Federal legislation could move Texas toward one of the Texas Medical Association’s long-time goals for improving maternal health – extending Medicaid postpartum coverage from two months to a full year.
Just last spring, the Texas Legislature passed House Bill 133, a TMA-backed measure that provided women enrolled in pregnancy-related Medicaid with six months of postpartum coverage, up from the current two months. Texas still needs to obtain a federal Medicaid waiver to enact the change.
Federal legislation may supersede this accomplishment by extending Medicaid coverage to 12 months, which is the period recommended by the Texas Maternal Mortality and Morbidity Review Committeeas well as national organizations such as the American Medical Association. The extension also would apply to those enrolled in the Children’s Health Insurance Program.
The federal budget reconciliation bill, also known as the Build Back Better Act, includes a permanent extension of Medicaid postpartum coverage, requiring states to extend benefits from 60 days to 12 months. Medicaid covers 53% of Texas births, according to Kaiser Family Foundation.
“The feds are moving toward having 12 months of postpartum coverage, which is better and definitely needed,” said TMA President-Elect Gary Floyd, MD, a Keller pediatrician who also is a member of the AMA’s Council on Legislation.
A significant number of pregnancy-related deaths take place in the year after a woman gives birth, according to the review committee’s 2020 biennial report with the Texas Department of State Health Services.
Among the 54 pregnancy-related deaths in Texas from 2013 – the most recent year in which in-depth data are available – 29% occurred during pregnancy, 40% occurred within 42 days of the end of pregnancy, and 31% occurred 43 days to one year from the end of pregnancy, according to the Maternal Mortality and Morbidity Review Committee.
“The biggest reason it needs to happen is that two months is too short, and six months you’ll just start getting at that postpartum depression that gets at many moms,” Dr. Floyd said. “I’m not sure even 12 months is enough, but it gets you down the road.”
The 12-month coverage would help with other types of postpartum complications as well, including cardiovascular and pulmonary conditions, he says. Domestic violence and substance use disorder also play a role in maternal deaths during this time, according to the review committee’s biennial report.
Even basic problems like lack of nutritional counseling and the availability of nutritious food can affect both mother and baby, Dr. Floyd says. Women who don’t eat a healthy diet may not be able to nurse their baby, he says.
If Congress does not approve the Medicare provision in the Build Back Better Act, the U.S. American Rescue Plan Act,American Rescue Plan Act, enacted in March, gave states another path to offering 12 months of postpartum coverage.
It established a temporary, five-year option for states to extend Medicaid postpartum coverage to 12 months beginning on April 1, 2022. However, because of the enactment of HB 133, Texas likely would need approval from lawmakers to take advantage of that extension.