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POLICY RECOMMENDATIONS Human Health
Policy Recommendation 5: States can prioritize maternal mortality reduction efforts.
The Human Health Subcommittee approved this recommendation citing a desire to improve broad care and support for both mothers and their babies. In addition, subcommittee members encourage states to tackle maternal mortality rates, especially along the lines of racial health care outcome disparities.
births to Black mothers.7 Given the disparate rates of maternal mortality and morbidity between Black and indigenous people and white people in the United States, there is an opportunity for state Medicaid agencies to take the lead in implementing policies that promote better health outcomes and address drastic racial disparities. Individuals with pregnancy-related Medicaid coverage typically lose their benefits 60 days after the end of pregnancy. The American College of Obstetricians and Gynecologists reports that maternal mortality is rising, and a growing body of evidence shows that many of these deaths, particularly from preventable causes such as overdose and suicide, occur after pregnancy-related Medicaid coverage ends.
One pathway to consider is the state plan amendment under the American Rescue Plan Act. This additional pathway allows states to extend Medicaid coverage for pregnant people from 60 days to one year postpartum, providing a key opportunity to better address maternal health.
The U.S. has the highest maternal mortality rate among Organization for Economic Co-operation and Development (OECD) nations, and there exist substantial disparities: 37.1 maternal deaths per 100,000 births for non-Hispanic Black women compared to 14.7 for non-Hispanic white women.1 Mental health screening is a particularly important health equity strategy during pregnancy and postpartum. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends screening pregnant women for substance abuse disorders in multiple settings, including the emergency department, OB/GYN visits, primary care visits and well-child visits.2 Currently, Black women are significantly less likely to be screened for postpartum depression than white women.3
Organizations such as the Commonwealth Fund and The American College of Obstetricians and Gynecologists are working towards expanding access to important perinatal care. They have each put forward recommendations advocating that state legislators work to expand pregnancy-related Medicaid coverage (among other services) in order to better address maternal health.4 States should additionally consider:
Establishing Maternal Mortality Review Committees.5
Requiring mental health and substance abuse screening during the perinatal process.6
Establishing state Perinatal Quality Collaboratives (PQCs).
According to the Commonwealth Fund, Medicaid is the health insurer for 45% of births in the United States and the insurer for 66% of all
State Examples
In Minnesota, Doula services, widely known for improving birth outcomes and experience in low-income communities of color, are now covered.8
In California, several policies have been adopted. These include implementing midwifery-led care models, establishing home visiting services in the prenatal and postpartum periods, waiving the requirement for pregnant immigrants to lawfully reside for five years before Medicaid eligibility, and telemedicine for pregnancy-related care.
Additional Resources
The Council of State Governments State Leader Policy Brief: Human Health (2022) — https://web.csg.org/csghealthystates/ wp-content/uploads/sites/23/2022/05/Healthy-States-National-TaskForce-Policy-Brief-Strategies-for-Improving-Health-Equity.pdf
2021-22 Council of State Governments Healthy States National Task Force, Human Health Subcommittee, June 2021 meeting — https://web.csg.org/csghealthystates/wp-content/uploads/ sites/23/2021/07/Human-Health-Subcommittee-Meeting-1-Summary. pdf
