Louisiana is facing a maternal health crisis. Our state has among the highest maternal death rates in the nation with Black and Brown women experiencing pregnancy-related death at three times the rate of white women. Our state is one of eight to receive an “F” grade on the 2020 March of Dimes Report Card. The number of preterm births and infant deaths has increased in recent years, reversing some years of gains. 

Fortunately, there are positive policy actions we can take now to help reverse harmful trends and enable more mothers and babies to thrive after birth. We can extend postpartum coverage to 12 months through our state Medicaid program, which has an important role to play in addressing our maternal health crisis

More than half of Louisiana births are covered by Medicaid. And, while babies remain covered by Medicaid and LaCHIP during their first year of life, mothers are less certain to remain covered and many face disruptions in care during one of the most vulnerable times in their lives. 

We can help Louisiana moms this Mother’s Day by following the lead of other states in extending Medicaid postpartum coverage from 60 days to 12 months. Research shows that continuous health insurance coverage leads to better health care access and better health outcomes for both moms and babies. 

Improve child health outcomes. Extending Medicaid coverage to 12-months postpartum is a two-generation strategy. It will improve health outcomes for mothers and children because children’s healthy development is dependent on healthy parents. 

Improve maternal health outcomes. Access to health insurance increases access to and use of life-saving health care services that impact entire families. Research on health outcomes in Medicaid expansion versus non- expansion states shows how access positively impacts health outcomes.  

Reduce Medicaid and severe maternal morbidity costs. When mothers go untreated, or churn through different forms of coverage, they often return to Medicaid sicker and are more expensive to treat. 

  • Medicaid bears a significant portion of the cost of untreated postpartum complications as people churn on and off of coverage. New Jersey found that 53 percent of women who were eligible for Medicaid because of pregnancy and lost coverage 60 days postpartum re-enrolled in the program within two years.
  • Reducing churn in Medicaid enrollment lowers average monthly per-capita spending in Medicaid, increases utilization of preventive care, reduces the likelihood of inpatient hospital admissions and emergency room visits, and prevents disruption for enrollees, health plans, and providers.

Extending coverage advances accountable quality care models. Gaps in coverage and changes in the source of coverage can make implementing value-based payment models for maternity care challenging because no single payer maintains responsibility for the mother’s care during pregnancy and the postpartum period. By extending the Medicaid postpartum coverage period, we can build on ongoing efforts to improve prenatal and postpartum quality care and better incentivize private managed care organizations to provide high-quality and efficient care. 

  • The Center for Medicare and Medicaid Innovation (CMMI) has taken note of the importance of continuity of coverage for advanced payment models. In their Notice of Funding Opportunity for the Maternal Opioid Misuse (MOM) Model, priority was given to applicants that proposed “sustainable postpartum coverage plans that address[ed] the period beyond 60 days after birth. Opioid abuse remains a pressing issue in Louisiana. 

The American Rescue Plan recognizes benefits of 12-month postpartum coverage. The American Rescue Plan Act provides states with a streamlined “state plan” option to extend Medicaid and CHIP pregnancy-related coverage to 12-months postpartum starting April 2, 2022. The option lasts for five years unless Congress acts to extend it. Previously, states had to apply to Centers for Medicare and Medicaid Services (CMS) using a Section 1115 waiver. 

Other states have already acted to extend postpartum coverage. As the benefits of postpartum coverage have become better understood, 32 states have taken actions in recent years to extend coverage through the postpartum period, including through Medicaid waivers, financial estimates, and other initiatives. As of May 2021, 13 states have approved extended Medicaid postpartum coverage or have pending legislation that has passed at least one chamber of the state legislature, including: 

  • Two states have implemented limited state-funded Medicaid coverage (California and Texas); 
  • Four states have enacted (Washington and West Virginia) or pending legislation (Maryland and Florida) to seek federal approval to extend postpartum coverage through a SPA or 1115 Waiver;
  • Four states have pending or proposed 1115 Waivers (Indiana, Virginia, Massachusetts and New Jersey); and 
  • Three states recently received approval to extend coverage through 1115 Waivers (Missouri, Illinois and Georgia).

Louisiana can build on its commitment to maternal health by extending Medicaid postpartum coverage to 12 months. Our state has done well to expand Medicaid eligibility to low-income adults. We have shown our commitment to addressing difficult problems through multiple initiatives at the Louisiana Department of Health and through legislative action, including the Healthy Moms Healthy Babies Advisory Council. It is time to take the next step and extend Medicaid postpartum coverage to 12 months. Louisiana can take action now by passing House Bill 468 by Rep. Landry and provide mothers with the peace of mind they deserve as they care for themselves and their babies through the first year.