Medicaid Eligibility is One Key to Maternal Health

Good medical care cannot proceed in fits and starts. It requires continuity. An expectant mother can’t call a timeout halfway through a nine-month pregnancy. Continuity of care is the key to better health outcomes – for both mother and baby.

But continuity of care is hard to come by. More than half of women who are covered by Medicaid or the Children’s Health Insurance Program when they give birth experience a gap in coverage in the following six months. Most of these gaps are the result of churn in the Medicaid program. Millions of people enroll in Medicaid every year, and millions more are removed because of complex enrollment rules or administrative snafus, only to then turn around and reapply. These interruptions are caused by factors including minor fluctuations in income, moving to another area, failure to submit periodic reports or being unable to renew enrollment on a timely basis.

Medicaid churn has been a problem for years. But it took the COVID-19 pandemic to expose many of the fissures in the way we cover and pay for health care. Congress put a temporary stop to Medicaid churn in March of last year when it bolstered the Medicaid program to support states during the pandemic and put a stop to Medicaid disenrollments for the duration of the COVID-19 public health emergency. President Joe Biden continued that support by extending the public health emergency declaration related to the pandemic.

When Congress passed the American Rescue Plan Act, it legally codified continuous eligibility for pregnant and postpartum individuals. The new law included the provisions of the Helping Medicaid Offer Maternity Service Act, which allows states to extend Medicaid coverage for new mothers for up to one year after giving birth. The provisions of the Helping MOMS Act ensure that new and expectant mothers have Medicaid coverage they can count on. It is a strong step toward addressing the maternal mortality crisis and the stark racial and ethnic disparities that currently plague maternal health outcomes.

But more needs to be done. The need for continuous coverage for all people covered by Medicaid will not end when the government declares the pandemic over. And the provisions of the Helping MOMS Act sunset in 2027. Because many people are afraid to go to clinics or hospitals now, they are delaying even essential care, from vaccinations to chronic care management to needed surgery. This pent-up demand will explode as the health care environment stabilizes. Cutting off Medicaid coverage to people who need it now – and who will continue to need it when the pandemic subsides – will hurt them when they need continuity of care the most.

Another piece of bipartisan legislation, the Stabilize Medicaid and CHIP Coverage Act, would provide for 12 months’ continuous coverage for everyone who qualifies for Medicaid or CHIP. This bill would streamline burdensome bureaucratic hurdles to Medicaid and CHIP enrollees, aligning Medicaid enrollment procedures with those for Medicare, Marketplace and commercial insurance, and helping safety net health plans and providers do less paperwork and focus on what they do best: delivering the care and services that help enrollees get and stay healthy.

Continuous Medicaid eligibility would close some of the yawning gaps in our insurance system that rising unemployment is making painfully obvious and assure better access to care for a longer period. Americans with low incomes, including new and expecting mothers, would be able to count on Medicaid as a stable and needed source of health coverage. If continuous eligibility is serving Americans well during the pandemic, why cast it aside after? Congress, make the temporary fix permanent.


Jennifer McGuigan Babcock is senior vice president for Medicaid policy for the Association for Community Affiliated Plans, a trade group representing 78 not-for-profit Safety Net Health Plans nationwide. Margaret A. Murray is the organization’s CEO. 

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