To thrive, babies need healthy moms. That's the uncomplicated yet powerful argument for a vital health reform Minnesota lawmakers should swiftly pass — extending postpartum coverage for new mothers enrolled in the state's Medical Assistance program.
Instead of letting medical benefits for many expire 60 days after giving birth, coverage should continue for a year. While the value of prenatal care has long been recognized, there's growing understanding of the pregnancy-related risks mothers face in the critical months after delivery.
Complications can include bleeding, infection, blood clots and heart conditions. About 700 women die annually in the United States from pregnancy-related conditions that are largely preventable, according to a 2018 federal report. Close to 20% of these deaths occur 45 days to a year after birth.
Sadly, the yearly death toll likely underestimates the number who die in this time period. Although many new moms struggle with depression, the estimate doesn't include deaths from suicide or substance use disorder, according to a March 18 letter sent to federal health officials by the American College of Obstetricians and Gynecologists (ACOG).
In addition, the ACOG letter noted, "for every individual who experiences a maternal death, it is estimated that 50 to 100 experience severe maternal morbidity." The latter term refers to serious but nonfatal related complications. It's little wonder ACOG concluded that the United States is in the midst of "maternal health crisis."
One solution with support from ACOG and myriad other experts is ending the 60-day cutoff that many enrollees face. The 60-day expiration occurs because income-based eligibility for medical assistance is more generous for pregnant women. It reverts back two months after birth, forcing women to find other coverage options, such as costly private insurance or going without. (Thankfully, medical assistance continues to cover the baby during this critical time period.)
In Minnesota, there's another public program for women who make too much to stay on Medicaid but too little to comfortably afford private insurance. It's called MinnesotaCare, and it's an excellent option. But navigating another program's enrollment is likely daunting for sleep-deprived parents struggling to take care of a newborn, older children or other responsibilities.
Keeping new moms on the same public program as their infant for a year would minimize red tape and help ensure seamless coverage, said state Rep. Kelly Morrison, DFL-Deephaven. Morrison is also a physician who specializes in obstetrics and gynecology. She's the lead author on a bill, HF 521, that takes advantage of a new opportunity to accomplish this.
Tucked inside the federal American Rescue Plan legislation passed this month is a provision that both encourages states to extend postpartum coverage for medical assistance enrollees and provides an expressway for federal approval to do so. Morrison's bill, if passed, directs the Minnesota Department of Human Services (DHS) to seek this approval, with extended coverage potentially beginning in 2022. The feds have to sign off because the state and federal governments jointly fund the program. The Biden administration would very likely look favorably upon such an expansion.
If the coverage is extended, DHS estimated that 1,145 women per month would be "newly covered" by medical assistance in Minnesota. The state's cost is estimated at $9.2 million for the 2022-23 biennium and then $29.3 million for the next two-year budgeting cycle.
In an era marked by divisiveness, the well-being of new moms and their babies should inspire cooperation to pass this important legislation. Another powerful incentive: Black and American Indian women are at significantly higher risk of dying from pregnancy-related complications. Extending coverage is a chance to take meaningful action to end those heartbreaking disparities and help young families thrive.