The U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services approved the extension of postpartum Medicaid and Children’s Health Insurance Program coverage in Hawaii, Maryland and Ohio on Tuesday. One advocate said all states should follow.

Through the American Rescue Plan, states have the option to extend postpartum coverage in their Medicaid and CHIP programs from the current mandatory 60-day timeline to 12 months following pregnancy. States can make the change through a State Plan Amendment, which is a proposed change to Medicaid plans. This option took effect April 1 and is available for five years, according to Kaiser Family Foundation. Before April 1, states extended postpartum coverage through a section 1115 waiver or by using state funds.

There’s a need for the extension, said Dr. Jen Villavicencio, lead for equity transformation at the American College of Obstetricians and Gynecologists. The organization has been a major advocate for extending postpartum Medicaid coverage to one year. About one-third of all maternal deaths happen between a week and a year after delivery, she said.

“The weeks following birth are a critical health period for an individual … The postpartum period must include ongoing access to healthcare, rather than a single encounter, with services and support — especially for patients with chronic medical conditions — tailored to each individual’s needs,” Villavicencio said. “This requires timely follow-up and ongoing coordination of care with other healthcare specialists in order to set the stage for long-term health and well-being. Yet, people will have a difficult time accessing this care if they do not have health insurance.”

So far, 21 states and the District of Columbia are implementing a postpartum coverage extension, while nine states are ready to implement it pending CMS approval, according to a tracker by the ACOG. 

Medicaid covers 42% of all births in the nation. With Tuesday’s approval, an additional 34,000 people annually are eligible for postpartum Medicaid and CHIP coverage for 12 months after pregnancy, HHS said in a news release. This includes about 2,000 people in Hawaii, 11,000 in Maryland and 21,000 in Ohio. In total, approximately 318,000 Americans annually are eligible, HHS stated.

Out of the 12 states that have chosen to not fully expand Medicaid, nine have sought or plan to seek an extension of postpartum Medicaid coverage, Kaiser Health News reported in June. But some politicians in non-expansion states, such as Wyoming, South Dakota and Mississippi, don’t want any form of Medicaid expansion, including with postpartum coverage.

If all states adopted the 12-month postpartum option, about 720,000 Americans annually would be guaranteed Medicaid and CHIP coverage for a year after pregnancy, HHS said.

“Through the American Rescue Plan Act, Congress has made available a simpler pathway for states to extend Medicaid coverage for pregnant people,” Villavicencio said. “Every state should be taking advantage of this opportunity.” 

Under the Covid-19 public health emergency, states are required to provide continuous coverage to Medicaid enrollees, KFF said. Therefore, postpartum coverage has been continuous throughout the pandemic.

Photo credit: Blue Planet Studio, Getty Images