Medicaid covers half of all Texas births. Why are people kicked off two months later?
Maternal health advocates want Texas leaders to prioritize support for pregnant people in the 2023 legislative session.
Maternal health advocates want Texas leaders to prioritize support for pregnant people in the 2023 legislative session. Medicaid currently pays for about half of all births in Texas, according to the National Center for Health Statistics and March of Dimes. Texas leaders are petitioning to extend it to six months, but currently, coverage only extends two months past delivery.
Educators and advocates are hopeful Texas leaders will extend pregnancy Medicaid coverage to 12 months postpartum. This coverage is associated with better health outcomes for parents and infants, like higher birth rates, management of chronic conditions and support for mental health issues like postpartum depression.
What does Medicaid coverage during pregnancy look like in Texas?
Pregnancy Medicaid is a program out of Texas Health and Human Services. For people who don’t have insurance, this Medicaid coverage lasts throughout pregnancy and up to two months after delivery.
“Texas Medicaid provides robust services,” said Amy Raines, an assistant professor in the Department of Pediatrics and Women’s Health with the University of North Texas Health Science Center at Fort Worth. “They cover prenatal vitamins, ultrasounds, prenatal visits, limited dental services, transportation services, substance abuse disorders, just a wide range of standard maternal health services.”
Diana Forester, the director of Health Policy for Texans Care for Children, says for people who are uninsured, qualifying for pregnancy Medicaid is a “golden window.”
“It's the chance to have access to health care to address issues that maybe have been building for a while, or have just appeared,” she said. “Those kinds of things that could, left unaddressed, build into something that would need surgery or more intensive intervention later. It just feels like that should be something that's accessible to everyone when they need it.”
How does coverage affect maternal and infant health outcomes?
Forester says that access to timely and affordable prenatal care means better birth outcomes for parents and infants.
“I think it's the difference between having a chance at a healthy pregnancy versus not,” she said.
Raines says issues like diabetes and hypertension that can happen before pregnancy can cause complications for infants and parents. Having spotty health coverage can make managing a chronic condition that much more challenging.
“We are able to hopefully manage these chronic conditions through the pregnancy, let them have a successful delivery, and then they don't have coverage again until they get pregnant again,” Forester said. “You're not in the best position that you could be to have a successful pregnancy.”
Untreated issues also can lead to pregnancy complications and death. The 2020 report by the Texas Maternal Mortality and Morbidity Review Committee identified that chronic disease was a top factor in pregnancy-related deaths. Cardiovascular and heart issues, mental health disorders, severe bleeding, infections and high blood pressure were also the leading causes of death among pregnant Texans. The report stated that almost 89 percent of pregnancy deaths in Texas were preventable.
“Continuous coverage is really important for maternal health,” Raines said. “It provides the opportunity to detect conditions, to manage them and to prevent conditions from happening.”
What do advocates, physicians and health policy experts think is missing?
Both Forester and Raines agree that coverage should be extended to 12 months postpartum.
“There's been a ton of research for the last eight to 10 years that show that 365 days postpartum is a really crucial period for moms, and allowing them to have access to health care prevents a lot of these pregnancy-associated deaths,” Forester said. “We know that having a mom is a great indicator of better overall health for kids and families.”
In the last few years, more than 35 states have passed laws extending postpartum Medicaid coverage to 12 months.
“We're so behind at this point,” Forester said.
Raines also adds that extending postpartum coverage should include extending healthcare for everyone of reproductive age. She also hopes that Texas eventually covers fertility services, like IVF or cryopreservation of embryos. According to a Kaiser Family Foundation report from 2020, only New York state “specifically requires their Medicaid program to cover fertility treatment.”
“The ability for [people] to choose when they want to have children, how to grow their family, and the ability to access those services is really important,” she said.
Forester adds that changing Medicaid policy for pregnant people could lead to expanded and improved services for everyone.
“If you can change the policy with Medicaid, then it's a leader and an indicator of where we're headed,” she said. “I feel like it’s the first step in getting the rest of the providers to follow suit.”
How does this relate to Roe v. Wade being overturned earlier this year?
After Roe v. Wade was overturned by the U.S. Supreme Court in June, abortion became illegal in Texas except in “limited circumstances, such as a life-threatening condition to the mother caused by the pregnancy.” Abortion access was already limited in Texas due to SB 8, with people traveling to neighboring states like Louisiana and Oklahoma to receive care. This meant that abortion access was expensive, time-consuming and challenging to obtain even before June, and people who couldn’t afford to travel and take time off work couldn’t get care.
Limiting abortion care also affects people disproportionately. Black people are the largest population group to receive abortions in the United States, according to a 2021 U.S. Centers for Disease Control and Prevention report. Black people are also impacted by maternal mortality in greater numbers. They’re three times more likely to die than their white counterparts nationally, and twice as likely in Texas.
A 2021 study from Duke University Press modeled that pregnancy-related deaths would increase after near-total abortion bans and affect Black people giving birth the most.
Raines and Forester say one way to prevent bad health outcomes for pregnant people is expanding access to health care like Medicaid.
“Pregnancy Medicaid is essential,” Raines said. “[About] 50% of pregnancies are covered by Medicaid in Texas every year. It's a key part of the whole picture of maternal health, from the prenatal care quality that you receive to the hospital where you're delivering, to the level of care that's provided at that hospital. It's a key ingredient to a healthy pregnancy in Texas.”
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