Today is the final day of Black Maternal Health Week, which raises awareness about the deplorably high maternal mortality rates for Black women in the United States. A key policy response is to extend pregnancy Medicaid (a type of Medicaid that is only eligible during pregnancy) from 60 days after delivery to her 12 months. Forty-six states currently have such laws in place, making them one of the single largest actionable steps society has taken to address the maternal mortality crisis. This kind of national consensus is a major achievement and should be celebrated. While Medicaid extension is an important step in the right direction, our research suggests that it alone will do little to solve the Black maternal and child health crisis in many states.
States where postpartum Medicaid extensions are unlikely to have a large impact are those that already have relatively generous Medicaid policies in place. But even many of these states have disastrous outcomes when it comes to black mothers. In New York State, for example, a recently published maternal mortality study found that non-Hispanic black women have five times the pregnancy-related death rate as non-Hispanic white women; It is reported that it accounts for %. Although there are associated deaths, they account for only 14% of births.
It's been nearly a year since New York policymakers passed a bill to prevent postpartum maternal deaths by extending Medicaid coverage during pregnancy from 60 days to 12 months postpartum. New York state law allows this coverage regardless of immigration status (we'll explain why this is important later). Although it is too early to measure the impact of this law on Black maternal morbidity and mortality, our ongoing research shows that the impact on U.S.-born Black women in New York State (and similar states) suggests that it is likely to be minimal. People who lost their insurance after giving birth.
An independent analysis of 2019 American Community Survey data estimates that only 5% of Black women in New York state were uninsured during the postpartum period, likely due to the Affordable Care Act (ACA). This may be due to the early success of Medicaid expansion. This percentage is similar for all her ACA expansion states combined (6%) compared to 16% for non-expansion states. Digging deeper, we found that the subset of Black women most likely to be uninsured after giving birth are noncitizens. It was 12% in expansion states and 30% in non-expansion states. That is, New York state law is likely to have the greatest impact on immigrant black women (and immigrants of other races and ethnicities) and may have a smaller impact on U.S.-born black women.
Nevertheless, there is reason to expect this policy to improve black maternal health in New York and other ACA expansion states.
First, states that choose to expand coverage regardless of immigration status will dramatically increase access to postpartum care among black immigrants. Black immigrant women are at higher risk for poor maternal health conditions, including severe maternal morbidity and gestational diabetes, compared to the population average. Therefore, a comprehensive postpartum Medicaid extension could have a significant impact on the approximately 4.6 million Black immigrants in the United States, who are often ignored by policymakers and public health agencies. (Conversely, it means that states such as New Jersey that exclude undocumented immigrants from postpartum Medicaid extensions are missing an important lever for effectiveness.)
Second, reducing the number of women who lose Medicaid after childbirth reduces administrative burden and strengthens health systems serving low-income communities. Continued enrollment in the postpartum period may increase access to health care and improve quality of care. Therefore, expanding postpartum Medicaid coverage would strengthen the health care safety net serving low-income women and ensure that all postpartum women, regardless of whether an individual woman is affected by coverage expansion, It has the potential to improve the quality of care.
Finally, from a patient perspective, guaranteed continued eligibility up to 12 months postpartum would be beneficial during the physically and psychologically taxing period of new motherhood (when pregnancy ends). It may help reduce stress and anxiety (bereavement if a healthy baby is not born). Our research team spoke with women who had Medicaid insurance and found it comforting and reassuring to know that they would be covered if they had a health problem. He said.
Because of these benefits, extending Medicaid to 12 months is an achievement, even in states where there are not as many black women losing postnatal coverage (and in states where they are, they benefit even more). At the same time, policymakers must focus on other policy tools to address the ongoing crisis.
There are no quick fixes to dismantling the systemic racism that is the root cause of the crisis, but we need to start by listening to the voices of Black women. Medicaid coverage goes beyond just existing evidence-based care such as home blood pressure monitoring, continuous blood sugar monitoring, expanded access to lactation services, fair reimbursement for doulas, and home health visits. It should be comprehensive, covering the following: Black women need access to quality care and health care providers who will listen to them. Policies that reduce structural racism, such as fair access to paid family leave, affordable housing, healthy food, and healthy environments to live and work, are all important. Policies must be continually evaluated to ensure they are implemented equitably and include the perspectives of Black women. Timely maternal health surveillance data must be accessible to the public and disaggregated to identify communities that can provide additional support.
On this Black Maternal and Child Health Week, the promise of the Postpartum Medicaid Extension Act should be celebrated, but we must also understand its limitations and maintain policy momentum to seek additional solutions.
