April 15, 2021 – This week is Black Maternal Health Week. Founded and led by the Black Mamas Matter Alliance, the week is meant to foster discussion and awareness of Black maternal health, center the voices of Black birthing people and families, and amplify community-driven policy and practice solutions. Maternal mortality and morbidity are growing health crises in the United States. While the majority of pregnancy-related deaths are preventable, they are increasing at an alarming rate. Black birthing people are three times more likely to die from pregnancy-related complications, regardless of income or education. For every person who dies of pregnancy complications, at least 70 suffer from severe illness or disability, with a rate of approximately two times more for Black people who give birth than white people.

Maternal health disparities are rooted in structural racism, resulting in poorer access to quality care for Black, Indigenous and other People of Color (BIPOC). Policy solutions that focus on reducing these racial inequities in maternal health will not only help close the gap in access and outcomes but improve the health of all birthing people. Over the past year, Health Care For All has met with amazing community advocates, policymakers and other stakeholders who have been fighting for maternal health equity for years. In listening to the work that has been done and areas others are leading, we tried to find a space where we could be helpful. One area that stood out – Medicaid postpartum coverage.

Medicaid plays an important role in improving maternal and perinatal outcomes. Timely postpartum visits provide an opportunity to address both pregnancy-related and chronic physical health conditions, such as diabetes and hypertension; mental health, including postpartum depression; substance use disorders; as well as help individuals connect with health-related social needs and parenting supports. Under current federal rules, pregnant and birthing individuals who are eligible for Medicaid on the basis of their pregnancy only receive coverage during their pregnancy and 60 days postpartum. Yet, there is ample research to show that 60 days of postpartum coverage is not a sufficient period to address the medical and behavioral health needs of birthing people. While Massachusetts has expanded Medicaid and subsidized health coverage to more low-income residents, many postpartum individuals may experience disruptions in coverage and care under current eligibility rules.

After years of advocacy led by Black women and birthing people, policymakers at the federal and state levels are beginning to take action to create pathways to continuous coverage for postpartum individuals. Beginning in April 2022, the American Rescue Plan provides a state option to extend Medicaid coverage for 12 months. Some states are proposing 1115 waivers to implement this policy now, as a bridge until the state option is available next year. Just this week, the Centers for Medicare and Medicaid Services (CMS) approved its first waiver – from Illinois – to extend postpartum coverage to 12 months. The White House Proclamation on Black Maternal Health Week also includes an announcement of this waiver approval and additional investments aimed at reducing maternal mortality and morbidity.

On the state level, Representative Miranda and Senator Lovely filed legislation to require MassHealth to file an 1115 waiver that extends postpartum coverage from 60 days to 12 months and ensure coverage equity for immigrant birthing people. This bill is one of Health Care For All’s top legislative priorities for the 2021-2022 legislative session. In addition, MassHealth recently announced its proposal to extend postpartum coverage as part of an 1115 waiver amendment. Health Care For All strongly supports this proposal and is hopeful that once filed, CMS will approve the waiver amendment quickly.

Coverage changes alone cannot address deep-seated racism, bias and inequities in maternal health care and outcomes, especially for Black birthing people. Medicaid has a significant role in providing health coverage for BIPOC individuals, and extending continuous coverage for a full year could provide more stable access to care during a critical time as well as provide a foundation for further structural reforms that address longstanding maternal racial health inequities

Suzanne Curry, Behavioral Health Policy Director