Medicaid is a public insurance program in the United States for people who are low income and meet other standards that vary by states. The program is funded by state and federal governments with the federal government paying for the bulk of the program’s costs. Most states cover pregnant women who are low income and the children they give birth to. The level of income that a woman can have varies by state and is based on a measurement of poverty called the “federal poverty level.” Federal legislators and government agencies set numerous standards for stated Medicaid programs, but states are also allowed to come up with innovative strategies for taking care of their low income residents. Some states even create additional programs to supplement their Medicaid programs. Recently, President Biden and his administration, who are focused on improving maternal health, announced a change to federal Medicaid standards that would allow states to innovate around the care of people after giving birth.
A New Post-Birth Medicaid Option
The new option offered by the Biden administration allows states to increase the amount of time that their Medicaid programs can cover women and birthing individuals for 12 months after a birth occurs. This is a big change because the prior coverage only lasted 60 days after birth. Women and birthing people on Medicaid account for 42% of all the births in the country (4 out of 10 births) so this change could have a significant impact on the lives of hundreds of thousands of pregnant individuals and their babies. The Biden administration estimates the number of people who could be impacted as 720,000. This option for longer coverage also includes the Children’s Health Insurance Program or CHIP. This is a program that increases the number of children who can benefit from Medicaid-type benefits in a state. It essentially raises the poverty level required to get Medicaid for children resulting in more children being eligible for the program.
Why Expand Coverage?
While the expansion in coverage may appear at first glance to be a good idea and likely to help pregnant individuals greatly, the rationale of the change should be questioned. Currently, the US is facing a crisis with regards to maternal mortality and pregnancy-related deaths. Our rates are much higher than similar high-income countries. And the rates are worse for certain groups of women – such as African American and American Indian women. These deaths occur during pregnancy and after pregnancy. According to the Centers for Disease Control and Prevention, about 1/3 of these deaths occur during pregnancy, 1/3 at delivery or in the week after, and 1/3 from 1 week to 1 year postpartum (after pregnancy). These deaths have many causes. Most are preventable. When people receive the right care at the right time, the number of deaths will decrease. However, lack of insurance prevents some individuals giving birth from getting that care. Expansion of Medicaid coverage helps women and other birthing individuals at least have basic health insurance coverage for their health care needs before and after giving birth. With this coverage, more clinicians are available and more services are available to these individuals.
Will States Make the Change?
Even with rational reasons for why Medicaid coverage should be expanded for one year after birth, not all states will select this option to expand the coverage. So, the question is which ones will and what motivates them to move forward with the change. Most states are concerned that expanding Medicaid coverage can threaten state budgets because more money is being spent on health insurance. The costs of coverage can be balanced by what that coverage prevents from happening. If coverage prevents maternal complications and deaths, the costs saved or prevented may more than account for the amount spent providing the additional services. Each state has to weigh the pros and cons to determine whether this new option is right for their population. When a state uses the option, it can study the impact of the new costs to determine if they are saving money or not. With this type of in-depth assessment of a health insurance policy change at the state level, better policies can be made.
