Montana Families Need Postpartum Medicaid Expansion

Feb 23, 2023

By Jackie Semmens

This session, Montana has the opportunity to help new families access medical care following the birth of a baby.

New state option provides health care coverage and stability

Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days after birth. Under a new provision in the American Rescue Plan Act, states have the option to extend Medicaid postpartum coverage to 12 months via a state plan amendment. Prior to this option, some states had chosen to provide coverage through a section 1115 waiver or by using state funds. To date, 29 states have extended coverage, seven more are planning to implement a 12-month extension, and several others are considering legislation.

While Governor Gianforte proposed extending postpartum coverage for 12 months in the executive budget, last week, the Joint Subcommittee on Health and Human Services voted to change the extension to only six months, and only for those with a substance use or mental health disorder diagnosis. This move will severely limit the efficacy of the postpartum Medicaid extension, and leave many Montanans without needed health care.

Currently, pregnant people in Montana whose incomes are less than 162 percent of the federal poverty level, or $37,308 a year for a family of 3, are eligible for pregnancy Medicaid.

Montana families would benefit from 12-month postpartum coverage

The year following the birth of a child is a challenging one for many families. By extending Medicaid coverage for this year, the legislature can help protect families from health complications and medical debt that place additional stress on new parents. 

People need postpartum for many reasons, including pregnancy related complications, breastfeeding support, mental and substance use disorders, accessing contraception, and managing chronic conditions. Women who continued on Medicaid due to the pandemic-related extension in Texas used twice as many postpartum services, 10 times as many contraceptive services, and 37 percent fewer services for a subsequent pregnancy, compared to those who were not on Medicaid, researchers found.

Limited coverage puts Montanans at risk

The legislature is currently considering limiting postpartum coverage to six months, and only for those with a mental health or substance use disorder diagnosis. This imposes a more severe restriction than any other state with extended postpartum coverage.

Limiting coverage to six months seriously limits ability to access health care. About 1 in 5 (17.9%) of women on Medicaid still sought outpatient services after 6 months postpartum. Postpartum depression can last for years after birth and may grow worse rather than improve. Opioid overdose deaths peak in the seven to 12 months postpartum. Suicide risk does not decrease after six months, according to a study out of Colorado, with other studies showing that risk increases through the year.

The proposal to limit postpartum Medicaid coverage to those with a mental health or substance use disorder would severely limit access to health care for many Montanans. Pregnancy-related deaths, such as heart disease and stroke, can occur up to one year after giving birth. Children would also be left at risk, with children being more likely to receive preventive care when their parents are on Medicaid. The proposal would also even limit access to care for those with substance use or mental health disorders, as many go undiagnosed.

Currently, Montana has the option to extend coverage via a simple state plan amendment. This is the option that nearly every state has pursued. If Montana chooses to limit coverage to people with a mental health or substance use disorder, it may need to pursue a more complicated 1115 waiver from the federal government.

Montana should fund health care, not tax cuts

While potentially lifesaving to thousands of Montanan families, extending postpartum Medicaid coverage comes only at a modest investment. The proposal would require $2.8 million in general funds over the biennium and bring in $6.5 million in federal funds. A limited postpartum extension invests less than $1 million of general funds over the biennium.

Instead of investing in health care, legislators are pinching pennies on postpartum coverage while giving lavish tax cuts to the wealthy. No parent should choose between receiving medical care and paying for groceries, especially while Montana has a significant surplus. Extending postpartum Medicaid coverage for the full 12 months is the right thing to do for Montana parents.