States across the country are making it easier for new moms to keep Medicaid on for the year after giving birth, a time when depression and other health problems can develop.
But tight government budgets and low program reimbursement may ultimately limit that push or make it difficult for women with extended coverage to find doctors.
“A lot has changed since the pandemic,” said Venessa Aiken, a new mom in Orlando, Florida. “A lot of places don’t take Medicaid anymore or if they do, you have to wait about two months before you can be seen.”
Many women enroll in government-funded Medicaid health insurance when they become pregnant because eligible income levels are higher than for women who are not pregnant. The federal government requires states to maintain this coverage for 60 days after childbirth or after the baby arrives. After that, mothers in many states lose coverage unless their income levels are extremely low.
As of the spring, 23 states and Washington, DC, said they would extend that coverage for a full year postpartum. Several other states are considering doing so.
These extensions will begin helping people after the federal government’s COVID-19 public health emergency ends, as states are required to keep patients enrolled during the emergency. It will currently run until at least early next year.
The push to expand coverage has grown to include both conservative and liberal states. It’s also endorsed by President Joe Biden’s administration as a way to improve equality: Postpartum death rates can be much higher among black and Native American or Alaska Native populations.
“There’s no reason we should stop before we have every mother and every baby (covered),” Health and Human Services Secretary Xavier Becerra told The Associated Press. “Why wouldn’t you want to give a new mother and a new baby a whole year of peace of mind?”
The state and federally funded Medicaid program covers prenatal doctor visits for mothers and about 42 percent of births in the United States.
This blanket took some stress off for Maureen Forman, who said she was already worried about her pregnancy when she gave birth to her son last year.
“It was really good not to worry,” the 41-year-old Bloomington, Indiana resident said. “I just knew everything was going to be covered. I wish other pregnant women had the same experience.
Care providers and researchers say coverage should extend well beyond 60 days after the baby arrives.
They note that many new moms need extra time to get to the doctor while they recover from childbirth and care for a newborn. Some also juggle a return to work while doing this.
Extended coverage “corresponds to the reality of the postpartum period,” said Usha Ranji of the nonprofit Kaiser Family Foundation, which studies health issues.
Problems like postpartum depression can develop months later, and some mothers may have lingering health issues that require care. Some may also need ongoing drug treatment.
Those who lose coverage may not be able to afford another option like private insurance.
The nonpartisan Congressional Budget Office estimated last year that about 45% of women on Medicaid will become uninsured after the 60-day postpartum coverage period ends.
While nearly half of states have expanded coverage, health economist Joe Antos said he thinks others will be reluctant to add the expense to their budgets.
Mississippi lawmakers scuttled a bill earlier this year that would have expanded postpartum coverage in part due to concerns about the program’s expansion.
The coverage extensions, which run for five years, are supported in part by funding from the American Rescue Plan Act 2021. States will have to foot part of the bill.
If the economy slips into recession, “states’ enthusiasm for further expansion will also wane as their own budgets tighten,” said Antos of the American Enterprise Institute.
Extending coverage does not automatically guarantee better care, as it can be difficult to find doctors.
Jennie Joseph says the idea of trying to get a referral to a mental health specialist for a Medicaid patient is “laughable.” The Florida midwife said patients first have to find a doctor to provide that referral and then find a therapist who accepts Medicaid, which is even harder.
Joseph is the founder of Commonsense Childbirth, a non-profit organization that operates a birthing center and clinic in central Florida. She said Medicaid’s low reimbursement rates and payment issues are challenging for healthcare providers. She said the government program pays her clinic less than half of what a commercial insurer would pay for a prenatal visit. Medicaid reimbursement for postpartum visits is even less, as low as $34.
“It’s about trying to get your claim paid, and they’re more easily denied than paid,” she said. “Because of this, providers are not scheduling postpartum appointments for these mothers.”
Aiken, Orlando’s newborn mom, gave birth at Joseph’s center in July. She has had difficulty getting a call back from her GP’s office and is worried about being referred to a specialist.
“It’s quite confusing,” she said. “Who do you go to when you don’t have a (primary care doctor)?”
Becerra says he knows access to doctors needs to be improved. But he sees coverage extensions as a step towards making things better.
“Let’s get people through the door and keep working to increase the number of quality caregivers who will be there to meet these people,” he said. “But today we have hundreds of thousands of women and babies who can’t even walk through the door. “
Follow Tom Murphy on Twitter: @thpmurphy
The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Department of Science Education. The AP is solely responsible for all content.
This story was originally published September 5, 2022 7:57 a.m.