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By Elizabeth Thompson
As budget negotiations drag on between the two chambers of the North Carolina General Assembly and the office of Gov. Roy Cooper, maternal health advocates are hoping a “game-changer” bill extending postpartum Medicaid will be included.
A provision in the Senate budget, but not included in the budget created by the House of Representatives, would allow pregnant people with incomes at or below 196 percent of the federal poverty guidelines – about $34,800 for a family of two – to remain eligible for coverage for 12 months postpartum.
Medicaid coverage for pregnant people usually ends after just 60 days, but many pregnancy-related deaths occur 43 to 365 days postpartum, according to the Centers for Disease Control and Prevention.
North Carolina has a maternal mortality rate of 21.9 deaths per 100,000 live births, according to the annual America’s Health Rankings report, which uses CDC data. The United States averages 20.1 deaths per 100,000 live births.
“If this passes, this is going to be a game-changer for new families in North Carolina,” said Sarah Verbiest, a member of the NC Child Fatality Task Force at its Perinatal Health Committee meeting in late September.
Parents can be medically vulnerable following the birth of a child, from health issues that may have been identified during pregnancy to mental health struggles, she said.
As advocates push for Medicaid to be extended for pregnant people, there is something on their side. It’s already happening. Because of an emergency order triggered by the COVID-19 pandemic, coverage has continued for people who have qualified for pregnancy Medicaid at any point during the pandemic.
Really? This is already happening?
Let’s rewind a bit.
As the COVID-19 pandemic began raging across the country in March 2020, the federal government jumped to act, passing the Families First Coronavirus Response Act. As part of this provision, Congress increased funding to state Medicaid programs, as long as they did not cut people off of the program during the public health emergency, said Emily Eckert, health policy manager for the American Colleges of Obstetricians and Gynecologists, which supports extending postpartum Medicaid for pregnant people.
“This federal policy basically waives that 60-day period and says if you were covered for Medicaid for your pregnancy, that you will continue to be covered until the end of this COVID public health emergency,” Eckert said.
Now it’s October 2021, and the public health emergency still isn’t over. Those who have gotten pregnant during the COVID-19 public health emergency and qualified for Medicaid because of that pregnancy have not been disenrolled, said Dr. Velma Taormina, a member of the Child Fatality Task Force at the Perinatal Health Committee meeting.
“This has already been in practice for the last 18 months,” Taormina said.
For new parents living in COVID times, it means that they have less pressure to scramble to find insurance in a pandemic and more time to focus on their baby and new lives.
When the public health emergency ends, so will those pregnancy Medicaid benefits for those who have already passed the 60-day mark.
But, there’s an opening: when the new Biden administration pushed through the American Rescue Plan, that new law included a provision that allows for states to extend pregnancy benefits to new parents for up to a year, starting in April 2022. This means that there’s an opening for North Carolina’s General Assembly to extend pregnancy and postpartum Medicaid coverage once again.
Although a final version of the budget has still not been agreed upon, the Raleigh News & Observer reported that budget writers expect the postpartum Medicaid expansion to be included.
More extensive Medicaid expansion, which would cover people with an income at or below 138 percent of the poverty line, however, is a different story.
“We have done some expansion within this budget,” Sen. Brent Jackson (R-Autryville), who is one of the top budget writers, told The News & Observer. “That is in there.”
Expanding postpartum Medicaid has received bipartisan support. It was originally introduced as a Senate bill by three Republican Sens. Jim Burgin (R-Angier), Joyce Krawiec (R-Kernersville) and Kevin Corbin (R-Franklin). North Carolina Health News reached out to all three senators via email to comment on the provision, but we did not receive a response by the time of publication.
“We believe that most people want to help themselves,” Corbin said at a town hall on Medicaid expansion in North Carolina held earlier this year. “We believe that they want to pull themselves up by the bootstraps and do better, and we’re gonna try to do what we can to help that.”
Extending the postpartum period
Obstetricians and gynecologists have a common saying: “a healthy mother is a healthy baby.” Access to health care before and after pregnancy can reduce infant mortality and preterm birth and improve maternal health, the Commonwealth Fund found.
Not to mention the racial disparities in maternal mortality. Black pregnant people are disproportionately more likely to die from pregnancy-related complications, NC Health News previously reported.
Perinatal care – referring to the time you become pregnant up until a year post-birth – is important for a variety of reasons. It gives providers the opportunity to recognize physical health problems early and take care of new parents’ mental health.
“Pregnancy is a stress test for life,” Verbiest said. Issues such as high blood pressure and diabetes can be identified and treated then, before they can get worse.
“That’s important for that person’s health, regardless of whether or not they’re going to have more children, period,” Verbiest said. “Having access to specialists, getting connected to a primary care provider that can help them manage their health long term is also really important.”
From 2014-2018, over half of the people who gave birth in North Carolina were on Medicaid, according to the North Carolina State Center for Health Statistics. Since North Carolina has not expanded Medicaid, many people are left without insurance when their 60 days are up — or at least they were pre-pandemic.
In North Carolina, parents only qualify for Medicaid if they have an income that is 41 percent of the federal poverty level, or about $6,828 a year for a single mother with a baby. Even if providers recognize and start treating problems in perinatal patients, when they lose Medicaid coverage, they might become uninsured, which disrupts that treatment progress.
“Part of what we do is also help identify higher levels of mental health care for individuals who need it,” said Dr. Mary Kimmel, co-director of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill, in an email.
“This can very much be a challenge when individuals lose pregnancy Medicaid.”
As the COVID-19 public health emergency continues, it is unclear when the public health emergency that has so far extended pregnant people’s Medicaid benefits will end.
Even if North Carolina does not extend postpartum Medicaid, it’s possible that it will be extended at the federal level, Eckert said.
“Legislation that was introduced in the House of Representatives includes provisions to actually make this a mandatory policy,” Eckert said. “So instead of it being optional for a state, making it a requirement.”
But similar to the North Carolina budget, nothing is done until it’s done.