Mothers have suffered tremendously during the pandemic. They have lost jobs at a higher rate than fathers and have borne the brunt of caregiving and virtual learning activities in many families. Pregnant women and new mothers have had to navigate virtual prenatal and postpartum care, and many have had more limited support from family and friends because of hospital policies and social distancing guidelines.

But with the passage of the American Rescue Plan Act, many new mothers and other birthing people can worry less about the possibility of losing their health insurance coverage. The bill contains a much-anticipated provision giving states the option, starting in April 2022, to extend pregnancy-related Medicaid/Children’s Health Insurance Program (CHIP) coverage for a year following the end of pregnancy. Currently, such coverage expires just 60 days after delivery, placing many new mothers at risk of uninsurance during a particularly critical time for mother and baby.

Extensive research evidence suggests this policy change could result in increased coverage and improved health care access and affordability among thousands of new mothers nationwide.

According to Urban Institute research, if every state adopts this new provision, approximately 123,000 uninsured mothers could become newly eligible for Medicaid/CHIP coverage during their infant’s first year. If policymakers in Florida, Georgia, and Texas alone choose to implement this provision, nearly 70,000 uninsured mothers could become newly eligible for postpartum Medicaid coverage. Thousands more covered by more expensive private plans could also benefit if they could instead retain Medicaid/CHIP, and even moms eligible for Medicaid under current policy could benefit from the certainty that their coverage would last a full year regardless of changes in income.

Several factors may limit the effectiveness of the postpartum extension. First, the extension is optional, so how many and which states choose to participate when the option goes into effect in April 2022 will be important. Cost to states may be a significant barrier because the law requires states contribute at their regular match rates, which range from 25 to 50 percent of costs. But, because policymakers in nearly half of states pursued extensions in recent years and several have pending waivers to implement extensions, interest appears high.

Second, more than one in four uninsured new mothers are likely already eligible for Medicaid but not enrolled, indicating that solving enrollment and retention challenges among eligible mothers will be critical. Third, about 30 percent of uninsured new mothers will likely remain ineligible for the extension or any other subsidized coverage because of their immigration status. Finally, this provision would still leave coverage gaps before pregnancy and after the first year postpartum, especially in nonexpansion states.

Despite these potential limitations, this provision represents the culmination of an advocacy campaign supported by a wealth of research evidence. It provides an important example of how evidence can support policy choices that will improve population health and well-being. Hundreds of thousands of mothers and, by extension, their children, could benefit if all states take advantage of the option. This provision does not, however, fully address the devastating maternal health crisis among Black women, nor the immigration restrictions that make so many Hispanic new mothers ineligible for public coverage, so a broader set of policy changes will be necessary to reduce these vast inequities and improve maternal health for all.

Read the full article about postpartum Medicaid by Stacey McMorrow, Jennifer M. Haley, and Emily M. Johnston at Urban Institute.