Forty-eight states, plus the District of Columbia, have been offering continuous Medicaid coverage for one year postpartum — but states do not always set clear expectations for how their managed care organizations can support this population.
In 2021, states were presented with an option to extend postpartum coverage from 60 days to one year, granting those who would otherwise exceed the Medicaid income threshold longer access. The Commonwealth Fund, which conducts health equity research and analysis, posted a brief Jan. 27 focused on Medicaid MCOs and the postpartum experience.
Here are six takeaways on the state of postpartum coverage:
1. Twenty-five states and the District of Columbia added at least one policy requirement rooted in postpartum best practices to their 2024-2025 Medicaid MCO contracts after extending Medicaid access, compared to their 2021-2022 contracts.
2. The most popular expectations added to 2024-2025 contracts included parameters around doulas, implicit bias training and postpartum case management.
3. While some states are bolstering their contacts with additional provisions, no more than half of applicable states require their MCO contracts to address five care priorities: postpartum visits, postpartum home visiting/in-home health services, postpartum case management, postpartum risk assessments and postpartum mental health screenings.
4. States that do establish requirements for these areas feature “highly variable” language in their contracts. For example, “high risk” can be ill-defined between states.
5. Only seven states referenced the American College of Obstetricians and Gynecologists’ guidance as it relates to postpartum care in their MCO contracts.
6. One of the Commonwealth Fund’s requests is to institute a “comprehensive postpartum standard of care,” which can be modified by state but would embrace best practices.
