To fight maternal mortality, Ohio Medicaid to extend women’s coverage to 12 months after they deliver babies

Published: Oct. 07, 2021

COLUMBUS, Ohio – The Ohio Department of Medicaid plans to extend coverage of women who have delivered babies from 60 days to 12 months for the next five years, with hopes to reduce the state’s maternal mortality levels.

About 2,000 Ohio women each year experience a severe morbidity, or an unexpected outcome of labor and delivery that results in significant short- or long-term consequences to their health. Twenty-one women die of complications related to their pregnancy each year, according to the Ohio Department of Health.

Black women are 2.2 times more likely to die from a cause related to pregnancy than white women. Complications can begin during pregnancy and continue through the first year after delivery. Ohio’s maternal mortality rate averaged 18.8 deaths per 100,000 live births of babies between 2015 and 2017. This is slightly above the national average of 17.1, although the group at the Ohio Department of Health that is studying maternal mortality cautions that state and federal surveillance methods differ.

“It’s no secret at this point that the state and the country are experiencing a maternal health crisis, and Medicaid is the largest single payer of maternal care in this country, and covers one in two births in Ohio,” said Hope Lane-Gavin of the Cleveland-based health and social services think tank the Center for Community Solutions. “Among Medicaid beneficiaries, women of color and women living in rural areas are at the greatest risk of experiencing maternal morbidity, which is like a near miss, an almost death – so stroke and hemorrhaging and other things. We have recognized Black and Indigenous women are almost three times as likely to die of a pregnancy-related cause, as related to white women in this country. Ohio’s numbers are very similar to the national numbers, which are very bad.”

Many of the pregnancy-related deaths are preventable, she said.

If moms aren’t well, the condition interferes with their ability to care for their babies, she said.

The Ohio General Assembly, in the two-year state budget bill passed in June, instructed the Ohio Department of Medicaid to receive permission from the federal government to extend postpartum coverage.

It will cost the state $4 million each during the current fiscal year and next fiscal year. The federal government will chip in $11 million each year, Ohio Medicaid spokeswoman Lisa Lawless said.

The American Rescue Plan Act of 2021 gives states the new option to extend Medicaid postpartum for a five-year period beginning April 1, Lawless said.

Ohio Medicaid officials are waiting for the federal Centers for Medicare and Medicaid Services to publish guidance that will let Ohio Medicaid update the definition of the postpartum period and submit a state plan change to Washington, she said.

Medicaid officials estimate around 14,000 women a year will gain 12 months of coverage, Lawless said. Another 55,000 Ohio women a year already receive extended coverage after delivery because they qualify for Medicaid through other means, such as Medicaid expansion, which is targeted at low-income Ohioans, or through parent/caretaker coverage, which is also for low-income people, but with different income limits, Lawless said.

“Continuous 12-month postpartum coverage will (be) available to all women enrolled in Medicaid at the time of delivery,” she said. “The 12-month option will prevent termination of Medicaid if a woman is not eligible for any category of assistance. Essentially, the postpartum protection acts as a parachute that isn’t deployed unless the woman would have otherwise had coverage terminated.”

The American College of Obstetricians and Gynecologists in the past year has pressed the state and federal government to expand Medicaid to 12 months postpartum, said Dr. David Hackney, the chair of the organization’s Ohio Section.

“As a high-risk obstetrician I take care of a lot of patients with diabetes, heart disease,” said Hackney, who practices in Cleveland. “And while they’re pregnant I’m trying to (monitor their levels) with insulin, control their blood sugars. But then from a health insurance standpoint, after they’ve delivered the baby they just go back out to the wolves. There’s no one to pick up the baton.”

Hackney said that extending Medicaid beyond 60 days will result in women getting seen by primary care doctors and specialists to get contraception, control their diabetes, obtain mental health services, among treatment.

“It’s coming and it will go into effect. We’re trying to get a lot of hospital systems to ramp up their pregnancy to life care transitions,” he said.