shows a big pregnant belly in a striped shirt.
Credit: Frank de Kleine / Flickr Creative Commons

By Elizabeth Thompson

Postpartum Medicaid will be extended from 60 days after birth to one year starting today, as a provision included in last year’s state budget comes into effect.

The provision allows pregnant people 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 had previously ended about two months after giving birth, even though 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 maternal deaths per 100,000 live births.

“This extended coverage is an important component to help improve the health of families in our state,” Deputy Secretary for North Carolina Medicaid Dave Richard said in a press release. “I hope we can build on this important step by expanding Medicaid in North Carolina to further support maternal health and reduce infant mortality by improving health before the pregnancy.”

Sarah Verbiest, a member of the NC Child Fatality Task Force called the provision “a game changer for new families in North Carolina” before the legislation was passed, at the group’s Perinatal Health Committee meeting in late September.

North Carolina for Better Medicaid said the move “​​has the potential to make a meaningful difference in the health of new mothers and their families,” in a press release in December.

What it means

The extended coverage applies to all categories of beneficiaries, according to the North Carolina Department of Health and Human Services. Those who are eligible for postpartum Medicaid will receive a letter detailing the change, according to NC DHHS.

The change comes after the postpartum Medicaid benefits for people who gave birth during the pandemic have continued for months past the 60-day cut off due to a provision in the Families First Coronavirus Response Act, which continues to cover new parents until the end of the federal COVID public health emergency, which is currently due to expire on April 16.

The American Rescue Plan Act of 2021 gave states the ability and the money to extend postpartum coverage to 12 months, which the North Carolina General Assembly included in its budget which passed in November 2021 at a cost of $12.5 million in state dollars in the current fiscal year (which ends on June 30) and another $50.8 million in state funds in the coming fiscal year.

Starting April 1, pregnant people on Medicaid for Pregnant Women will have coverage for full Medicaid benefits, meaning they will also have coverage for services such as dental, doctor’s visits, vision and behavioral health care. A full list of Medicaid services can be found here.

Advocates say the extension is important since many postpartum deaths are due to preventable causes, such as substance use disorder, cardiac disease or death by suicide, according to the American College of Obstetricians and Gynecologists

About 12 percent of women in North Carolina experience postpartum depression, according to NC DHHS.

New parents can be vulnerable in the first months after giving birth and may suffer from health conditions from physical health issues to mental health struggles, Verbiest previously told NC Health News. 

Advocates for women’s health have argued that extending postpartum Medicaid can help reduce deaths that occur outside of the 60-day window North Carolina had previously used for postpartum Medicaid, especially since 41 percent of births in North Carolina are financed by Medicaid, according to Kaiser Family Foundation.

Extension not expansion

While the state has extended Medicaid for pregnant people, it has yet to expand Medicaid for the remainder of low-income adults. Currently, the Tar Heel state is one of just 12 states that has not expanded Medicaid, something that became possible because of the Affordable Care Act. However, a bipartisan committee at the state Legislature is studying the possibility of expanding Medicaid.

Medicaid expansion has divided North Carolina’s legislature along party lines for almost a decade, with Democrats, including Gov. Roy Cooper, largely supporting expansion and Republicans largely opposing it.

38 states plus the District of Columbia have chosen Medicaid expansion since it became an option in late 2012.
North Carolina is one of 12 states that has not chosen Medicaid expansion since the policy was made available as a result of the Affordable Care Act in late 2012. Map, data: Kaiser Family Foundation

Medicaid expansion would allow households with an income below 133 percent of the federal poverty line to qualify for coverage. Currently, only low-income workers, low-income people with children, people with disabilities and pregnant people qualify up until they give birth and for 60 days thereafter.

Extending postpartum Medicaid was a bipartisan effort. 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). 

Both Krawiec and Corbin are on the Medicaid expansion committee. Corbin has been a vocal supporter of expanding Medicaid.

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Elizabeth Thompson is our Report for America corps member who covers gender health and prison health topics. Thompson is a UNC Chapel Hill graduate who has covered Texas politics for The Dallas Morning...