Reducing Cardiovascular Maternal Mortality by Extending Medicaid for Postpartum Women

Abstract

Maternal mortality has been increasing in the United States over the past 3 decades, while decreasing in all other high‐income countries during the same period. Cardiovascular conditions account for over one fourth of maternal deaths, with two thirds of deaths occurring in the postpartum period. There are also significant healthcare disparities that have been identified in women experiencing maternal morbidity and mortality, with Black women at 3 to 4 times the risk of death as their White counterparts and women in rural areas at heightened risk for cardiovascular morbidity and maternal morbidity. However, many maternal deaths have been shown to be preventable, and improving access to care may be a key solution to addressing maternal cardiovascular mortality. Medicaid currently finances almost half of all births in the United States and is mandated to provide coverage for women with incomes up to 138% of the federal poverty level, for up to 60 days postpartum. In states that have not expanded coverage, new mothers become uninsured after 60 days. Medicaid expansion has been shown to reduce maternal mortality, particularly benefiting racial and ethnic minorities, likely through reduced insurance churn, improved postpartum access to care, and improved interpregnancy care. However, even among states with Medicaid expansion, significant care gaps exist. An additional proposed intervention to improve access to care in these high‐risk populations is extension of Medicaid coverage for 1 year after delivery, which would provide the most benefit to women in Medicaid nonexpanded states, but also improve care to women in Medicaid expanded states.

Call for Action to Address Increasing Maternal Cardiovascular Mortality in the United States: Strategies for Improving Maternal Cardiovascular Care

“…1 In Medicaid nonexpanded states, eligibility levels for new mothers range between 17% and 100% of the Federal Poverty Level. 1 Thus, many women experience a sudden loss of health care coverage after delivery, with the greatest number of women affected in Medicaid nonexpanded states. 1 The postpartum period is recognized as critical for consolidating care, cardiovascular screening, patient education, and management of chronic cardiovascular conditions.…”

“…1 Thus, many women experience a sudden loss of health care coverage after delivery, with the greatest number of women affected in Medicaid nonexpanded states. 1 The postpartum period is recognized as critical for consolidating care, cardiovascular screening, patient education, and management of chronic cardiovascular conditions. 1,2 Improved, multidisciplinary postpartum care has the potential to prevent late postpartum cardiovascular deaths (attributable primarily to cardiomyopathy); to improve interpregnancy cardiovascular health, thereby optimizing subsequent pregnancy outcomes; and to modify long-term risk, resulting in increased lifelong cardiovascular health.…”

“…1,2 Improved, multidisciplinary postpartum care has the potential to prevent late postpartum cardiovascular deaths (attributable primarily to cardiomyopathy); to improve interpregnancy cardiovascular health, thereby optimizing subsequent pregnancy outcomes; and to modify long-term risk, resulting in increased lifelong cardiovascular health. 1,2 Standardization of optimized postpartum care is complicated by the sudden loss of Medicaid coverage by many women and by current bundled payment models that do not provide financial incentive for multiple postpartum visits. 1 In addition to Medicaid expansion in the remaining 12 states, Medicaid extension to provide 1 year of postpartum coverage has been proposed as one solution to increase health care delivery during this high-risk time.…”

“…1 In addition to Medicaid expansion in the remaining 12 states, Medicaid extension to provide 1 year of postpartum coverage has been proposed as one solution to increase health care delivery during this high-risk time. 1 The option for postpartum Medicaid extension was passed by Congress as a part of the American Rescue Plan Act. 1 Currently, at least 25 states have taken some action to extend postpartum Medicaid coverage beyond 60 days.…”

“…1 The option for postpartum Medicaid extension was passed by Congress as a part of the American Rescue Plan Act. 1 Currently, at least 25 states have taken some action to extend postpartum Medicaid coverage beyond 60 days. The Black Maternal Health Momnibus Act of 2020 is also expected to address several of the aforementioned concerns, including investing in social determinants of health that influence maternal health outcomes, improving the diversity and multidisciplinary nature of the perinatal workforce, providing support for maternal mental health, investing in digital tools including telehealth, and promoting innovative payment models.…”