Medicaid for Moms

In the House yesterday, the MOMS Act advanced out of subcommittee with a unanimous vote. This bill would allow states to extend Medicaid eligibility for recently pregnant women from the current sixty days post-partum to a year. States that elect to expand Medicaid eligibility would also receive an additional five points of federal matching funds. That payment bump would mean that a state like Mississippi would pay only 18% of the total costs of care instead of the standard 23% while states like Massachusetts would pay 45% of the costs instead of 50%.

 

Why is this happening?

 

The US has poor maternal health outcomes. We have high and increasing maternal morbidity. A significant proportion of the maternal deaths happen between 61 and 365 days after birth.

Dr. Jamie Daw and her co-authors have shown that pregnant women have high insurance churn in a recent Health Affairs blog. Medicaid already pays for a significant fraction of births in this country, so extending Medicaid eligibility for a year post-partum would decrease churn and lead to better care and better outcomes.

 

This policy change will be more valuable in states that have not expanded Medicaid.  States that have expanded Medicaid will already move a significant number of women who had a Medicaid covered birth from the standard reimbursement rate legacy Medicaid eligibility category to the income based Medicaid Expansion eligibility category.  However in states like North Carolina, Mississippi, and Texas, there is a tremendous gap in eligibility from pregnancy eligibility to parental eligibility so many more women lose coverage options at Day 61 than women in expansion states.

 

This bill is not particularly controversial.  Several states including some very red states have sought to expand the length of time new moms are eligible for Medicaid post-partum at the higher income qualifications using local funds.  This bill would dramatically reduce state costs as the federal cost-share rate would increase and the administrative complexity of creating a new waiver program would not be needed.  A much simpler state plan amendment could be filed by any state that seeks to improve maternal health.

 

It is a little policy change.  It is a meaningful policy change.  And it still needs a lot of things to go right for it to be enacted, but it is a step in the right direction.