Women make up about 36% of persons covered by Medicaid, including more than 16 million women of reproductive age. Roughly two-thirds (67%) of adult women on Medicaid are in their reproductive years (19 to 49), and Medicaid accounts for 75% of public family planning dollars. Medicaid is also the largest single payer of maternity care in the U.S., covering nearly half of all of U.S. births and playing a critical role in ensuring healthy moms and babies.

Medicaid is a state-federal program, meaning that states can determine qualifying income levels and can make various policy changes to their respective Medicaid program, so long as they comply with federal Medicaid statute. Visit CMS’ Resources for States to learn more about what your state Medicaid program covers and how your patients may qualify.

The Impact of the ACA

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. Additionally, the Affordable Care Act allowed states to expand Medicaid coverage, required that contraceptive services be included in essential health benefits, and prohibited discrimination based on pre-existing conditions or sexual orientation. Visit ACOG’s Patient Coverage Protections page to learn about how the ACA is a women’s health success story and what we are doing to build upon it.

Medicaid Reforms and 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. Section 1115 waivers are federally required to be "budget neutral."

States waivers may restrict or limit access, add conditions to the receipt of care, and/or alter the underlying financing of care itself. States can also seek to extend postpartum coverage through section 1115 waivers. ACOG supports the use of waivers to expand access to meaningful coverage and opposes efforts to use waivers to restrict access to coverage or shift costs to enrollees.

Extend Medicaid Coverage to One Year Postpartum

Individuals with pregnancy-related Medicaid coverage typically lose their benefits 60 days after the end of pregnancy.

The American Rescue Plan Act allows states another options outside of the 1115 waiver to extend Medicaid coverage, the State Plan Amendment, or SPA. This is similar to a Section 1115 waiver, as it requires federal approval and involves a funding match rate but does not require a public comment period and can therefore be implemented quicker. The states who have already received approval for their SPAs will be able to implement this coverage on April 1, 2022.*

Find more information on how your state can implement a SPA for 12-month postpartum coverage.

To learn more about ACOG's ongoing policy work at the state and federal level to extend postpartum coverage, see our Extend Postpartum Medicaid Coverage page.

Qualified Providers

Medicaid’s federal "any willing provider" and "freedom of choice" protections 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.

*Note: States have been required to provide continuous Medicaid coverage through the end of the month in which the national Public Health Emergency ends.

For questions or assistance with Medicaid policies, visit ACOG’s Payment Advocacy and Policy Portal.