March 10, 2022 – Last week, the state Senate unanimously passed An Act relative to expanding equitable access to maternal postpartum care (S.2731). The bill, sponsored by Senator Joan Lovely, extends postpartum MassHealth coverage from 60 days to 12 months. This policy change will help ensure that all eligible pregnant and birthing individuals, including immigrants, receive the care they need during a critical time. The bill aligns with current efforts on the state and federal level, consistent with MassHealth’s intended approach and recent federal action. Passage of this bill would codify the policy in state statute to ensure it continues under future administrations. HCFA is hopeful that the full legislature will take swift action this session to enact S. 2731.
Creating an equitable and safe maternal health system for pregnant and birthing people is long overdue. Today, maternal mortality and morbidity continue to grow at an alarming rate, especially for Black, Indigenous and People of Color (BIPOC). The statistics are staggering, yet many of these deaths are preventable. Despite advancements in medical care, around 700 people die each year nationally from causes related to pregnancy and childbirth. Nearly two thirds of these deaths are preventable. Approximately one third of deaths occur during pregnancy, over half occur during labor or within the first week of postpartum and another 13% occur between six weeks and one year. For every person who dies from pregnancy-related causes, 70 suffer from severe illness or disability.
The maternal crisis is also one of racial inequities. National data shows that Black women are three times more likely to die than white women, and American Indian/Alaska Native (AIAN) women are twice as likely. In addition, Black and Hispanic women are at significantly higher risk for severe maternal morbidity, such as preeclampsia—a serious blood pressure condition— which is significantly more common than maternal death. In Massachusetts, Black birthing people are two times more likely to die than their white counterparts from pregnancy-related complications. Further, a higher prevalence of postpartum depressive symptoms was observed among Black non-Hispanic and Asian non-Hispanic mothers as compared to white non-Hispanic mothers. Although the factors driving these disparities are complex, decades of longstanding structural and systemic barriers rooted in racism and discrimination have played a major role in shaping these health disparities.
While improving maternal health outcomes requires a multifaceted approach, adequate and consistent coverage through Medicaid is one part of the overall solution. Medicaid helps birthing people access critical postpartum visits that can help not only address pregnancy-related issues, but also longer-term health conditions. Perinatal care – before and after a pregnancy – is a critical time for birthing people to work with their providers on chronic disease management, such as for diabetes and hypertension, and receive support for mental health issues and/or substance use disorders. While Massachusetts has expanded Medicaid and subsidized health coverage to many low-income residents, it is common for postpartum individuals to experience disruptions in coverage and care under current eligibility rules that end postpartum coverage after 60 days.
Maternal health matters for the birthing person themselves, their families and their communities. Extending MassHealth postpartum coverage will promote continuity of care and uninterrupted support for birthing people during a vulnerable and sometimes risky time after delivery. This will help avert crisis situations, the development of intensive longer-term conditions and potential mortality.
Yaminah Romulus is the Policy Manager at Health Care For All.