Safe Healthcare Outcomes for Women Giving Birth

April 2019, I wrote on the topic of A Woman’s Right to Safe Healthcare Outcomes as asked by one organization a woman at ConsumerSafety.Org. It took me forever as I had to acquire greater understanding of the issues. In the end it was well received even though I did not feel it did the topic justice.

At the time I noted, commercial healthcare insurance, the ACA covers Postpartum care up to one year. Medicaid covered Postpartum cover after delivery for two months. Up till Joe Biden took office, the two month coverage was the limit in Medicaid. Newly elected Joe Biden was able to get this extended for 12 months.

It’s time to recognize the damage of childbirth, doctors and mothers say. The U.S. has one of the highest maternal mortality rates among developed countries, according to data from the  Organisation for Economic Cooperation and Development. There were 20 maternal deaths for every 100,000 live births in 2019, more than double the rate just two decades ago.

While in the hospital and if recognized, birthing mothers have a chance to survive preeclampsia and other issues associated with live births. More than half of these women, 52 percent died after delivery. Even so and as I wrote in A Woman’s Right to Safe Healthcare Outcomes, Lauren Bloomstein had accessible care in a hospital. The failure came in not recognizing a disorder called HELLP syndrome or Hemolysis, (a breakdown of red blood cells); Elevated Liver enzymes; and Low Platelet count. All attention was on a baby and the attendants failed to recognize Lauren was in stress.

The total numbers of death after giving birth are likely higher than reported, as deaths from suicide and drug overdoses among people who recently gave birth may not be listed as postpartum deaths. Black women are more than twice as likely to die as a result of childbirth than white women, underscoring racial and ethnic disparities.

Fifty-two percent of deaths occurred after giving birth to a healthy child. Recognizing the seriousness of the issues, “the American College of Obstetricians and Gynecologists issued recommendations to improve postpartum care. Recommendations including postpartum visits three weeks after a birth instead of six weeks and a comprehensive postpartum visit no later than 12 weeks after delivery.” The point was to capture the serious health issues of the mother.

Initially, Medicaid pays for births and covers qualified pregnant women through 60 days of postpartum care. After this period, states make very different choices regarding whether eligibility for Medicaid coverage is continued. In states not expanding Medicaid under the Affordable Care Act (ACA), many women were left without postpartum coverage, becoming uninsured two months after giving birth. 

With the advent of the Covid Pandemic, newly elected president Joe Biden was able to push through the Families First Coronavirus Recovery Act (FFCRA).

The FFCRA includes an enhanced federal match (FMAP) to states, contingent on meeting maintenance of eligibility (MOE) requirements. This includes ensuring continuous coverage for enrollees until the end of the month in which the public health emergency (PHE) is in place. Under earlier guidance issued by the Centers for Medicare and Medicaid Services (CMS), someone qualifying on the basis of pregnancy would remain enrolled in that group, even after the 60 days postpartum period. Under a new interim final rule effective on November 2, states can move a pregnant woman from the pregnancy group to another eligibility pathway if eligible for another full benefit group, such as ACA expansion, and the benefit package for the new group is the same or more generous than the pregnant woman benefit package, move to new group. However, if the pregnancy benefit package is more generous than another pathway or the person is ineligible for any other full benefit group, they would remain enrolled in pregnancy group.

Expanding Postpartum Medicaid Coverage | KFF

Come March 31, 2022, states have the option of extending Postpartum care via the American Rescue Plan Act of 2021 giving states a new option to extend Medicaid postpartum coverage to 12 months via a state plan amendment (SPA). This new option takes effect on April 1, 2022 and is available to states for five years. Staes have also been using 1115 waivers. Medicaid Postpartum Coverage Extension Tracker | KFF

Given you some history on Postpartum and briefly detailed why it is important for all women to have access to this care. In Mississippi, legislators went home today without passing the extension from 60 days to a year. Speaker of the House Philip Gunn’s refused to extend postpartum Medicaid coverage from 60 days to a year and went home.

The legislature meets ninety days per year except for the first year in a new term, which is a longer Session and continues through April and into May for 125 days. What this means for women who are using Medicaid Postpartum Care is this provision allowed in Biden’s bill will expire shortly. The bill passed the Senate and sits in the Mississippi House.

House Speaker Philip Gunn and the Medicaid Committee Chairman Joey Hood chose not to bring it up for a vote during this session. Chairman Joey Hood said they would bring it up during the next session in January 2023. Women will be left without care.

Speaker Phillip Gunn told The Associated Press he did not want anything appearing to be a broader expansion of Medicaid. Mississippi is one of a dozen states not expanding Medicaid to working people whose jobs do not provide health insurance. The Medicaid expansion was an option under the federal health overhaul (PPACA) signed into law by then-President Barack Obama in 2010.

Speaker Gunn knowing full well of Mississippi’ high maternal mortality of nearly twice of some states stated: “As I’ve said very publicly, I’m opposed to Medicaid expansion. We need to look for ways to keep people off, not put them on.”

Executive director of Mississippi Black Women’s Roundtable Cassandra Welchlin sharply criticized pro-life Gunn and Hood for killing the bill. “They quite possibly killed moms who won’t have access to health coverage to address issues that may arise after giving birth.” 

Moms giving birth are at risk well after the 60 days allowed in Medicaid. The cost of this expansion to one year was paid for out of federal funds.

Lost Mothers: Why Maternal Mortality In The US Is So High And Rising : NPR

Mississippi moms describe importance of postpartum Medicaid coverage (

It’s time to recognize the damage of childbirth, doctors and mothers say | PBS NewsHour

Democrats pitch industry-friendly Medicaid workaround to win Manchin’s support – POLITICO