Medicaid extensions for new moms on the rise, may go beyond
States across the country are making it easier for new moms to get Medicaid up to a year after giving birth, when depression and other health problems can develop.
But tight government budgets and the program’s low compensation may ultimately limit that push or make it harder for women with extended coverage to find doctors.
“A lot has changed since the pandemic,” said Venessa Aiken, a young mom from Orlando, Florida. “Many places no longer accept Medicaid, and if they do, you have to wait about two months before they can see you.”
Many women enroll in the government-funded Medicaid health insurance program when they become pregnant because the corresponding income level is higher than that of non-pregnant women. The federal government requires states to maintain this coverage for 60 days after the birth or after the baby is born. After that, moms in many states lose insurance, unless their income level is extremely low.
As of spring, 23 states and Washington, DC have said they will extend this coverage for a full year after delivery. Several other states are planning to do so.
These extensions will begin helping people after the federal government’s COVID-19 public health emergency ends, as states are required to retain patients registered during the emergency. Currently, it will last at least until the beginning of next year.
The desire to expand coverage has embraced both conservative and liberal-minded states. It is also endorsed by the administration of President Joe Biden as a way to improve equity: postpartum mortality rates can be much higher among blacks and American Indians or Alaska Natives.
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“There is no reason we should stop until we have (covered) every single mother and child,” Health and Human Services Secretary Xavier Becerra told The Associated Press. “Why don’t you give your new mom and newborn a year of peace of mind?”
Medicaid, funded by the state and federal government, covers prenatal doctor visits for moms and about 42% of births in the US.
The coverage took some of the stress off Maureen Foreman, who said she was already worried about her pregnancy when she gave birth to her son last year.
“It was very nice not to worry,” said the 41-year-old resident of Bloomington, Indiana. “I just knew it would all be covered. I want other pregnant women to have the same experience.”
Medical professionals and researchers say insurance coverage should go well beyond 60 days after the baby is born.
They note that many new mothers need more time to make time for doctor visits while they recover from childbirth and care for their newborn. Some also juggle a return to work while doing this.
The coverage expansion “is consistent with the reality of the postpartum period,” said Usha Ranji of the Kaiser Family Foundation, a nonprofit that researches health issues.
Problems such as postpartum depression may take months to develop, and some mothers may have long-term health problems that require treatment. Some may also need long-term treatment for substance abuse.
Those who have lost insurance may not be able to afford another option, such as private insurance.
Last year, the non-partisan Congressional Budget Office estimated that about 45% of women on Medicaid would be uninsured after the 60-day postpartum period.
While nearly half of the states have expanded coverage, health economist Joe Antos said he thinks others will hesitate to add spending to their budgets.
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Earlier this year, Mississippi lawmakers rejected a bill that would have expanded postnatal insurance in part because of concerns about expanding the program.
The coverage extension, which lasts for five years, is supported in part by funding from the American Plan of Rescue Act of 2021. States will have to pay part of the bill.
If the economy slides into recession, “government enthusiasm for further expansion will also fall as their own budgets tighten,” Antos of the American Enterprise Institute said.
Expanding coverage does not automatically guarantee better care because doctors can be difficult to find.
Jenny Joseph says the idea of trying to get a mental health referral for a Medicaid patient is “ridiculous.” The Florida midwife said patients must first find a doctor who will give this referral, and then find a therapist who takes Medicaid, which is even more difficult.
Joseph is the founder of Commonsense Childbirth, a non-profit organization that operates a birthing facility and clinic in central Florida. She said low Medicaid reimbursement rates and payment difficulties are a problem for health care providers. She said the government program pays her clinic for less than half what a commercial insurance company pays for an antenatal visit. Medicaid reimbursement for postpartum visits is even less, at just $34.
“It’s all about trying to get paid on your claim, and they get denied rather than paid,” she said. “Because of this, healthcare providers are not scheduling postpartum appointments for these mothers.”
Aiken, a newborn mom from Orlando, gave birth to Joseph in downtown in July. She had difficulty getting a call back from her PCP’s office and is worried about getting a referral to a specialist.
“It’s pretty confusing,” she said. “Who do you go to when you don’t have (therapist)?”
Becerra said he knows access to doctors needs to be improved. But he sees the expansion of coverage as a step towards improving the situation.
“Let’s invite people and continue to work to increase the number of qualified helpers who will meet these people,” he said. “But today we have hundreds of thousands of women and babies who can’t even get through the door.”