Did you or a loved one recently give birth while getting your health care through Medicaid? If so, July delivered some welcome news: Pregnant Minnesotans eligible for Minnesota’s Medicaid program, called Medical Assistance, will now continue to receive Medicaid coverage for 12 months after giving birth instead of only 60 days.
This investment is one of several ways the State is working to make progress on serious disparities in birthing outcomes for Black Minnesotans and Native Americans by supporting pregnant people before and after they give birth, marking a big win for Minnesota families.
Healthy families need healthy parents. Extending postpartum Medicaid coverage will directly impact more than 7,000 new parents and ensure they have access to routine medical care after giving birth.
It will also help with chronic health conditions, mental health needs, family planning services, and access to counseling on nutrition, breastfeeding, and other preventive health issues that affect the longer-term health of the birthing person and their newborn child.
Medicaid covers about four out of 10 of births in the state, and approximately eight out of 10 among Black birthing persons and nine out of 10 Native birthing persons. Yet before this policy change, those on Medicaid giving birth faced the reality that they could lose their health insurance just two months after this major life event. These disruptions in health insurance coverage have been shown to disproportionately affect Black, American Indian and Hispanic persons.
This is all occurring in an environment where the nation’s mortality rate for birthing people has risen, and at least one-third of those deaths occur after a person has given birth. A growing body of evidence shows that many of these deaths, particularly from preventable causes such as overdose and suicide, occur after pregnancy-related Medicaid coverage typically ends.
Mental health in particular is a major concern during and after pregnancy. Suicide among pregnant and postpartum people has risen in the past decade. At least one in 10 birthing people experience depression before, during or after giving birth. Some studies suggest higher rates but poorer access to treatments among Blacks and other communities of color and those with low incomes.
While postpartum care traditionally centered around one clinical visit six to eight weeks after delivery, a shift has occurred in how we view the importance of postpartum care. Supporting this “4th trimester” is an ongoing process, and evidence is showing that the best outcomes typically require multiple visits and follow-up care that may last a year or even longer.
In response to this growing body of evidence, and acknowledging the role Medicaid plays in access to care for our Black, American Indian and other communities of color, the American Rescue Plan Act gave states the option to extend Medicaid postpartum coverage from 60 days to 12 months.
Last year the Walz-Flanagan administration included this policy change in their budget proposal, and the 2021 Minnesota Legislature passed a law adopting the option. This June, the federal Centers for Medicare and Medicaid Services formally accepted Minnesota’s application to make this change, allowing it to go into effect July 1.
In 2021, the governor and legislature also expanded a successful program that improves overall health, social and economic outcomes for African American and Native American pregnant people and their babies. Minnesota is among states with the lowest rates for prematurity, low birth weight, and infant mortality. However, Minnesota has some of the nation’s highest disparities for these outcomes for African American and Native American people compared to White people.
The Integrated Care for High-Risk Pregnancies (ICHRP) program identifies African American and Native American pregnant people who are dealing with homelessness, hunger, untreated mental illness, substance use disorder, and exposure to institutional racism. It then works to reduce these stressors by providing culturally specific services and resources such as housing referrals, behavioral health care, food, and community supports through specially trained community health workers and doulas.
ICHRP collaboratives are co-led by community members, serve both parents, support workforce and leadership development within our community, and engage in broader education and advocacy for the health of pregnant people, positive parenting, and early childhood brain development.
The program is available in regions with the highest concentrations of African American and American Indian births in Medical Assistance, including Ramsey and Hennepin counties and Bemidji.
Giving birth is one of the most significant medical events in a person’s life. Minnesota’s Medicaid postpartum policy now delivers for the pillars of our families and communities with the coverage they need and deserve to recover their health and well-being.
Learn more at Integrated Care for High Risk Pregnancies (ICHIRP) / Minnesota Department of Human Services https://mn.gov/dhs/partners-and-providers/news-initiatives-reports-workgroups/minnesota-health-care-programs/integrated-care-high-risk-pregnancies/
Dr. Nathan T. Chomilo is the medical director for the State of Minnesota’s Medicaid/Medical Assistance & MinnesotaCare programs and practices as a general pediatrician in Brooklyn Center with Park Nicollet. He is a board member of the Minnesota Chapter of the American Academy of Pediatrics and an adjunct assistant professor of pediatrics at the University of Minnesota Medical School. He lives in Minneapolis with his wife and son.