Medicaid extensions for new moms grow, may run into limits

States across the country are making it easier to maintain Medicaid for new mothers in the year following childbirth. This is an important time because depression and other health problems could develop.

But tight government budgets and the program’s low reimbursement may ultimately limit this push or make it hard for women with extended coverage to find doctors.

“A lot of things have changed since the pandemic,” said Venessa Aiken, a new mom in Orlando, Florida. “A lot of places no longer take Medicaid or if they do, you have to wait like two months before you can be seen.”

Many women enroll in government-funded Medicaid health insurance when they become pregnant, because qualifying income levels are higher than for women who aren’t pregnant. The federal government mandates that the coverage be maintained for 60 days postpartum or after the baby is born. If moms are very poor, they may lose their coverage.

23 states and Washington, D.C. have announced that they will continue this coverage for one year after birth. Many more states have plans to do the same.

These extensions will start helping people after the federal government’s COVID-19 public health emergency ends because states are required to keep patients enrolled during the emergency. It is expected to continue at least through early next year.

Both liberal-leaning and conservative states have been embracing the push to expand coverage. It also is endorsed by President Joe Biden’s administration as a way to improve equality: Postpartum mortality rates can be much higher among Black and American-Indian or Alaskan Native populations.

“There’s no reason why we should stop before we have every particular mother and baby (covered),” Health and Human Services Secretary Xavier Becerra told The Associated Press. “Why wouldn’t you want to provide to a new mother and new baby a full year’s peace of mind?”

Prenatal visits by a prenatal doctor are covered by the federally funded Medicaid program. This covers about 42% percent of all births in the U.S.

Maureen Forman was relieved to have this coverage because she wasn’t worried about her pregnancy after giving birth to her son last January.

“It was really nice not to worry,” the 41-year-old Bloomington, Indiana, resident said. “I just knew it was all going to be covered. I wish other pregnant women had that same experience.”

According to researchers and care providers, coverage should be extended well beyond 60 days after the baby’s arrival.

These experts note that new mothers often need more time to see doctors while caring for their newborn. Others are also trying to balance work and childbirth.

A coverage extension “matches the reality of the postpartum period,” said Usha Ranji of the non-profit Kaiser Family Foundation, which researches health care issues.

Postpartum depression may develop several months later. Some mothers may have persistent health issues that require care. Some may also require ongoing treatment for substance abuse.

People who lose coverage might not be able afford private insurance.

According to the non-partisan Congressional Budget Office, approximately 45% of Medicaid-eligible women will lose their coverage after the 60-day postpartum coverage ends.

Nearly half of the states have increased coverage. Joe Antos, a health economist, said that he believes others won’t hesitate to add it to their budgets.

Mississippi lawmakers rejected a bill that would have extended coverage for postpartum care earlier in the year, partly because of concerns about expanding it.

These five-year coverage extensions are partly funded by the 2021 American Rescue Plan Act. The bill will be paid by the states.

If the economy slides into a recession, “state enthusiasm for further expansions will also drop off as their own budgets tighten up,” said Antos, who’s with the American Enterprise Institute.

The extension of coverage does not guarantee better care. Finding doctors can be challenging.

Jennie Joseph says the idea of trying to get a referral to a mental health specialist for a Medicaid patient is “laughable.” The Florida midwife said patients first have to find a doctor to provide that referral and then land a therapist who accepts Medicaid, which is even harder.

Joseph is the founder Commonsense Childbirth, which operates a central Florida clinic and birth center. Low Medicaid reimbursement rates and complicated payment processes make it difficult for providers. She stated that the government program paid her clinic half of what a commercial insurance would pay for a prenatal appointment. Medicaid reimbursement for postpartum visits can be as low as $34.

“It’s all about trying to get your claim paid, and they are more readily denied than they are paid,” she said. “Because of that, providers don’t make postpartum appointments for these mothers.”

Aiken, the Orlando newborn mom, gave birth at Joseph’s center in July. She has had a hard time getting a call back from her primary care doctor’s office, and she’s worried about getting a referral to a specialist.

“It’s pretty confusing,” she said. “Who do you turn to when you don’t have a (primary care physician)?”

Becerra stated that he is aware of the need to improve doctor access. He sees the extension of coverage as a step towards making things better.

“Let’s get people through the door and let’s continue to work to increase the number of quality caregivers who will be there to meet those folks,” he said. “But today we have hundreds of thousands of women and babies who can’t even walk through the door. “

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Follow Tom Murphy via Twitter: @thpmurphy

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