A Barrier Finally Torn Down: Extended Postpartum Medicaid Coverage

Good news from Washington, D.C., is always cause for celebration. Especially when it’s news that’s likely to save lives right here in Texas.

John Hawkins, President/CEO, Texas Hospital Association — John Hawkins

Last month, our hospitals finally realized a major legislative goal when the Centers for Medicare & Medicaid Services (CMS) approved Texas’ state plan amendment to extend postpartum Medicaid coverage for mothers to one year. That means as of March 1, Texas mothers will have 12 months of continuous coverage after birth, saving lives and taking steps to ensure access to care for babies and moms.

The importance of this extension simply cannot be understated. For years now, Texas has faced a major maternal mortality crisis that left many of our youngest children without mothers; maternal mortality has increased every year and doubled since 1999. Statistics from the state’s Maternal Mortality and Morbidity Review Committee (MMMRC) say 90% of the deaths related to pregnancy were preventable, especially in minority communities; the effect on Black mothers has been disproportionate. Today, nearly half of all births in Texas are covered by Medicaid. In a state where our uninsured rate remains No. 1 in the country, moving the needle on issues like this closes the gaps for those who need it most.

THA has long had a voice in the postpartum-coverage conversation, and we were particularly eager to see what happened at this point – the CMS approval stage – after last time around. After the 87th regular session of the Texas Legislature in 2021 – when lawmakers passed a bill to extend postpartum coverage from the current two months to six months – CMS declined to approve the state plan amendment that would have made it official.

However, as we headed into the 88th legislative session early last year, there were encouraging signs of bipartisan support for extended postpartum coverage. House Speaker Dade Phelan (R-Beaumont) placed the issue on his priority item list for session, and the rising risks for mothers moved legislators to act. THA pushed hard for House Bill 12 by Rep. Toni Rose (D-Dallas) through to its final passage with just days to go in session, and Gov. Greg Abbott signed it weeks later. Now, after CMS’ final approval, Texas becomes the 41st state to extend postpartum coverage to one year.

One last statistic to illustrate why we see this as such a momentous move for access to care: MMMRC’s latest joint report with the state shows that in 2019, 27% of pregnancy-related maternal deaths occurred between 43 days and one year after the end of the pregnancy. Now, this extended access to coverage should improve access to care and save lives.

We all know that efforts at the Texas Capitol to expand Medicaid outright are slowed by political divides and partisan clashes over federal encroachment on state operations. But as we look toward more wins like this one in the future, it’s important that this victory is marked down as a major step forward for hospitals and patients. It not only shows that bipartisan work on big health care issues is possible in Texas, but also that health care legislation needs both sides to agree on mutual goals. For health care advocates, the strong collective effort from grassroots engagement to cooperation with lawmakers is how victories like these come to fruition. Now, let’s keep our new moms as healthy as we can, and strive for more legislative progress.