Postpartum coverage bill: extending care from 2 months to 12

In Washington State, low-income pregnant women can get comprehensive, no-cost health coverage through the Apple Health/Medicaid program. But this coverage ends two months after pregnancy ends. Postpartum health needs continue well beyond that, for twelve months post-pregnancy, and complications requiring care arise well after Apple Health coverage lapses. Our state’s Maternal Mortality Review Panel found that 30% of all pregnancy-related maternal deaths and most suicides and accidental overdoses occur 43 to 365 days after delivery.

Senate Bill 6128, sponsored by Senator Emily Randall (D-Bremerton), would extend this coverage for the full twelve-month postpartum period. The continuity of coverage and care that the bill provides would do much to reduce significant racial and ethnic health disparities in maternal mortality and morbidity. As the bill recognizes, “In this state, American Indian and Alaska native women are six to seven times as likely to die from a pregnancy-related cause than white women.” A Health Impact Review of the bill performed by the State Board of Health found “very strong evidence that SB 6128 will decrease inequities by geography, immigration status, race/ethnicity, and socioeconomic status. To address these inequities, the Washington Maternal Mortality Review Panel report to the Legislature in October 2019 included a recommendation that the state “ensure funding and access to postpartum care and support through the first year after pregnancy.” 

In her speech on the Senate floor supporting the bill, Senator Randall noted that “maternal mortality in the great state of Washington is disturbingly high . . . Those numbers are even more disturbing in communities of color and in rural communities across Washington . . . In spite of the incredible expansions that we’ve made in health care coverage . . . we continue to have gaps in coverage and for new mothers, continuity of care is critical . . . This bill . . . is not just about mom’s health, but about families . . . a full year of coverage is particularly important for us to ensure that we are covering health concerns before they become emergent, especially given that a large number of suicide attempts occur between months 8 and 12 . . . healthy parents are better prepared to do the difficult and important work of parenting and we are excited to support them in that work.”

The bill would phase in the expansion of coverage over four years, starting in 2021 with the lowest-income individuals, until it reaches the income level of the pregnant women program (193% of federal poverty). At the Senate Ways & Means Committee hearing, Senator Randall stated the importance of phasing in “coverage of postpartum Medicaid to our neediest Washingtonians first . . . allowing us to make a really important investment in the health of our community in a fiscally responsible fashion.” Should federal funding be approved, the bill would immediately extend 12-month postpartum coverage to all postpartum persons with income up to 193% of federal poverty. 

 The bill passed the Senate unanimously and is awaiting a hearing in the House Appropriations Committee which has not yet been scheduled as of this writing. NoHLA is actively supporting this bill, along with many other organizations supporting 12-month postpartum coverage, including the American College of Obstetricians and Gynecologists, the American Medical Association, the Washington State Medical Association, the Washington Chapter of the American Academy of Pediatrics, MomsRising, the Perigee Fund; Public Health-Seattle & King County, the American Indian Health Commission, and the Association of Washington Healthcare Plans.

–Kristin Babik, NoHLA Extern