Ohio plans to let more women be eligible for Medicaid for a year after giving birth, which advocates hope will lead to more new moms getting the care they need.
When the American Rescue Plan passed, it included federal support for states that expand eligibility for Medicaid coverage for women until a baby’s first birthday. The newly based state budget calls for Ohio Medicaid to take up this offer, as long as the federal government signs off.
Currently, about half of Ohio births are covered by Medicaid, because women can have an income above the typical Medicaid cutoff and still qualify during pregnancy and for 60 days after giving birth. Then the criteria goes back to the typical limits at 60 days.
But this cut off can lead to a disruption in provider relationships and disruption in care still being received access to preventive services such as contraception and intrapartum care.
Several maternal health advocacy groups have supported this change, saying it could help address the complex problems that drive maternal mortality and severe maternal morbidity in Ohio.
When Ohio released in 2019 its first report in years on maternal mortality, it found over half of pregnancy-related deaths in Ohio were preventable and black women died at a rate more than two and a half times that of white women.
And nationally, about 12% of pregnancy-related deaths occurring after six weeks postpartum, with cardiomyopathy as the leading cause between 43 and 365 days postpartum.
“We know that maternal mortality and maternal morbidity are a huge problem, and especially a problem in our state,” said Hope Lane, policy associate with Cleveland-based human services think tank Center for Community Solutions, who has closely followed the maternal health policy.
Lane, who supported the Medicaid postpartum expansion, said with postpartum spending, there’s also care like treatment for postpartum depression that’s needed over the long-term, well beyond the 60 days.
Dr. Sheela Barhan, associate professor of obstetrics and gynecology at Wright State’s Boonshoft School of Medicine, said initially after birth there’s a few weeks of adaption to just being able to care for their own newborn baby and they’re dealing with their own physical recovery changes.
“It takes quite a while for them to prioritize their own health needs, or turn their attention more inward so that they can maintain their own health,” said Barhan, also an OB/GYN with Wright State Physicians.
Barhan said extended health coverage for the first year after birth would also allow the primary care provider to keep working with the patient on health conditions that are found in pregnancy that don’t just disappear if they aren’t resolved in 60 days.
“There’s an opportunity to do a more comprehensive evaluation with the mother after she’s adapted to the prioritization of caring for her newborn and those opportunities happen in the several months following birth,” Barhan said. “Without having access to care, patients will have less opportunity to focus their health inward.”
The new option can take effect starting April 1, 2022, and will be available to states for five years. To go into effect, Ohio’s request needs federal approval, but the American Rescue Plan made this approval process easier.
Medicaid is jointly funded by the state and federal governments, so this expansion would impact both budgets.
The Congressional Budget Office estimates that extended Medicaid coverage will result in almost $6.1 billion in federal spending over the first 10 years, Kaiser Family Foundation reports.
The health research foundation said states that adopt this extension would also incur costs since the extended coverage would remain at the same federal matching level, which ranges from 56.2% to 84.51%. But it is not clear if the estimates account for factors such as giving more people greater access to cost-saving preventive services.
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