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Op-Ed: NJ Should Extend Medicaid Postpartum Coverage

Every year, thousands of women in New Jersey lose Medicaid coverage 60 days after having given birth; New Jersey can — and should — change that

Linda Schwimmer
Linda Schwimmer

Two months after a new mother gives birth is not the time for her to lose her health insurance. Yet each year that happens to thousands of New Jersey mothers. They slip through the cracks when their Medicaid coverage runs out 60 days after delivering their babies. The number represents just 4 to 9 percent of all women in the state giving birth — but that’s still too many.

The postpartum period can be a medically complex time for a woman — with pregnancy-related depression possible as well as other pregnancy-related complications. Enabling women to maintain their insurance for at least six months or, better, up to a full year after birth would support the overall health of mothers as well as their current and future children.

State legislators are now discussing a bill (A-4934) that would close the gap that sends these women scrambling to find and afford new insurance with a two-month-old baby at home. Again, this is not the best time to ask a new mother to seek out new physicians in a new insurance plan. As New Jersey commits to reducing maternal mortality, strengthening access to care for all new mothers is critical.

Here’s how the current plan works. New Jersey residents with incomes below 138 percent of the federal poverty level are eligible for health insurance coverage under the state’s Medicaid program. The state, recognizing the value of providing health insurance for pregnant women, raised the eligibility level to 205 percent of the federal poverty level for women who are pregnant. About 3,000 to 9,000 women fit in this category, and many are working in low-income jobs.

But the coverage for these women with slightly higher incomes ends 60 days after the last day of pregnancy. It’s true that they can obtain health insurance through the marketplace of the Affordable Care Act with relatively low premiums because of their low income. Yet that means these new mothers must change their insurance plans, likely change their physicians, and most likely will be disconnected from the provider network that would continue to care for their children. And we know that a portion of these women inevitably would not go through the application process and would instead go without any health insurance coverage.

Bureaucratic roadblocks

Why are we creating bureaucratic roadblocks that disrupt a new mother’s access to care? The issue is one faced in all 50 states. New Jersey can be the first state in the nation to extend Medicaid coverage for these higher-income women beyond 60 days postpartum.

Access to healthcare is important both before and after a pregnancy. Allowing women to maintain their coverage can help uncover and treat cardiovascular disease, substance abuse disorders, diabetes, hypertension, and other problems that could create complications in future pregnancies. Postpartum problems such as weight gain should be addressed promptly to help a woman maintain her health for the rest of her life.

Uninterrupted insurance would also provide access to comprehensive reproductive health services, including contraception. Supporting the health of women during their childbearing years has economic payoffs that would, in our opinion, offset the cost of extending coverage for new mothers. And keeping mothers and their children in the same insurance plan makes preventive healthcare for the entire family easier to achieve. We should be not adding another layer of complexity to a time that’s already stressful for a new family.

Extending postpartum coverage is a meaningful step that lawmakers can take this year to address maternal mortality and the racial disparities that First Lady Tammy Murphy has rightly made a priority.

At the Quality Institute, our mission is to advance healthcare safety, access and affordability — and this change would support our mission. This bill alone does not address all the work we need to accomplish to improve maternal and child outcomes. But extending coverage to women who would otherwise fall off the bureaucratic cliff just makes sense.

Linda Schwimmer is president and CEO of the New Jersey Health Care Quality Institute, which works to improve the safety, quality and affordability of healthcare for everyone.

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