Ending the Public Health Emergency Could Prove Disastrous for New Moms on Medicaid

For many pregnant people and new moms who qualify for Medicaid, the crisis of COVID is far from over, and the end of pandemic-era flexibilities could mean disaster.

Clara Sharp, left, and Sonja Watley, right, both doulas, visit expectant mother Claire Littleton, center, who is on Medicaid, at her home in Minneapolis. Almost half of all U.S.S births are covered by Medicaid, but generally, those who enter the program while pregnant are dropped from coverage just 60 days after giving birth. (Leila Navidi / Star Tribune via Getty Images)

Earlier this month, the Senate narrowly passed a bill that would end the national emergency declaration for the pandemic after two years. Next month, the nationwide public health emergency—which Health and Human Services Secretary Xavier Becerra extended earlier this year—is set to end as well. While the steadily falling case numbers are encouraging, these measures suggest that we are, finally, safe from the pandemic and its far-reaching impacts. But for many pregnant people and new moms who qualify for Medicaid, the crisis is far from over, and the end of pandemic-era flexibilities could mean disaster.

Almost half of all births in the country are covered by Medicaid, but generally, those who enter the program while pregnant are dropped from coverage just 60 days after giving birth. The extension of the public health emergency has protected Medicaid enrollees from being dropped from the program, allowing moms to retain insurance for themselves and their babies during the critical postpartum period. When this protection is lifted, hundreds of thousands of new mothers could be left without the coverage and care they desperately need.

The U.S. already struggles to support and care for pregnant people and new moms—it has the worst maternal mortality rate when compared to other similarly developed countries. Black women bear the brunt of this crisis, dying from pregnancy-related causes at three times the rate of white women. The majority of these deaths are preventable, and about a third of them occur during the postpartum period. 

New data just released by the CDC show that the pandemic has only made matters worse: The maternal mortality rate among Black women increased by 26 percent in 2020. Black women are at increased risk of death due to COVID-19 when compared to other demographic groups, and the virus can cause a myriad of complications for pregnant people, including increased risk of preterm birth and stillbirth.

In 2020, I examined the impact of Medicaid coverage loss for new mothers after giving birth. In my research, I centered the experiences of mothers of color, as they make up a disproportionate share of Medicaid enrollees, face the most challenges when trying to access healthcare, and are most likely to experience poorer maternal health outcomes. 

The impact of Medicaid coverage loss during the postpartum period was clear: New mothers lacked the care and support they were afforded while on insurance, including critical services such as mental healthcare, contraception and family planning and lactation support. For mothers grappling with substance use disorders and other social support needs, they no longer had access to a care coordinator who helped to ensure continuity of care in high-need situations. 

Loss of coverage also led to an increase in out-of-pocket costs associated with healthcare services, which further entrenched mothers with low incomes into economic hardship. Disruptions in coverage caused critical health concerns to go unaddressed, leading to poor health outcomes for both mom and baby. 

While the Families First Coronavirus Response Act requires states to provide continuous coverage under the Medicaid program until the public health emergency ends, some states have taken action to extend postpartum Medicaid coverage for new mothers through Section 1115 waivers and state legislation. To date, five states have approved waivers and 15 states have enacted legislation extending postpartum coverage. This is certainly progress, but a permanent solution must be put into place in order to eliminate the patchwork of coverage currently seen across states. Continuous Medicaid coverage should be afforded to every mom, no matter her zip code.

In March of last year, President Biden took a first step toward ensuring coverage when he signed into law the American Rescue Plan Act, which gave all states the temporary option to extend postpartum Medicaid for twelve months through state plan amendment. But it’s not enough—a mandatory and permanent solution is still desperately needed, now more than ever as new moms face the impacts of both the pandemic and the maternal health crisis combined. 

The version of the Build Back Better Act that passed out of the House in November included historic investments to support mandatory and permanent extension of Medicaid postpartum coverage for 12 months. As Congress works to determine which pieces of Build Back Better will make it into a future package, it’s critical that the Medicaid postpartum coverage extension remain a priority (not to mention the other historic investments in maternal health included in the Build Back Better Act). 

The end of the public health emergency could prove catastrophic as new mothers and their families are left vulnerable to disruptions in insurance coverage and an unmet need for vital healthcare. And for Black moms who are dying of needless and preventable pregnancy-related deaths, as well as grappling with the increased likelihood of contracting COVID-19, the situation could not be more dire.  

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Dr. Jamila K. Taylor is director of health care reform and senior fellow at The Century Foundation, where she leads TCF’s work to build on the Affordable Care Act and develop the next generation of health reform to achieve high-quality, affordable, and universal coverage in America. A renowned health policy expert, Taylor also works on issues related to reproductive rights and justice, focusing on the structural barriers to access to health care, racial and gender disparities in health outcomes, and the intersections between health care and economic justice.