Postpartum Medicaid Coverage Extension Passes Through the American Rescue Plan

By the Mom Congress Policy Team

The American Rescue Plan Act of 2021 passed Congress and is now on its way to the President’s desk to be signed into law. The implementation of this health care heavy bill will require an immense amount of coordinated work from the U.S. Department of Health and Human Services to roll out provisions that fall within its jurisdiction.

Although the 628-page bill contains incredible provisions for women, children, and families, the Medicaid coverage extension for postpartum women is one to highlight.

Current Medicaid Policy for Postpartum Coverage

Prior to the passage of the American Rescue Plan Act of 2021, federal law requires all states to provide Medicaid eligibility for pregnant women with incomes up to 138% of the federal poverty line (FPL) - note the vast majority of states provide eligibility beyond the 138% FPL.

This is often referred to as “pregnancy Medicaid.” This coverage must last through 60 days postpartum with the infant eligible for Medicaid for the first year after birth.

At the conclusion of the 60 days, mothers with incomes up to 138% of the FPL and who reside in a state that has expanded Medicaid under the Affordable Care Act (ACA) can retain their coverage. Mothers with incomes above the 138% FPL may qualify for health insurance subsidies under the ACA marketplace. Mothers residing in the 12 non-Medicaid expansion states are left with little coverage options as Medicaid income eligibility criteria for parents is much lower and enrolling in the ACA marketplace would be prohibitively expensive.

This policy has left mothers in a “coverage gap”—incomes above the Medicaid eligibility criteria, but not low enough to warrant subsidized health insurance through the ACA marketplace. Many congressional attempts to address this gap have remained unsuccessful.

Modifications To Address Coverage Gaps for Pregnant and Postpartum Women

The COVID-19 pandemic has proved to be a perfect storm for lawmakers to address longstanding federal programmatic funding issues. Section 9812 within the American Rescue Plan Act of 2021 has finally addressed this coverage gap for mothers, giving states the new option of extending postpartum Medicaid coverage for 12 months.

Matching Federal Funds

States that are interested in extending postpartum coverage an additional 10 months will have to submit a Medicaid state plan amendment in order to receive the additional matching funds from the federal government. These matching funds will enable more states to expand their Medicaid programs to extend postpartum coverage for mothers. Prior to this provision, the federal government only provided matching funds for 60 days, making it difficult for states to expand their Medicaid postpartum coverage without additional funding from the federal government. This coverage extension option is available to states for 5 years, beginning with the start of the first calendar year quarter, one year after enactment.

Closing Gaps for SOME Mothers

Medicaid is the largest single-payer of maternity care in the U.S. Approximately 2 million people each year are covered by Medicaid for pregnancy with an astounding 45% becoming uninsured after the 60 days postpartum coverage ends. As the United States continues to face a maternal mortality crisis, the ability to have sustained access to critical health care services 12 months postpartum brings us one step closer to ensuring mothers across the nation are cared for.

Sadly, the majority of moms in need reside in states who haven’t expanded Medicaid and those same states are likely to not take advantage of this matching fund application process.

Though this is an incredible step in the right direction, it’s going to take continued advocacy and illustration that a mandate to extend Medicaid is good for the health of the nation, not just for direct beneficiaries.

We are grateful for the groundwork and at the same time remind ourselves, where we live shouldn’t matter, all women should have access to coverage and healthcare.