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Forecasting the lasting legacy of the Medicaid postpartum expansion | Viewpoint


How one full year of postpartum care impacts health equity, outcomes, and care costs.

One unexpected silver lining of the nation’s pandemic response has been the lasting extension of Medicaid postpartum coverage.

Susan Torroella, CEO of ProgenyHealth (Image provided by author)

Susan Torroella, CEO of ProgenyHealth (Image provided by author)

As of January this year, all state expansions gained through the American Rescue Plan Act of 2021 have been made permanent. This milestone is a major win for maternal advocates nationwide, extending access for over 1.5 million new mothers from just 60 days following childbirth to one full year.

While always imperative, this news comes at an especially pivotal moment. In March, the CDC released data revealing the nation’s maternal mortality rate – already theworst of all developed nations – increased in 2021 yet again, this time by a staggering 40% year-over-year.

While improvements are required across the board, stark outcome discrepancies by race persist: the data revealed that Black women are nearly 3 times as likely as white women to die after giving birth.

This expanded standard of coverage advances a new approach to maternal care management, one which could not come at a more important time.

By ensuring a seamless continuum of care from conception through to prenatal, delivery, and a full year postpartum, health plans and providers alike can promote the kind of proactive and preventative comprehensive care that promotes healthier pregnancies, healthier deliveries, and healthier starts to life. Below, I’ve outlined three key areas that will be most impacted - for the better - by the recent expansions.

The expansion’s impact on maternal health outcomes

The postpartum period, colloquially known as the “fourth trimester,” is an essential healing, recovery, and newborn bonding window that is critical for maternal health.

While many might presume that the majority of pregnancy-related deaths occur during delivery, they might be surprised to learn that justover half (52%) of all maternal mortalities occur in the days, weeks, and months following delivery.

For the 42% of American mothers covered by Medicaid, this makes a world of difference. Prior to these expansions, they were liable to lose their insurance coverage only six to eight weeks after delivery, meaning that remaining risk factors, warning symptoms, and unusual vital sign readings would be overlooked. Now, the expansion ensures access to comprehensive postpartum care that will provide additional postpartum check-ups, home visits, lactation education, mental health screenings, and will help keep high blood pressure and other dangerous chronic conditions in check.

This offers great promise, as studies indicate that an estimated 67% of pregnancy-related deaths could be avoided if symptoms are caught early. With access to healthcare coverage and regular chronic condition monitoring, the Medicaid extension means that millions of new mothers now have access to the recurring postpartum check-ups that can help identify troubling signs earlier and prevent more unnecessary deaths.

The impact of expanded care on health equity

Extending Medicaid coverage helps ensure more equal access to healthcare, as a disproportionate number of women enrolled in Medicaid through pregnancy are women of color. At their time of delivery, 65.3% of American Indian/Alaska Native women were covered by Medicaid, along with 64.8% of Black women, and 58.8% of Hispanic women - as compared to 29.8% of White women.

As the racial disparities in maternal mortality are especially stark, expanded coverage makes an outsized difference for women of color and their newborns. Research reveals a significant association between Medicaid expansion and seven fewer maternal deaths per 100,000 live births; this proved especially true among Black, non-Hispanic women and Hispanic women.In another early review of expansion states, data revealed improvements across various key metrics, including reduced racial disparities in preterm birth and low birth weight and decreased infant mortality.

The expansion’s impact on the cost of care

In addition to advancing health equity and driving healthier maternal outcomes, the Medicaid postpartum expansion will also serve to mitigate overall costs associated with pregnancy and childbirth. By advancing a new standard of care that proactively mitigates risk and conducts frequent monitoring, the expansion will help promote healthier pregnancies that require less intensive care services.

Without recurring medical attention and preventative healthcare, the likelihood of needing emergency, acute, and/or costly inpatient care increases. In contrast, under the ACA Medicaid expansions, studies have demonstrated a greater use of outpatient, preventative care visits during the prenatal and postnatal periods, which help limit complicated, or catastrophic, care needs.

A research article compared hospitalization rates for women covered by Medicaid who lived in expansion states and those who did not. It found a 17% reduction in hospitalizations during the critical first 60 days postpartum - and evidence of additional decreases between 61 days and six months postpartum. These reductions not only demonstrate healthier outcomes for new mothers, but also lower levels of utilization for the complex care services that drive costs.

Expansion helps achieve healthier starts life

In the years to come, the long-term impacts of Medicaid postpartum expansion will continue to emerge. Thankfully, we now have a chance to share this life saving coverage with so many of our nation’s new mothers.

This policy action has galvanized caregivers and payers alike, unifying them around a single, shared goal: improving the health, happiness, and long-term outlook of mothers and infants statewide.

For the few remaining non-expansion states, the only path forward is to take action to guarantee continuous, high-quality care for new mothers and infants during those critical first 365 days.

Susan Torroella is the chief executive officer of ProgenyHealth

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