Mapping Where Medicaid Changes Can Improve Black Maternal Health

Expanding Medicaid and extending Medicaid coverage to one-year postpartum are two necessary and evidence-based reforms

Anna Bernstein | a Century Foundation feature

Medicaid plays a critical role in maternal health, covering over 40 percent of all births in the United States. For Black women and birthing people—who face over two and a half times the risk of maternal mortality when compared to white women—this proportion is even higher, at 65 percent. Addressing the Black maternal health crisis, then, requires ensuring Medicaid coverage is robust and comprehensive—before, during, and after pregnancy.

Expanding Medicaid (closing the gap in coverage that leaves individuals with incomes too “high” for Medicaid but too low for ACA marketplace subsidies) and extending Medicaid coverage to one-year postpartum are two necessary and evidence-based reforms: both have demonstrated their positive impacts on maternal health outcomes. Despite federal incentives for both, though, many states have not taken up these live-saving options.

Even more concerning, many of the remaining states have higher maternal mortality rates, some of the highest populations of Black residents, and high proportions of births financed by Medicaid. The Medicaid coverage gap in particular disproportionately impacts people of color—and Black adults especially.

In President Biden’s budget for Fiscal Year 2024, the administration not only doubled down on its commitment to investing in maternal health equity, but it also named these Medicaid policies specifically. The budget proposed a mechanism for providing expansion-like coverage to states who have not yet expanded Medicaid, as well as for requiring extension of postpartum Medicaid coverage to one full year. Although this budget—particularly with a GOP majority in the House of Representatives—largely serves as a messaging document, it lays out proven and attainable improvements to Medicaid coverage for pregnant and birthing people in the states that need it most. Regardless of what progress is possible at the federal level, it is past time for every state to expand Medicaid and extend comprehensive postpartum coverage to a full year.

The maps below denotes states who have not yet implemented these reforms. Although most states have implemented at least one of these policies, Texas and Wisconsin currently have neither expanded Medicaid coverage nor extended postpartum coverage to a full year. Notably, some states have proposed or adopted Medicaid 1115 waivers for extension of postpartum coverage for less than twelve months, or to provide care that is not comprehensive or complete (see an earlier comment letter on Texas’ proposal to extend coverage for only six months, which would also exclude people who receive abortion care). For this map’s purposes, only states that have adopted (or are planning to adopt) comprehensive, full-year postpartum coverage are categorized as having fully implemented the policy; as more states consider extending postpartum coverage, it should be achieved through the option for a state plan amendment, rather than a Medicaid waiver.