-5-12 of the Code of West Virginia, 1931, as amended, relating to expanding certain insurance coverages for pregnant women; and providing an effective date. In: legislature WV, editor. House Bill 4416. Charleston, WV: West Virginia Legislature; 2021.

Searing A, Ross, DC. Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies. 2019. https://ccf.georgetown.edu/2019/05/09/medicaid-expansion-fills-gaps-in-maternal-health-coverage-leading-to-healthier-mothers-and-babies/

 

 


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