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Advocates are hopeful that a provision that extends Medicaid benefits for people who are pregnant to one year will be in the finalized budget, especially since those benefits are currently being extended due to the emergency pandemic order.
By Élisabeth Thompson
As budget negotiations drag on between the two houses of the North Carolina General Assembly and Gov. Roy Cooper’s office, maternal health advocates hope a “game-changer” bill extending Medicaid post -partum will be included.
A provision in the Senate budget, but not included in the budget created by the House of Representatives, would allow pregnant women with income equal to or less than 196 percent of federal poverty guidelines – approximately $ 34,800 for a family of two – to remain eligible for coverage for 12 months after childbirth.
Medicaid coverage for pregnant women usually ends after only 60 days, but many pregnancy-related deaths occur 43 to 365 days after childbirth, according to the Centers for Disease Control and Prevention.
North Carolina has a maternal mortality rate of 21.9 deaths per 100,000 live births, according to the annual health ranking in the United States report, which uses data from the CDC. The United States averages 20.1 deaths per 100,000 live births.
“If this passes, it will be a game-changer for new families in North Carolina,” said Sarah Verbiest, a member of the North Carolina Infant Mortality Task Force at its Perinatal Health Committee meeting in late September.
Parents can be medically vulnerable after the birth of a child, from health issues that may have been identified during pregnancy to mental health issues, she said.
As advocates push for Medicaid to be extended to pregnant women, there is something on their side. It’s already happening. Due to an emergency order triggered by the COVID-19 pandemic, coverage continued for people who qualified for Medicaid pregnancy at any time during the pandemic.
Truly? It’s already the case ?
Let’s go back a bit.
As the COVID-19 pandemic began to rage across the country in March 2020, the federal government jumped on action, passing the Families First Coronavirus Response Act. As part of the provision, Congress increased funding for states’ Medicaid programs, as long as they didn’t cut people off the program during the public health emergency, said Emily Eckert, head of health policy. for the American Colleges of Obstetricians and Gynecologists, which supports the extension of postpartum Medicaid for pregnant women.
“This federal policy essentially waives that 60-day period and says that if you were covered by Medicaid for your pregnancy, you will continue to be covered until the end of this COVID public health emergency,” Eckert said.
We are now in October 2021 and the public health emergency is still not over. Those who became pregnant during the COVID-19 public health emergency and who qualified for Medicaid because of this pregnancy were not unenrolled, said Dr Velma Taormina, a member of the Child Mortality Task Force during the perinatal health committee meeting.
“This has already been in practice for 18 months,” said Taormina.
For new parents living in the days of COVID, this means they have less pressure to scramble to find insurance in the event of a pandemic and more time to focus on their babies and their new lives.
When the public health emergency ends, so too will these Medicaid pregnancy benefits for those who have already passed the 60-day mark.
But, there is an opening: When the new Biden administration pushed through the US bailout, that new law included a provision that allows states to extend pregnancy benefits to new parents for up to one year, from April 2022. This means there is an opening for the North Carolina General Assembly to further expand Medicaid coverage in pregnancy and postpartum.
Budgetary affairs
Although a final version of the budget has not yet been finalized, the Raleigh News & Observer reported that budget writers expect Medicaid’s postpartum expansion to be included.
A more extensive expansion of Medicaid, which would cover people with incomes at or below 138% of the poverty line, is another story, however.
“We’ve done some expansion in this budget,” said Sen. Brent Jackson (R-Autryville), who is one of the top budget writers. The news and the watcher. “It’s in there.”
The postpartum extension of Medicaid has received bipartisan support. It was originally introduced as a Senate bill by Three Sense Republicans. Jim Burgin (R-Angier), Joyce Krawiec (R-Kernersville) and Kevin Corbin (R-Franklin). North Carolina Health News contacted all three senators via email to comment on the provision, but we have not received a response at the time of publication.
“We think most people want to help themselves,” Corbin told a town hall on the expansion of Medicaid in North Carolina held earlier this year. “We think they want to get up and do better, and we’ll try to do what we can to help them.”
Extend the postpartum period
Obstetricians and gynecologists have a common saying: “A healthy mother is a healthy baby. Access to health care before and after pregnancy can reduce infant mortality and premature births and improve maternal health, the Commonwealth Fund has found.
Not to mention the racial disparities in maternal mortality. Black pregnant women are disproportionately more likely to die from pregnancy-related complications, North Carolina Health News Previously reported.
Perinatal care – referring to when you get pregnant for up to a year after birth – is important for a number of reasons. It gives providers the opportunity to recognize physical health problems early and take care of the mental health of new parents.
“Pregnancy is a stress test for life,” said Verbiest. Problems like high blood pressure and diabetes can then be identified and treated before they get worse.
“It’s important for that person’s health whether or not they have more children, period,” Verbiest said. “Having access to specialists, connecting to a primary care provider who can help them manage their long-term health is also very important. “
From 2014 to 2018, more than half of the people who gave birth in North Carolina were on Medicaid, according to the North Carolina State Center for Health Statistics. Since North Carolina has not extended Medicaid, many people find themselves without insurance when their 60 days are up – or at least they were before the pandemic.
In North Carolina, parents are only eligible for Medicaid if they have an income that is 41% of the federal poverty line, or about $ 6,828 per year for a single mother with a baby. Even if providers recognize and begin to treat problems in perinatal patients, when they lose Medicaid coverage, they may no longer be insured, disrupting the progress of treatment.
“Part of what we do is also help identify higher levels of mental health care for those who need it,” said Dr. Mary Kimmel, co-director of the Perinatal Psychiatry program at the University. from North Carolina to Chapel Hill, in an email. .
“It can be very difficult when people lose their Medicaid pregnancy. “
As the COVID-19 public health emergency continues, it is unclear when the public health emergency that has so far extended Medicaid benefits to pregnant women will end.
Even if North Carolina does not extend postpartum Medicaid, it is possible that it is at the federal level, Eckert said.
“Legislation presented to the House of Representatives includes provisions to make it a mandatory policy, ”Eckert said. “So instead of it being optional for a state, make it a requirement.”
But like the North Carolina budget, nothing gets done until it’s done.
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