Sarah Bernstein and Shetal Shah: Utah’s proposal to extend postpartum Medicaid falls short

No matter how you look at the numbers, Utah is short-changing new mothers.

(Teresa Crawford | The Associated Press) In this Aug. 7, 2018 photo, a doctor performs an ultrasound scan on a pregnant woman.

Too many mothers are dying. As neonatologists, we’ve seen new grandmothers collapse in sorrow after being told their daughters are dead. We’ve hugged new fathers who, in an instant, were forced to confront the loss of a partner and the fear of raising a child alone. We’ve witnessed firsthand the devastating loss to families when the baby survives but the mother does not.

Too many mothers are dying, and the state of Utah isn’t doing enough to prevent it.

In 2021, approximately 1,200 new mothers died in the United States. Among 11 major industrialized nations, the United States ranks last in maternal deaths. Mothers here are dying at twice the rate of those in France, the second-to-last country. Racial disparities persist with black mothers dying at three times the rate of white mothers.

Nationally, 17 out of every 100,000 mothers die within a year of giving birth. In Utah, that rate is much higher with 28 out of 100,000 mothers dying in the postpartum period. A woman giving birth in Utah is nearly three times more likely to die than a woman giving birth in California.

But there is hope. New opportunities allow state governments to act decisively to help new mothers thrive. A recent federal bill extended an option to states to split the cost of expanding Medicaid coverage to postpartum women from a two-month minimum to a full year after delivery. The ability for states to provide this insurance coverage, with the assistance of federal dollars, was previously time limited. It has now been extended indefinitely.

So far, 36 states have fully extended this coverage to low-income mothers. Unfortunately, Utah is not one of them.

While the state petitioned the federal government to extend coverage in May of this year, it will only cover new mothers who make 185% of the Federal Poverty Level (FPL) — or roughly $36,500 for a family of two — a threshold that’s lower than the majority of other states, which range from 200% to 265% of the poverty level. Wisconsin, for example, offers pregnancy insurance for families who make 306% of the FPL, while Georgia covers families up to 255% of the FPL.

Providing health insurance to these new mothers for up to one year may reduce rates of maternal death by 50%. Pregnant women are screened for chronic conditions like thyroid disease, high blood pressure and diabetes and receive treatment for these illnesses while pregnant. Medicaid finances approximately 1 in 5 births in Utah.

Yet in this new proposal, Utah falls short of the national standard to cover more mothers, setting the income limit so low that many mothers will fall into a gap in which they earn too much to qualify for Medicaid after birth, but not enough to pay for expensive private insurance.

Women who fall into this coverage gap will miss the chance to continue treatment for issues discovered during prenatal care. Only 20% of low-income postpartum women with risk factors for heart disease can see a doctor after having a baby. The same is true for women with diabetes.

No matter how you look at the numbers, Utah is short-changing new mothers.

Instead of creating artificial barriers for women to seek care like these restrictive income levels, Utah should be looking for ways to better invest in maternal care. Better maternal care means healthier moms. It allows physicians to screen for postpartum depression, which affects up 15% of all mothers. Increasing insurance levels for postpartum coverage will engage more low-income mothers with the healthcare system, allowing them smoking cessation treatments and contraceptive services.

Babies benefit, too. Infants born to mothers in states that have lengthened the duration of Medicaid after birth are more likely to also be insured. These babies also receive developmental screening and routine preventive care at higher rates than uninsured infants.

Opponents object to using state dollars to expand coverage to more women for a longer period of time, but rarely are there chances to improve the health of new babies and mothers at such a relatively low cost. The federal government pays for up to 90% of the added cost of covering these mothers after birth.

Too many mothers are dying, and the federal government is offering an option to ensure they get the care they need. Utah should not miss out on this bargain to protect more moms.

Sarah Bernstein, MD, MHA, FAAP

Sarah Bernstein, MD, MHA, FAAP, is a practicing neonatologist in Salt Lake City and a member of the American Academy of Pediatrics Section on Neonatal Perinatal Medicine.

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP, is a member of the national Pediatric Policy Council and a member of the American Academy of Pediatrics Section on Neonatal Perinatal Medicine.