By Maggie Clark and Kay Johnson
As the 117th Congress completes its work in the ”lame duck” session this month, policy makers are considering a range of maternal health policy priorities. These changes are urgently needed: the nation’s maternal mortality rate increased for the fourth year in a row in 2021, and the latest data from the Centers for Disease Control and Prevention show that racial disparities persisted in the rates of pregnancy-related deaths among Black and white mothers. Hispanic mothers, who, pre-pandemic, experienced the lowest rates of maternal mortality, saw significant increases during 2020 and 2021. Indigenous women (classified in statistics as American Indian or Alaska Native persons) also experience high rates of maternal death. At the same time, Maternal Mortality Review Committee analyses show that more than 80 percent of maternal deaths are preventable.
Adding to the urgency is the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which allows states to ban abortion—at least 13 states have done so already. Research suggests that cutting off access to abortion could increase maternal death rates and further exacerbate current racial, economic and social inequities in maternal and infant health.
As we pointed out in a blog earlier this year, policymakers have more work to do to address the maternal health crisis, particularly for Black women. Congress could take action in the Lame Duck through spending bills or other legislation to make progress.
Medicaid Postpartum Coverage
At the top of the list for many policymakers is making the currently-optional postpartum Medicaid coverage extension both mandatory and permanent. So far, more than half the states have taken the American Rescue Plan Act-created option to extend postpartum Medicaid coverage to extend the postpartum coverage period from 60 days to 12 months, and more are on the way. This longer period will help make sure new moms have time to deal with any postpartum health issues they may face, like postpartum depression, which often does not appear until six months or more after the baby is born. It also will help protect new parents from medical debt if they need care more than two months after the end of pregnancy, after their Medicaid coverage has run out.
While the 12-month postpartum coverage option has proved popular in states so far, there are still more than a dozen states that have taken no action towards extending the postpartum coverage period, and the option is currently scheduled to expire in 2027. Making the option permanent and requiring all states to take it would ensure that people have access to the yearlong postpartum care they need, regardless of where they live or when they are pregnant.
Priorities in the Black Maternal Health Momnibus
Lawmakers also have another chance in the lame duck session to consider the Black Maternal Health Momnibus, encompassing 12 component bills introduced by members of the Black Maternal Health Caucus. Most provisions of the Momnibus Act were included in the Build Back Better bill passed by the House in November 2021, but ultimately left out of the smaller Inflation Reduction Act, which was enacted into law in August. A few pieces of the Momnibus were enacted as part of the Fiscal Year 2022 Appropriations bill signed into law earlier this year, but the majority of the provisions have yet to be further acted on. Congress could enact standalone legislation or, in what is a more likely scenario, include the remaining Momnibus priorities in a larger appropriation or spending bill package adopted in the year-end session. More detail on the specific actions taken on the Momnibus policies are outlined in the attached chart.
Other Maternal Health Legislation
Other maternal health-specific proposals Congress could take up during the end-of-year session to advance maternal health include the House-passed bipartisan Pregnant Workers Fairness Act, which would require employers to offer reasonable accommodations to pregnant workers while on the job, and the Restoring Hope for Mental Health and Wellbeing Act, a large-scale behavioral health bill which, among other things, includes funding for more states grants for maternal mental health Psychiatric Access Lines, increasing capacity for mothers calling the National Maternal Mental Health Hotline (1-833-9-HELP4MOMS), and improving federal coordination for maternal mental health programs.
The Democratic leaders of the Senate Subcommittee on Labor, Health and Human Services, Education and Related Agencies also included provisions in their Fiscal Year 2023 Appropriations Bill specifically intended to address needs for reproductive and maternal health in the wake of Dobbs Supreme Court decision such as increased funding for teen pregnancy prevention, increased access to contraception and other public health investments.
Addressing the nation’s worsening maternal health crisis will require sustained, structural changes in a broad range of areas, including health coverage, growing and diversifying the perinatal workforce, health care quality and building a more robust data infrastructure to better track and improve maternal health outcomes, to address the full magnitude of this crisis. Investing in these maternal health policy and system changes is a first step towards making sure all pregnant people, women and infants have the opportunity for health.
Kay Johnson, M.Ed., M.P.H., has been a leader in health policy for women, children, and families for 35 years, active in Medicaid and children’s health policy at the federal and state levels since 1984 and has advised more than 40 state health and/or Medicaid agencies. Her work is supported by the Commonwealth Fund.
This content was originally published here.