LWV asks HHS to extend postpartum Medicaid

The League joined a coalition letter to the Department of Health and Human Services urging an extension of postpartum Medicaid from 60 days after birth to one year after birth. During a pandemic and with birthparent deaths on the rise, it is critical that the government step up and build out Medicaid. LWV was also successful in advocating along our DEI principles within the coalition to include a statement that not all birthparents are mothers/women. On Wednesday, LWV got another win: the House Energy and Commerce Committee released their relief legislation, including a provision to support states in extending postpartum Medicaid!

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Norris Cochran

Acting Secretary

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201

 

Liz Richter

Acting Administrator

Centers for Medicare and Medicaid Services

Box 8016, Baltimore, MD 21244-8016 Dear Acting Secretary

 

Cochran and Acting Administrator Richter:

The undersigned 113 national organizations and 151 state and local organizations dedicated to improving maternal health write today to urge the Centers for Medicare and Medicaid Services (CMS) to act as soon as possible to approve pending section 1115 demonstration projects aimed at extending the postpartum coverage period for individuals who were enrolled in Medicaid while pregnant to a full year after the end of pregnancy. The Biden Administration has a unique opportunity to elevate maternal health among its Medicaid priorities by acting swiftly to approve these state requests. As you review these waiver proposals, we encourage you to take all possible steps to work with states to extend comprehensive coverage to a full year after the end of pregnancy regardless of health condition.

The United States is the only industrialized nation where maternal deaths are on the rise. According to the Centers for Disease Control and Prevention (CDC), approximately 700 pregnancy-related deaths occur in the U.S. each year and 60 percent of these deaths are preventable. There are stark racial inequities in maternal mortality. Black women are three times more likely to die from a pregnancyrelated complication than non-Hispanic White women; Indigenous women are more than twice as likely to die from a pregnancy-related complication than non-Hispanic White women. The COVID-19 pandemic risks exacerbating the maternal health crisis. A recent study from the CDC suggests that pregnant women are at a significantly higher risk for severe outcomes, including death, from COVID-19 than non-pregnant women. 

Continuous access to Medicaid is crucial to addressing our nation’s rising rate of maternal mortality. Medicaid paid for 43 percent of U.S. births in 2018, including 50 percent of births in rural areas, 60 percent of births to Latina women, and 66 percent of births to Black women. Under current law, women who are eligible for Medicaid based on the fact that they are pregnant become ineligible for coverage 60 days after the end of pregnancy. While some women are able to successfully transition to other sources of coverage at this time, many are left in the untenable position of being uninsured shortly after a major medical event. Insurance coverage disruptions are one of many factors that contribute to high rates of maternal mortality among the Medicaid-eligible population. Importantly half of all uninsured new mothers report losing Medicaid after pregnancy as the reason they became uninsured. These coverage disruptions also disproportionately affect women of color; nearly half of all non-Hispanic Black women had discontinuous insurance from pre-pregnancy to postpartum and half of Hispanic Spanish-speaking women became uninsured in the postpartum period.

There are major risks to becoming uninsured shortly after experiencing pregnancy. For example, one in seven women experience symptoms of postpartum depression in the year after giving birth, and evidence suggests women with substance use disorder are more likely to experience relapse and overdose seven to 12 months postpartum. Additionally, 18 percent of women who lost Medicaid coverage and became uninsured in the postpartum period reported either gestational diabetes or pregnancy-related hypertension – both conditions that would benefit from ongoing monitoring and treatment after the end of pregnancy. Moreover, about one-third of the women who lost coverage were recovering from a cesarean section and just over one-quarter reported being depressed sometimes, often, or always in the months after giving birth. Many of these postpartum health risks could be mitigated if women were able to maintain coverage through the Medicaid program.

Our organizations appreciate President Biden’s stated commitments to improving maternal health and ending preventable maternal death in the United States. We urge CMS to act swiftly on these commitments by approving pending section 1115 demonstration projects to extend Medicaid coverage for pregnant individuals beyond 60 days postpartum. Should you have any questions, please contact Emily Eckert, Policy Manager with the American College of Obstetricians and Gynecologists, at [email protected].

Sincerely,

For full list of signatories see attached letter