States rolled out their extended Medicaid coverage for pregnancy-related care on April 1. The change allows people who gave birth to access care up to one year after they deliver — a step up from the federal minimum of 60 days. 

Medicaid provides coverage for more than 40% of U.S. births. Black mothers, in particular, are overrepresented. 65% of their births are insured through the public healthcare program. 

While Black mothers access Medicaid most, they’re also dying from pregnancy-related issues more than other groups. The Centers for Medicare and Medicaid (CMS) says the 10-month coverage extension is an opportunity to improve these outcomes, as many of the deaths are preventable. 

“The newly extended postpartum coverage option offers states an opportunity to provide care that can reduce pregnancy-related deaths and severe maternal morbidity and improve continuity of care for chronic conditions such as diabetes, hypertension, cardiac conditions, substance use disorder, and depression,” CMS wrote in a statement. 

Medicaid’s standard policy provides birthing people with 60 days of support following childbirth. During this time, depending on the state they live in, the new parents can access a six-week postpartum visit, mental health screening, and lactation consultation. 

But once the 60 days are over, they’re dropped. This creates a “coverage gap,” where low-income people don’t have access to medical and behavioral care because their states haven’t extended Medicaid coverage. 

While coverage may end at 60 days, complications don’t stop there. More than half of pregnancy-related deaths occur sometime during the first year after birth. And 12% happen after six weeks. 

“That 60-day cutoff is based on a false belief that pregnancy-related complications end then,” Dr. Charlene Collier, an OB-GYN at the University of Mississippi Medical Center in Jackson, Mississippi, and chair of the state’s Mortality Review Committee, told the Pew Charitable Trusts

“Now we know those complications extend through the end of the first year.”

Black women are three and a half times more likely to die six weeks to one year after childbirth than white women. 

Heart conditions, infection, and mental health conditions — including substance abuse and suicide — are the most common causes of maternal death in the postpartum period, according to the Commonwealth Fund

Based on a study conducted by examining death certificates, Black women are three and a half times more likely to die six weeks to one year after childbirth than white women. 

Additionally, postpartum cardiomyopathy was the leading cause of late maternal death among all groups. Black women were six times more likely than white women to suffer from it.

The American Rescue Plan Act of 2021 made it possible for all states to extend postpartum healthcare access up to one year, but it’s optional. States must apply for a State Plan Amendment (SPA) or a Section 1115 waiver to make it available. 

When states choose the SPA route, the coverage extension also applies to birthing people enrolled in the Children’s Health Insurance Program (CHIP). 

So far, Georgia, Missouri, Illinois, Virginia, and New Jersey are approved through 1115 waivers. 

Several states and the District of Columbia have enacted legislation for federal approval through SPA or 1115 waiver; which include California, Washington, Colorado, Texas, Minnesota, Wisconsin, Indiana, Ohio, West Virginia, Maryland, Connecticut, Maine, South Carolina, and North Carolina. 

Oregon, Arizona, Alabama, Kentucky, Hawaii, and New Hampshire are pending legislation for federal approval through SPA or 1115 waiver. 

New Mexico, Michigan, Pennsylvania, and Massachusetts plan to submit a SPA or 1115 waiver. Meanwhile, Florida has a pending 1115 waiver. 

The year-long postpartum coverage is available to states for only five years. After that, it will expire — unless there’s a move on behalf of Congress to extend it or make it permanent. 

“Our country is facing a maternal health crisis, and it is disproportionately harming people of color,” CMS Administrator Chiquita Brooks-LaSure said in a statement following the extension in New Jersey. “Access to postpartum care is critical to keeping our nation’s families healthy.”