The United States has one of the highest maternal mortality rates of any developed country in the world. While this data might surprise many, there is now an opportunity for both the nation and Pennsylvania to improve, should our state’s Department of Human Services (DHS) opt to do so. In the recently enacted American Rescue Plan (ARP), Congress provided states, like Pennsylvania, the option to extend postpartum coverage for new mothers enrolled in Medicaid from the current period of 60 days to 12 months.
Currently, because of the COVID public health emergency, few Pennsylvanians (including new moms) are losing Medicaid coverage. That is because federal law suspended Medicaid’s regular eligibility renewal and redetermination process. However, when the public health emergency ends many people, including new mothers, stand to lose their Medicaid coverage and services. The continuation of postpartum care is critical.
Current Medicaid policy of covering postpartum care for only 60 days is not rooted in modern medical knowledge. The Medicaid and CHIP Payment Access Committee (MACPAC) recently reported that almost 12 percent of maternal deaths occur in the late postpartum period, and a considerable share of these deaths are potentially preventable. In the year following a pregnancy, multiple health issues may arise. These go beyond the physical recovery from childbirth and include behavioral health needs such as postpartum depression and substance use disorder (SUD), family planning, and chronic conditions that predated the pregnancy or arose because of it. These all may require ongoing medical care. Moreover, racial and ethnic disparities in pregnancy-related mortality and morbidity have been well documented. Black women are three times more likely to have pregnancy-related deaths than white women in Pennsylvania.
Leading state child advocates like Pennsylvania Partnerships for Children (PPC) and Public Citizens for Children and Youth (PCCY) are working on this issue with stakeholders. According to PPC, when Medicaid “coverage ends 60 days after the birth of a baby, moms in our state miss out on critical access to care ranging from receiving a maternal depression and anxiety screening to other services that can lower maternal mortality rates. Between 2013 and 2018, 58% of maternal deaths in Pennsylvania occurred between six weeks to one year after babies were born – the period after their coverage ends.” Postpartum depression, a possible pulmonary embolism, or complications from a heart condition do not just disappear 60 days after giving birth.
ARP gives Governor Wolf and the Pennsylvania’s Department of Human Services an opportunity to exercise the option to extend postpartum coverage and reduce inequities in maternal health care coverage and access. PHLP will keep readers updated about this important opportunity.