Postpartum coverage for Medicaid-eligible pregnant Arizonans has been expanded from 60 days up to one year. The coverage expansion went into effect on April 1st, and will help improve health outcomes of birthing parents and children and increase access to life-saving healthcare services.
“Medicaid covers more than half the births in Arizona. Extending postpartum coverage will help us address healthcare disparities for our postpartum population, which includes a disproportionate number of our American Indian or Alaskan Natives at increased risk of severe morbidity,” Gov. Katie Hobbs said in a press release.
The expansion in coverage provides full benefits for pregnant and postpartum people for up to 365 postpartum days. Postpartum coverage is crucial for birthing people who are recovering from childbirth, and provides opportunities to address complications that contribute to postpartum mortality and morbidity. The extension in coverage will also ensure ongoing mental health services, and assist with managing infant care.
Last year, the state legislature passed House Bill 2863, which included the postpartum coverage extension for Medicaid members, and was signed into law that summer. The federal budget impact includes almost $10.4 million for 2023 and 2024.
The Children’s Action Alliance (CAA) is a Phoenix-based nonprofit that works to identify and eliminate barriers to the well-being of children and families, which has also been advocating for the postpartum coverage expansion.
The nonprofit believes that the health of children and families is shaped before conception: birthing parents who have access to nutritious foods, preventative care, and behavioral health supports prior to becoming pregnant are more likely to have healthy babies and safe pregnancies.
According to the CAA, healthcare is essential for parents and children, ensures healthy infant development, and supports the physical and mental health of postpartum people. Prior to the extension coverage going into effect, some postpartum Arizonans lost coverage as soon as they stepped out of the hospital. This has forced many Arizonans to delay or go without essential emotional and physical care simply due to exorbitant costs.
While the US is among the wealthiest nations in the world, its residents receive far from the best healthcare outcomes. The crisis of maternal mortality and morbidity has been increasing over the past several years, with BIPOC birthing parents disproportionately becoming critically ill, or dying within one year after pregnancy.
The Arizona Department of Health Services released a publication listing maternal mortalities and severe maternal morbidity in Arizona in 2020. The department found that Indigenous Arizonans are almost four times as likely to die during or after pregnancy. Black Arizonans are nearly two times as likely to die during or after pregnancy, while LatinX, Asians and Pacific Islanders, and uninsured Arizonans are more than 1.5 times as likely to die during or after pregnancy.
The CAA found these postpartum deaths are not due to the lack of education or understanding of parents, but are instead due to the systemic deficiencies and discrimination related to healthcare access, adding that the link between pregnancy-related deaths and affordable healthcare is “clear” for low-income, Black and Indigenous parents—especially among the uninsured, underinsured, undocumented, and those underrepresented in the healthcare system.
Each year, 70 Arizonans die within one year of being pregnant, while about 1,000 Arizonans experience severe and life-threatening complications. What’s more concerning is that more than 80 percent of pregnancy-related deaths—where pregnancy was a direct factor in the death of the birthing person—could have been prevented with adequate interventions. The CAA stated that about 35 percent of pregnancy-related deaths in the state take place between 42 days and one year postpartum.
Leading causes of pregnancy-related deaths are strokes and heart conditions, which make up more than one-third of deaths. March of Dimes, an organization that advocates for the health of all babies and mothers, stated that regular healthcare checkups before, during, and after pregnancy can assist with preventing these types of deaths.
Deaths during birth are primarily caused by emergencies, like heavy bleeding and amniotic fluid embolisms. During the first postpartum week, deaths are mainly caused by heavy bleeding, high blood pressure, and infection. From one week to one year after birth, cardiomyopathy—which is a weakened heart muscle—causes most deaths during this time.
March of Dimes suggested that birthing people maintain close contact with their providers during and after pregnancy, and to reach out immediately to their providers if they experience any postpartum symptoms, including chest pain, dizziness, fever, nausea, vomiting, trouble breathing, severe abdominal pain, and visual changes, among others.
Matt Jewett, director of health policy for CAA, discussed the postpartum coverage extension with State of Reform.
“I would say that, most importantly, we shouldn’t expect anyone to worry about losing their health coverage just 60 days after giving birth. Even having to deal with changing to another plan that might be available could cause people to fall through the cracks at a particularly critical time in both maternal and child health.”
— Jewett
The coverage expansion is set to sunset on March 31st, 2027.