Without Medicaid coverage, Claire Brown doesn’t think she would have gotten the help that could have saved her life. Nine months after the birth of her third child, Brown realized she had fallen into a deep depression. She struggled with “the basics,” like getting out of bed, preparing meals, and folding laundry. “It seemed like the smallest thing could really make me feel really stressed,” Brown said.
She admitted she had problems and told her husband, who was pursuing his doctoral studies. “It was like an SOS,” said Brown, who is now 32 and lives in Chapel Hill, North Carolina.
She received six days of intensive therapy and counseling in a psychiatric unit. She saw a doctor and was prescribed different medications to treat her depression. Since then, she has been attending weekly therapy sessions.
Brown, who qualified for Medicaid based on her income, said she knew the cost of the postpartum mental health care she needed could have easily “added up,” but thanks to her coverage She “didn’t have to worry about those exorbitant doctors bills.”
Starting this month, more people could have the same experience. A new provision guarantees access to health care through Medicaid for residents of certain states during one of the most vulnerable times in their lives – the months following childbirth.
Four out of 10 births in the United States are paid for by Medicaid, the public health insurance program that covers nearly 79 million people nationwide. Women who are normally excluded from Medicaid due to an income threshold but do not earn enough to pay for other insurance have special eligibility during pregnancy and the postpartum period. Before the COVID-19 pandemic, most people who gave birth under Medicaid lost their coverage 60 days after giving birth, if they weren’t otherwise qualified to stay in the program. This is especially true in the 12 states that have not expanded Medicaid under the Affordable Care Act. But when the Trump administration declared the coronavirus a public health emergency, people on Medicaid received continued coverage, so they didn’t have to worry about re-enrolling or potentially losing their health insurance amidst the pandemic. pandemic.
The benefits of this unprecedented extension of coverage may have laid the foundation for more lasting effects. Congress ensured that more generous postpartum benefits — 12 months of health coverage under Medicaid and the Children’s Medicare program — would be available under the U.S. bailout last year, and the Centers for Medicare and Medicaid Services offered guidance to states on this option in December. . The extension, which began on April 1, enabled around 720,000 pregnant and postpartum people to benefit from these benefits.
This extended coverage option lasts for five years, but to access it states must modify their Medicaid plans and obtain federal approval. So far, 15 states and the District of Columbia, including North Carolina where Brown lives, have enacted legislation or submitted waivers to seek such approval. Five states – Illinois, Missouri, New Jersey, Virginia and Georgia – have officially submitted waivers and have been approved.
Among states that have opted for expanded access to Medicaid, benefits may vary. In California, people with postpartum depression are eligible for a full year of Medicaid postpartum under legislation that has yet to receive federal approval. In Georgia, the coverage window extends from 60 days to six months postpartum.
“This policy catches women during a vulnerable time,” said Dr. Sarah Gordon, assistant professor of law, policy and health outcomes at Boston University.
Recent research has shown that up to one-third of women experience a change in health insurance from the time they become pregnant until after they give birth, according to federal data. Disruptions like losing health care coverage or not having consistent access to a primary care provider can lead to worse health outcomes, including preventable deaths, Gordon said, for example. when dire health conditions slip through the cracks undetected.
“If I was in a situation where I didn’t know if my insurance would cover it, I don’t think I would have received this care,” Brown said.
Improving “outcomes for two generations”
The United States stood out as one of the worst developed countries for pregnancy and childbirth support. In 2020, 861 women died from pregnancy-related causes in the United States, the Centers for Disease Control and Prevention reported, up from 754 women the previous year. The maternal mortality rate is 23.8 per 100,000 live births, more than three times the rate recorded in Germany or the United Kingdom. And while maternal mortality declined globally between 2000 and 2017, it actually increased in the United States over the same period.
These tragic statistics are worse in black and brown communities and are a stark reminder of the influence of systemic racism in health care in the United States. Black women have died from pregnancy and childbirth at disproportionate rates for years, steadily increasing since 2018. In 2020, black women accounted for 55.3 pregnancy-related deaths per 100,000 live births , nearly three times the rate of white women, according to the CDC.
“Pregnancy and childbirth should be a dignified, safe and joyful experience for all,” President Joe Biden said in an April 8 written proclamation marking Black Maternal Health Week. “For far too many mothers, however, pregnancy, childbirth and postpartum complications can lead to devastating health outcomes, including hundreds of deaths each year.”
More than half of pregnancy-related deaths occur in the first year after childbirth, according to a Commonwealth Fund study. And mental health issues, including postpartum depression, suicide deaths and fatal drug overdoses, are among the leading underlying causes of maternal death beginning about six weeks after childbirth. Prior to this benefit extension, millions of people lost their Medicaid coverage while their bodies were still actively healing after carrying and delivering newborns.
For years, data and research have shown with increasing clarity how the American healthcare system and society as a whole are largely failing caregivers and their infants. A patient can be diagnosed with postpartum depression, begin treatment, “and then watch pregnancy Medicaid coverage disappear,” said Samantha Meltzer-Brody, a psychiatrist at the University of North Carolina at Chapel Hill, who leads also the UNC Center for Women’s Mood Disorders. . “And that’s just awful.”
Before the pandemic, states that expanded Medicaid reported lower maternal mortality rates than states without the expansion, according to a February 2020 study. This was especially true among black people. But COVID has made it virtually impossible to ignore these conditions, she said, and this extension of postpartum benefits “reflects a sea change.”
“We can continue to treat the women and hope they recover,” she said. “It’s going to be good for mom and good for the baby. You are helping to improve health outcomes for two generations.
Making postpartum healthcare more accessible and affordable is a step towards ‘preparing the next generation’ and solving an issue that has ‘covered for far too long’, Health Secretary Xavier Becerra said on 28 March at a press conference. “It’s outrageous that in the richest country in the world we still have women who die after giving birth.”
What happens when the aid runs out
In May 2019, Katrina Percell gave birth to a healthy baby boy, but she struggled to maintain her own mental well-being. During her pregnancy, Percell said she “started having bad thoughts.”
She contacted her doctor, who listened to her and put her in touch with a psychiatrist. Her pregnancy and childbirth qualified Percell for Medicaid, which paid for her drug treatment and cognitive therapy to help her manage her anxiety and depression. Throughout his life, Percell said both conditions had gone untreated until that time. But her cover only lasted six weeks, she said, “enough time to do my six-week postpartum checkup.”
Over a year later, in September 2020, Percell found out she was pregnant again. After the birth of this child in May 2021, she was able to retain her Medicaid benefits under the public health emergency and resume her mental health treatment and therapy. She found prescriptions that gave her better results – paying $3 for a month of potentially life-saving drugs. If she needed dental care, she could get it.
“I’ve been stress free,” she says. “I was able to get things done.”
A trained assistant teacher and single mother raising three young children, Percell, 31, said times remained difficult. She works part-time in a fast food restaurant to earn extra money and lives with her parents, sharing a single bed with her children: “It’s quite tight.”
A few weeks ago, she received a letter telling her that her Medicaid benefits would be cut next month, shortly after her youngest child’s first birthday. His sanity hardly takes calendar dates into account, even with the extension of North Carolina. Although she had Medicaid for a calendar year after giving birth to her third child, Percell still struggles with insurance rollover and how it complicates her access to the mental health care she needs for herself and her family. family.
“If I don’t get Medicaid again, I won’t be able to take my meds,” Percell said. “I’m not going to be able to afford it.”