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More than 16 million women of reproductive age are covered by the Medicaid program. Medicaid is the largest single payer of maternity care in the U.S., covering more than 40% of U.S. births and playing a critical role in ensuring healthy moms and babies.

Medicaid accounts for 75% of public family planning dollars, every $1 of which saves Medicaid $7.09. The Affordable Care Act’s Medicaid expansion reduced the uninsured rate among women ages 18-64 by nearly half, from 19.3% to 10.8% in 5 years.

ACOG advocates for:

  • Access to meaningful coverage for low-income women
  • Appropriate reimbursement for physicians in the Medicaid program
  • Extension of pregnancy-related Medicaid coverage to one-year postpartum

ACOG opposes state and federal reforms aimed at reducing participation in the Medicaid program and establishing barriers to care.

Extend Medicaid Coverage One Year Postpartum

Women with pregnancy-related Medicaid coverage typically lose their benefits 60 days after birth.

Our nation’s rate of maternal mortality is rising, and a growing body of evidence shows that many of these deaths, particularly from preventable causes such as overdose and suicide, occur after pregnancy-related Medicaid coverage ends.

There is growing consensus, including by state maternal mortality review committees, that extending Medicaid coverage would ensure that medical and behavioral health conditions can be managed and treated before becoming progressively severe.

ACOG advocates at the state and federal level to enable all women whose pregnancies are covered by Medicaid to keep their Medicaid coverage for one year postpartum, including the full range of appropriate services such as case management and outreach, substance use disorder treatment services, and mental health screening.

State Efforts to Extend Medicaid Coverage for Pregnant Women Beyond 60 Days Postpartum

(through December 31, 2019)

This map demonstrates recent state action to extend Medicaid coverage for pregnant women beyond 60 days after the end of pregnancy. For pregnant women, Medicaid coverage is time-limited. Federal law requires states to provide postpartum coverage for 60 days after delivery. Once postpartum coverage ends, many women enter a period of uninsurance. This applies to women in states that expanded Medicaid coverage under the Affordable Care Act (ACA) and states that did not. Nearly half of women in ACA non-Medicaid expansion states and nearly one in three women in ACA Medicaid expansion states experience an insurance disruption from prepregnancy to postpartum.This is especially concerning given that one in three pregnancy-related deaths occur in the postpartum period.Giving pregnant women continuous Medicaid coverage for at least one year postpartum can help improve maternal health outcomes. 

For more information on actions you can take to extend Medicaid coverage in your state, contact ACOG at stateleg@acog.org and follow @ACOGaction. Methodology: To be included on this map, states must have taken legislative and/or regulatory action in 2019 to extend Medicaid coverage for pregnant women beyond 60 days postpartum. This may include introducing and/or passing legislation, drafting/submitting a Section 1115 Waiver, or releasing budget details. The information on this map will be updated monthly. If you feel action in your state has been misrepresented, please email stateleg@acog.org

The information below is meant to summarize legislative and regulatory action in 2019 to implement a postpartum coverage extension. For more information on a particular state, please email stateleg@acog.org.

Passed in 2019 Not Adopted/Approved in 2019 Pending for 2019/2020
  • CA (state only
    funds; July 2020
    implementation)
  • IL
  • MO
  • NJ (state only
    funds; January 2020
    implementation)

Legislation

  • TX
  • WI

Waivers

  • SC

Legislation

  • DC
  • PA
  • TN
  • VA
  • WV

Waivers

  • IL
  • MO

1“High Rates of Perinatal Insurance Churn Persist After The ACA, “ Health Affairs Blog, September 16, 2019. DOI: 10.1377/hblog20190913.387157
2Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;68:423–429.

Medicaid Reforms/1115 Waivers

States historically utilized Medicaid Section 1115 waivers to create or test innovative demonstration programs to expand care to new populations, offer new services, and deliver care in alternative settings. Waivers have been both broad, affecting large segments of the Medicaid program, and narrow, focused on specific populations or services.

Recently, states have sought waiver authority to restrict or limit access, condition the receipt of care on meeting standards outside of the objectives of the Medicaid program, and/or alter the underlying financing of care itself, shifting financial risk to enrollees.

ACOG supports the use of waivers to expand access to meaningful coverage for low-income women and opposes efforts to use waivers to restrict access to coverage or shift costs to enrollees.

Qualified Providers

Medicaid’s federal “any willing provider” and “freedom of choice” protections were enshrined in law to ensure that there are enough providers to care for Medicaid beneficiaries. Legislative or regulatory attempts to deny or restrict provider participation in the Medicaid program would jeopardize access to primary and preventive care for millions of Americans.

ACOG opposes efforts to limit access to qualified women’s health care providers.