Last month, Minnesota legislators discussed a pressing maternal mortality crisis that is primarily affecting Black, Indigenous and People of Color (BIPOC) communities.
Lawmakers discussed Senate File 3511, which would require county-based Medicaid health plans to cover prenatal, maternity, and postnatal care during a Senate Health and Human Services Committee meeting earlier this month.
SF 3511 sponsor Sen. Alice Mann (DFL-Edina) said the requirement of prenatal, maternity, and postnatal care would result in no cost to Medicaid beneficiaries in the state. The bill would provide coverage for a minimum of 48 hours of inpatient care after a vaginal birth, and a minimum of 96 hours of inpatient care following a cesarean section. The health plans would not be allowed to provide compensation to encourage a birthing parent and their newborn to leave inpatient care earlier than the previously discussed minimums.
SF 3511 would also require health plans to provide coverage for post delivery outpatient care if the duration of the inpatient care is less than 48 hours for vaginal births and less than 96 hours for cesarean sections. Delivery outpatient care would consist of at least one home visit by a registered nurse, and all post delivery outpatient care provided to a newborn and birthing parent that is recommended by a healthcare provider and related to the delivery and wellbeing of the pair.
“We have a maternal morbidity and mortality crisis in America. Maternal mortality rates in America [are], on average, about 23.8 deaths per 100,000 live births, and that number’s a couple years old. It is now higher than that,” Mann said.
The U.S. has higher maternal mortality rates than other western nations. According to Statista, Canada has a maternal mortality rate of 8.4 deaths per 100,000 live births, while the Netherlands has a maternal mortality rate of 1.2 deaths per 100,000 live births.
In 2021, 1,205 American women died from maternal causes, an increase of 344 deaths from 2020. Black women had a maternal mortality rate of 69.9 deaths per 100,000 live births, while white women had a maternal mortality rate of 26.6 deaths per 100,000 live births in 2021.
“The majority of these deaths in America, over 80 percent of them, are preventable,” Mann said.
Mann recommended expanding Medicaid coverage to one full year postpartum; increasing access to midwives; and providing comprehensive reproductive healthcare access and free or affordable primary care and maternity care prior to, during, and after pregnancy.
“Expanding maternity coverage can also reduce the high cost associated with preterm births and low birth weights. This bill seeks to take that next step so that we can continue to decrease the rates of maternal death and morbidity in Minnesota,” Mann said.
Minnesota has taken steps to diversify its workforce through the International Medical Graduate Program, which was established in 2015 to remove barriers to practice for international medical graduates to practice in the state, Mann noted.
Dr. Eileen Crespo spoke on behalf of the Minnesota chapter of the American Academy of Pediatrics, which represents over 1,000 pediatricians statewide. Crespo said SF 3511 encompasses many components that are critical to ensuring access to care for newborn infants and their birthing parents.
SF 3511 would require insurance plans to cover medically necessary transfers of a newborn, the birthing parent, or the newborn’s siblings to a different medical facility.
“No infant should be separated from their birthing parent at this stage. Bonding between a parent and infant begins immediately, and is likely more critical in cases where an infant requires additional care.”
— Crespo
Touch, smell, and cuddling between a parent and their newborn releases hormones that bond infants to their families, Crespo said. Skin-to-skin contact for infants is especially critical for patients who are ill because it helps decrease stress, stabilize body temperature, and regulate heart rate and breathing, she said.
“Of course, this cannot happen when the baby and parent are separated,” Crespo added.
Gender Justice, a legal and policy advocacy organization dedicated to advancing gender equity through law, submitted a letter of support for SF 3511 to the legislature, stating that the cost of copays and cost-sharing around pregnancy care—especially for childbirth and postnatal care—are unpredictable and daunting, even for those with insurance.
“People covered by larger employer plans average out-of-pocket costs from $2,600 to $3,200 for childbirth depending on the type of delivery, and these costs can be much higher depending on the plan,” Gender Justice Executive Director Megan Peterson said. “The timing of plan year and deductible, delivery complications, and postnatal care needs for (the) baby and birthing parents can all add to the cost and stress.”
The Birth Justice Collaborative of Hennepin County joined several other organizations to submit a letter in support of SF 3511 as well.
“No parent should be forced to decide whether to receive healthcare or stay with their newborn,” the letter stated. “The Birth Justice Collaborative urges you to join us in supporting SF 3511, to ensure pregnant people and their newborns have access to healthcare during the perinatal period, without fear of family separation or the stress brought on by medical debt.”
Sen. Melissa Wiklund (DFL-East Bloomington) said SF 3511 would be laid over for possible inclusion in the existing omnibus bill.