AMA Backs Extending Medicaid to 12 Months After Childbirth

Marcia Frellick

June 14, 2019

CHICAGO — Women are only covered by Medicaid for 60 days after giving birth in 19 states, leaving them vulnerable to pregnancy-related health challenges that often arise many months later, delegates heard here at the American Medical Association (AMA) 2019 Annual Meeting.

"In our current system of care, the baby is the candy and the mother is the wrapper," said Alison Stuebe, MD, from the University of North Carolina at Chapel Hill. "Once the candy is out of the wrapper, the wrapper is cast aside."

Because states can decide whether or not to extend coverage after 60 days, and many have widely varying policies, AMA delegates voted on Thursday to adopt a policy recommending the nationwide extension of postpartum Medicaid coverage to 12 months.

"Medicaid covers nearly half of all births and plays a critical role in ensuring the health of mothers and babies. As physicians, we know new mothers' medical needs extend beyond Medicaid's current coverage period, and a longer coverage period would offer a healthier start for America's families," Willarda Edwards, MD, a member of the AMA board of trustees, said in a statement.

Extending coverage is "an important step toward a medical system that values the health and wellbeing of women," said Stuebe. She noted that the policy recommendation from the AMA aligns with ongoing efforts of the 4th Trimester Project, which she coleads.

As physicians, we know new mothers' medical needs extend beyond Medicaid's current coverage period.

"I am hopeful that the collective voice of America's physicians will ensure that policy makers who care about mothers and children will extend pregnancy Medicaid for at least 12 months postpartum," she told Medscape Medical News.

Stuebe and her colleagues detailed the challenges that women on Medicaid face after giving birth in a recent report in Health Affairs.

They explain that four in 10 mothers on Medicaid don't have a postpartum visit and don't get care for problems such as postpartum depression and breast-feeding issues. "When women do attend a postpartum visit, fewer than half report getting enough information about nutrition, exercise, and how long to wait before getting pregnant again," they add.

Returning to work is often problematic. For women in the lowest 10% income bracket, "just 4% have access to paid parental leave, and 31% have access to sick leave," the authors report.

The nation's maternal mortality rate is the highest in the developed world (Health Aff [Millwood]. 2018;37:140-149). In fact, as maternal mortality declined by 44% globally from 1990 to 2015, it increased in the United States by 26.6%, according to the World Health Organization.

Highest Maternal Mortality Rates in the Developed World

Since 1987, the rate of pregnancy-related deaths in the United States has more than doubled, according to Health Resources and Services Administration. And severe maternal morbidity has increased by about 75% over the past 10 years.

"Maternal mortality in the United States deserves the full attention of America's healthcare providers and policymakers," said Ted Anderson, MD, PhD, president of the American College of Obstetricians and Gynecologists (ACOG). "The US Centers for Disease Control and Prevention has found that one in three pregnancy-related deaths occurred between 1 week and 1 full year after birth; this figure does not include deaths related to suicide or overdose, which are a leading cause in pregnancy-related deaths in a growing number of states."

Anderson praised the AMA action. "ACOG is pleased that our physician colleagues from across specialties and around the country have joined ob-gyns in speaking out in support of extending Medicaid coverage to 12 months postpartum. There is clear value in helping women receive reliable postpartum healthcare beyond the 60 days that are currently covered."

Stuebe, Edwards, and Anderson have disclosed no relevant financial relationships.

American Medical Association (AMA) 2019 Annual Meeting. Presented June 12, 2019.

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