New moms are quickly cut off Medicaid in much of the South. Why it matters that some states are considering a change

If you’re a pregnant person in most Southern states, there’s a better than average chance that your prenatal checkups, delivery and other healthcare are covered by Medicaid. But if you’re covered by Medicaid for your pregnancy care, there’s also a better than average chance you’ll lose that coverage two months after the birth of your baby. 

Why does that matter? Why should non-birthing people care? Here’s our quick and easy explainer on pregnancy Medicaid – and the changes that might be coming for Southerners: 

OK so Medicaid is…what, exactly? 

Medicaid is the public health insurance program for low-income Americans. The requirements to get Medicaid vary from state to state, but the program is designed to help people afford things like doctor’s appointments and surgeries. 

Pregnant people can qualify for pregnancy Medicaid, which means Medicaid will cover the cost of prenatal doctor’s checkups, delivery of the baby and other health services up to 60 days after the birth. 

And Medicaid covers a LOT of births, especially in the South. 

Nationally, Medicaid covers about 4 in 10 births. But in the South, that percentage is far higher. Most Southern states are in the top 10 for Medicaid-covered births and the entire South falls above the national average. 

Here’s a look at the share of births in Southern states that were financed by Medicaid in 2020: 

Louisiana: 61%
Mississippi: 60%
Alabama: 50%
Texas: 50%
Tennessee: 49%
South Carolina: 48%
Kentucky: 48%
Georgia: 47%
Florida: 47% 

If you have a baby in most Southern states, you’ll likely lose your Medicaid coverage just 60 days later. 

In most of the U.S., after that 60-day postpartum period ends, a low-income birthing parent can keep getting health services covered by Medicaid based on income. This is because most states have chosen to expand Medicaid, which means health insurance is typically available to people whose income is up to 138% of the Federal Poverty Level, or about $38,295 per year for a family of four.  

But non-expansion states are different. Income eligibility levels are much lower, which means that even though a birthing parent is poor, their income may still be too high to qualify for Medicaid. 

In Alabama, for example, a single birthing parent with a newborn loses Medicaid coverage two months after the birth if they earn more than $3,144 a year 

If that same parent lived in Virginia, which expanded Medicaid in 2019, they could make more than seven times that amount (up to $24,000 a year) and still keep their coverage. 

Of the 12 states that chose not to expand Medicaid, most are in the South:
South Carolina
North Carolina

Which means many birthing people in the South become uninsured just two months after giving birth. 

Federal law says pregnancy-related Medicaid coverage must last from pregnancy through 60 days after the birth.  

A few non-expansion states, like Georgia and Florida, have enacted legislation to get a federally approved waiver that allows them to extend pregnancy Medicaid coverage to six months (Georgia and Texas) or even 12 months (Florida) postpartum. 

But in other states, like Alabama and Mississippi, most birthing people who used Medicaid during the pregnancy are left without a way to afford care for physical or mental health issues that arise more than two months after the birth. 

This is a major problem because…  

The Deep South has abysmal maternal health outcomes. Many Southern states have high rates of maternal death. Outcomes are even worse for Southern women of color. Black women are three times more likely to die in pregnancy or childbirth than white women. 

And for every maternal death there are 70 near-misses that result in major consequences to the person’s health, according to the American College of Obstetrics and Gynecology.  

Southerners also have high rates of the kinds of health problems that make pregnancy more dangerous, like high blood pressure, obesity and diabetes. 

Postpartum care isn’t just about a doctor’s visit six weeks after the baby is born. Continued doctor’s checkups and visits with mental health or other providers may be needed to keep a mother or birthing parent healthy – which in turn helps keep the baby and family healthy. 

No health insurance can mean no health care. 

But change is coming (maybe). 

Last year, Georgia extended Medicaid coverage to six months postpartum after years of lobbying by maternal health advocates. This year, Georgia Gov. Brian Kemp included funding in his recommended state budget to extend Medicaid coverage for a full year after a person gives birth.  

Other Southern states have passed legislation to extend pregnancy Medicaid coverage, or are considering doing so. Late last year, Florida legislators voted in favor of extending Medicaid coverage to one year postpartum; that’s expected to take effect sometime this year. Tennessee’s and North Carolina’s legislatures recently allocated state funding to extend their Medicaid coverage to one year postpartum. 

The 2021 federal American Rescue Plan Act has made extending coverage a little easier for states. It gives states the option to extend postpartum coverage to pregnant people to a full year.  

Which means discussions are happening now in non-expansion states to take advantage of this new opportunity to keep birthing parents covered.  

How do I get involved? 

Here are a few groups working on Medicaid issues in the South: 

Southerners for Medicaid Expansion 

Cover Alabama 

Health Care for Florida 

Georgians for a Healthy Future 

Mississippi Health Advocacy Program 

North Carolina Justice Center 

Palmetto Project (South Carolina) 

Tennessee Justice Center 

Sick Of It TX (Texas) 

The Reckon Report.
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