As of November 2024, 46 states and the District of Columbia are newly providing 12 months of Medicaid/Children’s Health Insurance Program (CHIP) coverage after the end of pregnancy for eligible individuals, regardless of changes in income or need to undergo eligibility redetermination. This brief examines the implementation of postpartum coverage extensions in five states (New Jersey, New Mexico, Ohio, South Carolina, and Virginia) and identifies key considerations for ensuring extended coverage translates to the use of comprehensive services.

Why This Matters

The United States is experiencing a maternal health crisis, with severe racial and ethnic inequities in maternal mortality rates. Because over half of pregnancy-related deaths occur up to one year after giving birth and most deaths are preventable, increasing health care access in the postpartum period could improve maternal health. Underserved populations and people of color rely disproportionately on Medicaid and CHIP for pregnancy-related health care, highlighting the potential of Medicaid/CHIP postpartum coverage extensions to improve maternal health and reduce racial disparities in maternal outcomes.

Key Takeaways

The study states launched promising initiatives to support continuity of care, incorporated extended coverage into existing maternal health programs, and explicitly prioritized equity as part of postpartum coverage extensions. But we found limited communications and outreach about postpartum coverage extensions to enrollees, providers, and other maternal health stakeholders, which could dampen the potential positive effects of extended coverage. Study participants reported pregnant and postpartum people face ongoing challenges to accessing care and suggested several priorities for strengthening the health care delivery system and leveraging managed care authorities to support the health and well-being of postpartum people under postpartum Medicaid extensions:

• Expanding communication and education about extended postpartum coverage and available services to Medicaid enrollees, health care providers, and other key maternal health stakeholders.
• Improving quality and utilization of postpartum care and reducing barriers to care, such as by educating pregnant people about postpregnancy health and wellness, increasing the comprehensiveness and frequency of postpartum check-ups, addressing mistrust and other barriers to health care, and increasing availability of integrated care models for mom-baby dyads.
• Supporting access and continuity of care throughout the postpartum year with a focus on equity by ensuring postpartum people’s access to comprehensive physical, behavioral, and social support services and tailoring care to people at the highest risk of poor maternal health outcomes, such as Black mothers and those living in underresourced communities.
• Strengthening accountability mechanisms for managed care organizations (MCOs) by (1) leveraging managed care contracts to require that MCOs ensure access to comprehensive services and reduce maternal health disparities in the perinatal period and (2) monitoring and publicly reporting on MCO performance against their contract obligations and quality measures.
• Monitoring and refining implementation, including collecting and acting on input from enrollees, providers, and advocates to ensure postpartum extensions optimally meet enrollees’ needs.

How We Did It

We reviewed relevant published literature and conducted interviews with 37 Medicaid and maternal health stakeholders at the national level and in the study states, including state Medicaid and public health officials, health plan and provider representatives, maternal health and birth equity advocates, and state maternal morbidity and mortality review committee members.