The United States has an embarrassingly high maternal mortality rate compared to other highly industrialized nations. The majority of maternal mortality happens after childbirth — close to a quarter of pregnancy-related deaths take place between six weeks to a year after childbirth. So, it is baffling that federal law only guarantees 60 days of pregnancy-related Medicaid coverage for new mothers.
Medicaid benefits provide a lifeline for new moms. As states like North Carolina push to extend Medicaid to a full year after childbirth, other states must now follow suit. Women are at greater risk in states like Wyoming, Texas and South Dakota that do not accommodate Medicaid expansion under the Affordable Care Act. New mothers in those states, who lose coverage two months after giving birth, are more likely to suffer lethal heart and blood conditions, strokes, infections and mental health emergencies that result in overdose or suicide.
As a new pandemic mom who received Medicaid throughout my pregnancy and for one year after I had my baby, I can honestly say it saved my life. As a person with a pre-existing psychiatric condition, Medicaid gave me access to therapy and medications which helped me avoid my increased likelihood of experiencing postpartum psychosis. I’d like to see other moms be able to grab on to that lifeline, too.
Extended Medicaid coverage gives mothers access to mental health screenings and treatment. It also provides access to preventative care to monitor chronic health conditions like diabetes. Medicaid also covers family planning counseling and contraceptives to help mothers avoid the risks of having babies back-to-back.
The COVID-19 pandemic has proved a Pandora’s box, revealing the necessity for extended Medicaid benefits. Emerging research on maternal mental health during the pandemic indicates the elevated risk of pregnancy-related complications.
New mothers have experienced more symptoms of depression, anxiety and post-traumatic stress disorder during the pandemic compared to the same period pre-COVID-19. The pandemic set a precedent for extended postpartum care and coverage to address worsening conditions for maternal health.
Social isolation, restricted child care support, difficulties with remote work and concerns about infection also triggered negative physical and psychological effects. Intimate partner violence and financial hardship, coupled with harmful coping mechanisms, such as substance abuse, pose challenges for well-being.
New extended Medicaid benefits could also help address the stunning maternal health disparities due to systemic racial inequities in medicine. Given that the majority of pregnancy-related Medicaid holders are non-white, extended coverage is crucial to address the gap in maternal health care for communities of color.
On average, Black women die at three to four times the rate of white women from childbirth related causes – and up to 12 times the rate in some U.S. cities, including New York. Maternal mortality is also high for Native Americans, Asians, Pacific Islanders and some Latina women.
Medicaid is already the largest maternity-care financer — covering 42 percent of all births. The Mar. 11 American Rescue Act now presents a new avenue for states to extend pregnancy-related Medicaid coverage from only 60 days after birth to one year. If many states decide to opt in, the Medicaid extension would address the health concerns of an even bigger percentage of new mothers and their babies.
Since Congress did not enroll states automatically, public advocacy is crucial to persuade local governments to extend coverage before the April 1, 2022 deadline. With support from advocates, legislators and stakeholders, states should be able to generate the finances and regulations to make Medicaid extension possible by next spring.
Even before the pandemic, states overlooked preventable symptoms of maternal mental illness. California mothers with Medicaid, for example, reported receiving insufficient care and support in a series of national surveys run by the National Partnership for Women and Families. Participants complained of feeling left out in the cold to battle alone with severe problems involving breastfeeding, returning to work and symptoms of mood and anxiety disorders.
Worse still, throughout the country, 45 percent of women who died within one year of childbirth had a history of mental health issues and 58% had a history of substance abuse. Suicide deaths exceeded mortality caused by hemorrhage and hypertensive disorders. Even in cases where new mothers did not die, psychiatric near-miss events, such as psychosis, pose grave risks for both mother and child.
Extending Medicaid for one year postpartum can provide treatments to avoid both death and physical or psychological damage. By providing women with the right to health, this reform also increases women’s opportunities to parent and return to work successfully.
Image Description: Black-and-white image of a Black mother’s baby bum cradled by her hands
Nadia Naomi Mbonde 