Virginia became the latest state to offer 12 months of postpartum Medicaid and Children's Health Insurance Program coverage after the Centers for Medicare and Medicaid Services approved the state's Medicaid plan amendment Thursday.
More states will likely follow suit next year after an American Rescue Plan provision to simplify the application for expanding postpartum coverage for 12 months goes into effect in April 2022.
Maternal mortality rates have worsened in the U.S. over the past three decades and especially among Black women, according to a September report from the U.S. Commission on Civil Rights. Health complications related to childbirth cost the U.S. at least $32.3 billion, another study found.
Medicaid pays for more than 40% of births in the U.S. But federal law currently only requires states to offer postpartum Medicaid coverage to people earning up to 138% of the federal poverty level for 60 days. Many states cover pregnant people beyond the minimum income level, but in states that have not expanded Medicaid under the Affordable Care Act, people may not have an easy path to coverage when their two months on Medicaid are up.
States currently have to keep people enrolled in Medicaid – including people who gave birth over 60 days ago – as a condition of receiving additional federal Medicaid funding during the COVID-19 Public Health Emergency.
The Biden administration wants to advance maternal health and tackle pregnancy-related mortality.
"When we think about trying to really move the needle on maternal health outcomes, a critical issue is making sure that we maintain coverage," CMS Administrator Chiquita Brooks-LaSure said at the National Association of Medicaid Directors Conference on Tuesday.
The American Medical Association agreed 12 months of postpartum Medicaid coverage is necessary during its House of Delegates meeting Tuesday and said pregnancy should count as a qualified life event for special enrollment in the individual coverage marketplace. The AMA also said a standard definition of maternal mortality should be developed and states and tribes should get resources to collect and analyze maternal mortality data, among other policies.
New Jersey and Illinois expanded coverage to 12 months postpartum earlier this year. CMS approved partial expansions of coverage as well—Georgia offers postpartum coverage for six months, and Missouri provides extended postpartum coverage for substance use disorder and mental health treatment for beneficiaries with substance abuse disorder.
According to the Kaiser Family Foundation, additional states including Pennsylvania and Massachusetts plan to take advantage of the American Rescue Plan Act provision that goes into effect April 1, 2022 and removes barriers for states to get approval for a year of postpartum Medicaid and CHIP coverage.
The reconciliation package Democrats want to pass through Congress this year would require states to provide 12 months of continuous postpartum Medicaid and CHIP eligibility.
Virginia's 12 months of postpartum coverage goes into effect Thursday and lasts until June 30, 2029, though the state can apply to extend it further. Postpartum individuals can enroll any time in the 12 months after their pregnancy. The state expects the new coverage to encompass 6,000 people.