76 Members Request Immediate Guidance for States to Extend Postpartum Medicaid Coverage

Washington, D.C. – Today, Senators Tammy Baldwin (D-WI), Tammy Duckworth (D-IL), Richard Durbin (D-IL), Cory Booker (D-NJ), and Sherrod Brown (D-OH), as well as Representatives Robin L. Kelly (D-IL), Lauren Underwood (D-IL), Ayanna Pressley (D-MA), Anthony Gonzalez (R-OH), and Jaime Herrera Beutler (R-WA), led a bipartisan group of 14 Senators and 62 House Members and in writing to Centers for Medicare and Medicaid Services (CMS) to request that CMS take immediate steps to implement the new State plan option authority granted by Congress in the American Rescue Plan to provide 12 months of postpartum Medicaid coverage.

“Despite considerable technological advancements and increased spending on maternal health care in recent decades, pregnancy-related deaths in the United States continue to climb,” wrote the Members. “Congress took a critical step to help address the maternal health crisis and close the postpartum coverage gap by creating a new state plan option under Medicaid to extend coverage for individuals from 60 days to one year postpartum.”

“The success of the State plan option is dependent on strong Federal guidance and a meaningful partnership with CMS in regards to adoption, implementation, oversight and evaluation of the program. To help facilitate postpartum coverage extensions across the country, we urge CMS to swiftly issue guidance to State Medicaid programs on this new option.”

Roughly 700 American women die per year from pregnancy-related causes or childbirth, which translates to 17 maternal deaths for every 100,000 live births in the U.S.—more than double the ratio of deaths related to maternal mortality in other high-income countries.

The majority of deaths related to childbirth in the U.S. occur during the postpartum period—between 43 days and 365 days after the end of pregnancy. The danger is even greater for women of color. Black and Indigenous women are two to three times more likely than their non-Hispanic white counterparts to die from a pregnancy-related complication. Senator Baldwin previously helped introduce a historic legislative package to address the United States’ urgent maternal health crisis.

Extending Medicaid coverage for postpartum care is essential to combating the maternal mortality crisis. In 2018, Medicaid paid for nearly half of the nation’s births. The broad consensus of the medical community and state maternal mortality review committees is that Medicaid coverage should be available through the postpartum period of one year.

Full text of the letters is available here and below.

July 26, 2021

VIA ELECTRONIC DELIVERY

The Honorable Chiquita Brooks-LaSure

Administrator

Centers for Medicare and Medicaid Services

200 Independence Avenue, SW

Washington, DC 20210

Dear Administrator Brooks-LaSure:

Congratulations on your recent confirmation as Administrator for the Centers for Medicare and Medicaid Services (CMS). We look forward to working with you to address health disparities, and specifically to reduce our Nation’s dismal maternal mortality rate and the racial, ethnic and economic disparities in maternal health outcomes, and we write to encourage you to take immediate steps to implement the new State plan option authority granted by Congress in the American Rescue Plan to provide 12 months of postpartum Medicaid coverage so that new mothers in States nationwide can be assured of quality, continuous, accessible health care.

While we applaud U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and CMS for the recent approval of Medicaid demonstration waivers to extend postpartum coverage for women who rely on Medicaid for pregnancy-related care, we remain concerned by the maternal health crisis facing our Nation.

Despite considerable technological advancements and increased spending on maternal care in recent decades, pregnancy-related deaths in the United States continue to climb. Roughly 700 American women die per year from pregnancy-related causes or childbirth, which translates to 17 maternal deaths for every 100,000 live births in the U.S. – more than double the ratio of deaths related to maternal mortality in other high-income countries. It is even more distressing that a majority of the deaths related to childbirth in the U.S. occur during the postpartum period – between 43 days and 365 days after the end of pregnancy. The danger is even greater for women of color. Black and Indigenous women are two to three times more likely than their non-Hispanic White counterparts to die from a pregnancy-related complication.^[1]  

In 2018, the Medicaid program paid for nearly half of the Nation’s births.^[2] Under longstanding Federal law, Medicaid eligibility based on pregnancy status has been limited to just 60 days of postpartum coverage. Too many women who rely on Medicaid are forced to forgo access to essential care only 61 days after experiencing a major medical event. A recent study found that half of all uninsured new mothers became uninsured after losing Medicaid just 60 days after giving birth.^[3] The broad consensus of the medical community, led by clinical guidance from the American College of Obstetricians and Gynecologists, is that Medicaid coverage should be available through the postpartum period of one year.^[4][5] This is also the leading recommendation by State maternal mortality review committees. 

Congress took a critical step to help address the maternal health crisis and close the postpartum coverage gap by creating a new state plan option under Medicaid to extend coverage for individuals from 60 days to one year postpartum. Signed into law as part of the American Rescue Plan Act, this provision becomes available to states on April 1, 2022 and is currently slated to sunset after five years.

The success of this policy is dependent on uptake by the States. Fortunately, interest among States in extending postpartum coverage has grown significantly in recent years. On April 12, 2021, Illinois became the first State to offer yearlong postpartum coverage for all Medicaid-eligible individuals after Secretary Becerra announced the approval of Illinois’ waiver. Building on the momentum and model from Illinois, several States have submitted Medicaid demonstration waivers to CMS, seeking authority to extend postpartum coverage. In addition, several States, including California, Florida and Maryland, have passed legislation to implement the State plan option upon its effective date. And other states, including Ohio, have passed legislation obligating their state Medicaid departments to take up this new State option.^[6]

However, the success of the State plan option is also dependent on strong Federal guidance and a meaningful partnership with CMS in regards to the adoption, implementation, oversight and evaluation of the program.

To help facilitate postpartum coverage extensions across the country, we urge CMS to swiftly issue guidance to State Medicaid programs on this new option. We strongly encourage CMS to issue such guidance in the form of a State Medicaid Director Letter, or other similarly effective communication, and accompanied by a toolkit for States to facilitate implementation of the State plan option no later than April 1, 2022. Such communication and toolkit materials should include:

• Considerations around the need for State legislation and financing;
• Options for the States to provide continuous coverage to postpartum women between the end of the COVID-19 public health emergency and the effective date of the State plan option; and
• Other topics of importance as determined by CMS and relevant stakeholders.

One of the top priorities of the United States Congress is to improve the health of our Nation’s mothers, including those covered by the Medicaid program. We look forward to working with you to address our Nation’s maternal mortality crisis. Thank you for your attention to this timely request.

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