By: Eva Lorenz

Extending Medicaid coverage “is not a sufficient policy intervention to address the U.S. Black maternal health crisis.”

Despite the extension of Medicaid coverage to 12 months postpartum in states without the Affordable Care Act (ACA) Medicaid expansion, racial gaps in maternal mortality (death from complications of pregnancy or childbirth) and morbidity (short- or long-term health problems resulting from childbirth) persisted for Black women, according to a Columbia University study published in the American Journal of Preventive Medicine.

“Our goal was to examine changes in postpartum uninsurance, Medicaid coverage and private insurance before and during the continuous coverage provision among Black and white women and to understand how those changes differed in Medicaid expansion and non-expansion states,” said lead study author Teresa Janevic, ​PhD, in a Columbia University press release.

Although overall maternal mortality in the United States has been decreasing since 2019, in 2024, the maternal mortality rate for Black women (44.8 deaths per 100,000 live births) was three times that of white women (14.2 deaths per 100,000 live births), according to the Centers for Disease Control and Prevention.

“Postpartum is a crucial time for preventing postpartum morbidity and mortality,” said Janevic. “The postpartum period is one of intense physiologic and psychosocial adaptation and requires consistent monitoring of health to support women during this critical time.”

While the ACA expanded Medicaid coverage for many adults, the policy was not adopted in every state. In 2021, the Biden administration enacted the American Rescue Plan Act, part of which gave states the option to extend postpartum Medicaid coverage from 60 days to 12 months in order to help address health inequities exacerbated by the COVID-19 pandemic. The extension was expected to have the largest impacts in states that did not expand Medicaid coverage under the ACA.

Using American Community Survey data from 2016–2019 and 2021–2023 for all 50 states and the District of Columbia, the researchers gathered ethnicity, race and insurance information on 91,622 women before the pandemic and 65,394 women after the extended postpartum Medicaid extension.

Before the pandemic, 16.5% of Black women were uninsured in ACA non-expansion states compared with 6.4% in expansion states; for white women, those proportions were 11.1% and 5.4%, respectively.

Noninsurance rates in non-expansion states declined for Black and white women after extended postpartum Medicaid coverage. For Black women, decreases in uninsurance rates were primarily driven by gains in Medicaid coverage, while for white women, they were driven mostly by private insurance.

“Overall, this study suggests that postpartum Medicaid extension plays an important role in improving access to postpartum maternal health care, but it is not a sufficient policy intervention to address the U.S. Black maternal health crisis,” wrote the study’s authors.