New guidance to implement 12 months of postpartum Medicaid coverage, up from 60 days  

Ohio’s 2022-23 state budget that was signed into law in June 2021 included a provision that would provide Medicaid coverage for birthing people up to 200 percent of the federal poverty level for a full year after giving birth. The current policy is to provide Medicaid coverage for 60 days postpartum for this group 

This policy change will go a long way toward improving access to care and identifying factors contributing to high rates of maternal mortality in the postpartum period, as Medicaid covers about half of all births in Ohio. States that already have expanded coverage beyond 60 days postpartum have seen an “increase in postpartum care visits, continuity in coverage, and enhanced engagement of individuals in health care.”1 This is especially important to reduce the staggering disparities we see for Black and American Indian/Alaska Native birthing people who have rates of maternal mortality and morbidity as high as four times that of white birthing people. 

States that already have expanded coverage beyond 60 days postpartum have seen an “increase in postpartum care visits, continuity in coverage, and enhanced engagement of individuals in health care.

American Rescue Plan Act provides for more comprehensive postpartum care 

Moving from 60 days to 12 months of postpartum coverage was made easier by a provision in the federal American Rescue Plan Act of 2021 that streamlines the process for states to make this policy change in their Medicaid plan. In order to implement the changes, states were waiting on guidance from the Centers for Medicare and Medicaid Services (CMS). CMS delivered the guidance for the new state plan option on December 7, 2021.  

What will the new Ohio policies for postpartum Medicaid coverage look like? 

What follows are some highlights from the federal guidance. The Ohio Department of Medicaid is prepared to implement this change in eligibility on April 1, 2022, the earliest allowed by the federal guidance.  

  • Anyone eligible for this coverage type must receive the full Medicaid benefit package.  
  • The 12-month postpartum period begins on the last day of a beneficiary’s pregnancy and extends through the end of the month in which the 12-month period ends.”2 This coverage is continuous for this time period.
  • States are “strongly encouraged but not required” to maintain this state plan through March 31, 2027, which is the time frame approved in the American Rescue Plan Act 
  • The CMS guidance specifically highlights that states should use this eligibility change as an opportunity to improve maternal health. Specifically, “CMS encourages states to make a concerted effort to increase awareness of the extended postpartum coverage to both providers and beneficiaries.” It is “critical for states to measure and monitor utilization and quality of care in the postpartum period, and to work with health plans, providers and other stakeholders to improve maternal health care.”3 
  • Included in the guidance, CMS outlined eleven core measures that can track progress on improving maternal and infant health. Titled the Maternity Core Set, these include measures that track: 
    • timeliness of prenatal care 
    • postpartum care visits 
    • contraceptive care 
    • elective delivery, and  
    • low-risk cesarean section births 

This guidance is an important step, and outlines important ways that this policy change will impact birthing people and their children.  

Community Solutions will further explore this guidance in future blogs and continue to track the implementation of this eligibility change at the state and federal levels. This guidance is an important step, and outlines important ways that this policy change will impact birthing people and their children if we do this with a focus improving care and outcomes, especially for disproportionately impacted populations.   

[1] Gordon, S.H., B.D. Sommers, I. Wilson, O. Galarraga, and A.N. Trivedi. “The Impact of Medicaid Expansion on Continuous Enrollment: A Two-State Analysis.” Journal of General Internal Medicine, vol. 34, no. 9, 2019, pp. 1919–1924.

[2] https://www.medicaid.gov/federal-policy-guidance/downloads/sho21007.pdf

[3] Ibid.