CMS on Monday approved Illinois' request for a 1115 waiver to extend Medicaid coverage for women from 60 days postpartum to one year. It's the first state to continuously provide full Medicaid benefit coverage for mothers.
HHS Secretary Xavier Becerra explained during a press conference that the waiver's approval emphasizes the Biden administration's commitment to addressing maternal mortality and that Illinois' is "An important model for states across the country to follow."
The waiver will allow the state Medicaid program to cover mothers from 60 days postpartum to 12 months starting April 12, 2021. The state will monitor the impact of the waiver through Dec. 31, 2025.
Recent data show nearly half of women on Medicaid have experienced disruptions in care within six months postpartum, leading to delayed care and preventative services. Nearly a quarter of women report severe complications up to a year following pregnancy. About 700 women die each year due to pregnancy complications, with Black and Native women two to three times more likely to be affected than white women, according to the Centers for Disease Control and Prevention. The waiver also provides $12 million in funding to Rural Maternity and Obstetrics Management Strategies to test solutions to "unmet" needs for populations suffering from healthcare disparities.
Black women are also more likely to suffer from disruptions in coverage of ongoing care, due to higher risks of chronic conditions such as hypertension.
In 2019, the CDC found the maternal mortality rate for non-Hispanic Black women was 44 deaths per 100,000 live births, higher than that of white women (17.9) and Hispanic women (12.6) combined. Maternal health advocates say that institutional racism continues to affect access to care and how seriously women's concerns are taken during pregnancy, making women of color particularly vulnerable. Around 60% of these pregnancy-related deaths are preventable, according to Pew Research, with this trend markedly increasing for Americans over the past 30 years.
Biden's American Rescue Plan includes a provision allowing other states to expand Medicaid postpartum coverage from 60 days to 12 months.
While Biden's state option is an easier pathway to extending coverage, states like Missouri and New Jersey have opted to request their own 1115 waiver. The waiver can cover a wide range of services, including mental health, family planning, and COVID-related services and extends access to affordable care.
Whereas, the lack of additional funding for those services in Biden's state option make his plan less practical, experts said.
Illinois expects 2,500 women with incomes up to 208% of the federal poverty level to benefit from this extension of coverage during the year. CMS will help Illinois monitor the results of the waiver throughout its demonstration.