In the United States, the stark disparities in Black maternal health outcomes have worsened in recent years. Complex factors contribute to the poor maternal health outcomes experienced by Black women, including both structural and social determinants of health such as limited access to health care services, income and economic insecurity, food insecurity, housing insecurity, and personal safety. The COVID-19 pandemic exacerbated the maternal health crisis and deepened longstanding disparities in Black maternal and infant health:
- Black women have alarmingly high rates of serious pregnancy-related health complications and are three times more likely to die from pregnancy-related causes than White women.
- The maternal mortality rate for Black women was 69.9 deaths per 100,000 live births in 2021 compared to the national rate of 32.9.
- The Black infant mortality rate is more than twice the rate for White infants.
- Black women (18 percent) report experiencing postpartum depressive symptoms at a higher rate than White women (11 percent) and are less likely to receive mental health care.
- Thirty percent of Black women report experiences of mistreatment during maternity care, such as receiving no response to requests for help.
Each year, April 11–17 is recognized nationally as Black Maternal Health Week since its founding seven years ago by the Black Mamas Matter Alliance. Addressing the ongoing maternal health crisis is a national and state priority. The White House Blueprint for Addressing the Maternal Health Crisis outlines five priorities and includes 50 actions that federal agencies are undertaking to help improve maternal health. Medicaid is one of the largest payers of maternity care in the United States, and the Centers for Medicare & Medicaid Services has identified key gaps in maternity care services and actions for improvements in its Maternity Care Action Plan. The Health Resources and Services Administration (HRSA) is advancing cross-cutting initiatives to improve maternal health, including the Enhancing Maternal Health Initiative to strengthen and accelerate HRSA’s maternal health work in select states and supporting programs in all states to strengthen Black maternal health.
States continue to develop and implement policies to improve maternal health outcomes, using a range of policy levers to increase access to maternity care, strengthen the quality of maternity care, and improve health outcomes during pregnancy and the postpartum period. Many states are prioritizing Black maternal health and are implementing strategies to address the stark disparities in health outcomes, including taking advantage of new federal opportunities.
Extending Medicaid and CHIP Postpartum Coverage
Medicaid plays a significant role in perinatal health coverage as the largest single payer of pregnancy-related services, covering 41 percent of births nationally and the majority of births in several states. Extended postpartum coverage is one strategy states are using to ensure continuity of coverage during the period of elevated health risk following childbirth. Most states (46 states including Washington, DC) have extended continuous eligibility for pregnancy-related Medicaid and Children’s Health Insurance Program (CHIP) coverage from 60 days to 12 months, a pathway made permanent under the Consolidated Appropriations Act of 2023.
Expanding and Supporting the Perinatal Workforce
States are expanding and supporting the perinatal workforce by providing Medicaid coverage for services provided by doulas, midwives, and community health workers as part of longstanding efforts to increase access to care and improve health outcomes during pregnancy and the postpartum period. Community-based providers can support pregnant people of color who are seeking a holistic birth experience due to personal preference, cultural practice, or challenges in traditional health care settings. Expanding Medicaid coverage to community-based providers can support a diverse maternity care workforce and provide people with more options for their birthing experience during pregnancy, labor and delivery, and postpartum. Several states are providing Medicaid coverage for services provided by doulas, midwives, and community health workers:
- Thirteen states (including DC) have implemented a statewide Medicaid doula benefit. Other states allow or encourage Medicaid managed care organizations (MCOs) to offer doula services to their members.
- All states (including DC) reimburse services performed by certified nurse-midwives. At least 19 states (including DC) also reimburse services performed by midwives without a nursing degree (e.g., certified professional midwives and certified midwives).
- Twenty states provide Medicaid coverage for community health worker services through a Medicaid state plan amendment or section 1115 demonstration waiver. Eleven states encourage or require their Medicaid MCOs to reimburse for services provided by community health workers.
Acknowledgements
This blog is a publication of the National Academy for State Health Policy (NASHP). This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Supporting Maternal and Child Health Innovation in States Grant No. U1XMC31658; $398,953. The information, content, and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.
