Key advocates reflect on Hawaii postpartum Medicaid coverage extension


Nicole Pasia


Hawaii health care advocates recently commended the extension of Medicaid postpartum coverage from 60 days to 12 months. State of Reform spoke to 3 experts who helped bring about the extension about what it means for the future of Hawaii maternal health.


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The extension comes from a $2.4 million appropriation to the Department of Human Services in the FY 2023 Executive Supplemental Budget, which passed earlier this year. The appropriation will be matched by $3.4 million in federal funds. Hawaii was one of several states that enacted this change, due to a provision in the American Rescue Plan Act that allows states to extend coverage through a state plan amendment. 

Rep. Sylvia Luke (D-Makiki), Chair of the House Finance Committee and a strong advocate of the expansion, said expanding safety net services was a top priority for lawmakers last session. 

“Cutting off health benefits and postpartum care after 2 months significantly not only impacts the mothers but also impacts the child as well,” she said. “Mothers have to stay healthy, and expanding the coverage from 2 months to 12 months will significantly decrease mortality rates, address health needs, and provide support for new mothers who gave birth.”

Aside from extending postpartum care, other Medicaid appropriations in the budget include the restoration of adult dental benefits and provider reimbursement rate increases. 

Extending postpartum coverage has been a priority in Hawaii for years, said Reni Soon, MD, Chair of the American College of Obstetricians and Gynecologists Hawaii Section, despite delays from the COVID pandemic. Keys to the movement’s success included input from community-based organizations and findings from the Hawaii Maternal Mortality Review Committee under the Department of Health. 

“One of the things [the committee] found was half of the maternal deaths are actually occurring after 42 days, or later in postpartum,” Soon said. “If we’re really going to be serious about prioritizing maternal health, we can’t just go about thinking that the effects of pregnancy and pregnancy related conditions ends at 42 days.”

With the postpartum coverage in effect, Med-QUEST providers are looking to invest the state budgetary funds into improving care coordination services. 

“As a Medicaid health plan, [the extension] allows us to also extend into that period our care coordination services,” said Paula Arcena, Executive Vice President of External Affairs at AlohaCare. “We’re in touch with the mother, helping her to access services that she might need. We’re checking in to see how she’s doing and trying to facilitate access to care, whether it’s for signs of postpartum depression, mastitis, or difficulty getting an appointment. We have a provider shortage in Hawaii and sometimes that can be a barrier because our providers are working as hard as they can, but it’s difficult to get in and see [a provider].”

Arcena added the extension comes at a time when Med-QUEST enrollment rose significantly in Hawaii, as those who lost their jobs during the pandemic also lost their employer-sponsored health coverage.