The Alliance of Health Insurers is a non-profit advocacy organization representing commercial and local health plans in Wisconsin. Our members collectively provide coverage to nearly 3 million Wisconsinites through public and private insurance programs, including over two-thirds of enrollees in Badger Care Plus and SSI-Medicaid (Wisconsin’s Medicaid managed care programs). Member health plans are dedicated to delivering affordable, high-value care to the state’s Medicaid population.
Currently, the state’s Medicaid program – BadgerCare – provides coverage for income eligible women 60 days postpartum to meet the minimum requirement under federal law. After those 60 days, the mother’s eligibility is proactively terminated, and she can only remain eligible for BadgerCare if she is making under $21,150 (for a family of 2). Infants, however, born with Medicaid coverage remain eligible, regardless of any changes in the family’s income, up to a year after birth.
Under the American Rescue Plan Act of 2021, the federal government allowed states to extend postpartum Medicaid coverage to mothers for a full 12 months, and the Consolidated Appropriations Act made this option permanent. Wisconsin is now one of just two states that has not extended postpartum coverage to 12 months.
For AHI Medicaid managed care health plans, our focus is to deliver healthy outcomes for the state’s Medicaid population. Stability of coverage and continuity of care are critical elements in driving positive maternal and infant health outcomes – and they lead to better health care cost management for Wisconsin taxpayers and the healthcare system overall.
Research shows that postpartum women who lose Medicaid coverage are at an increased risk for life-threatening conditions, including high blood pressure, cardiovascular diseases, and depression. In fact, data from 38 U.S. states found that 84% of pregnancy-related deaths were preventable, with nearly 27% occurring 43–365 days postpartum,1 further stressing that life-threatening conditions can happen well after 60 days postpartum. Even if postpartum complications occur within 60 days, many require long-term recovery during which they may lose health coverage in the midst of treatment.
Currently, when a postpartum mother is terminated from Medicaid coverage 60 days after the delivery of her child, she will be forced to seek and enroll in other health coverage (either through the health insurance marketplace or if available, employer-sponsored coverage) or opt to not have health care coverage. When choosing a new plan, she will need to re-establish a relationship with her new health plan and possibly a new primary care provider at a time when she is actively supporting a newborn in the home. Part of this process includes determining if her current providers are in her new network, re-scheduling new appointments to ensure care is continued, and ensuring continued adherence to any medications. This process will inevitably delay critical pregnancy-related chronic and mental health interventions and treatments that often require attention far beyond 60-day postpartum. While transitioning to a new plan comes with a host of potential challenges during this time in a mother’s life, these challenges are further compounded for the many women who experience postpartum depression. Low-income women report higher rates of postpartum depression symptoms – up to 48% compared to approximately 19% of women across all income levels.2
Extending coverage to 12 months postpartum guarantees alignment of health care coverage for both the mother and baby. This will ensure that existing care coordination continues for the family postpartum, while reducing any barriers to care as the family will continue to access the same providers postpartum as pre-natal. Since infant health is tied strongly to maternal health, prioritizing the mother’s care is essential for the baby’s health in its first year of life and beyond.
Importantly, extending postpartum coverage does not create a new benefit or add new individuals onto the Medicaid rolls. It simply lengthens the amount of time an already eligible mother would be able to remain on Medicaid coverage after pregnancy.
Wisconsin women deserve to get the safe, essential care they need before, during, and after pregnancy, and maintaining continuity of health insurance coverage is essential to that access. Ensuring continuous coverage for the mother to the full year after delivery, also allows the family to stay on the same health plan, leading to better care coordination for both the mom and baby. Ultimately, extending Medicaid postpartum coverage to a full year will lead to better health outcomes for mothers and infants and results in more efficient healthcare spending and cost savings for taxpayers and the state. For all these reasons, AHI respectfully asks the Committee to support the bill.
If you have any questions, please contact Abbey Rude or Caty McDermott at 608-258-9506.
1https://www.cdc.gov/maternal-mortality/php/data-research/index.html#:~:text=Among%20pregnancy%2Drelated%20deaths%20in,was%20identified%20for%20511%20deaths
2https://pmc.ncbi.nlm.nih.gov/articles/PMC4313576/#:~:text=Approximately%2019%25%20of%20postpartum%20women,three%20months%20of%20giving%20birth.&text=Up%20to%2048%25%20of%20low,report%20elevated%20postpartum%20depression%20symptoms