Women’s History in the Making: States Expand Medicaid Postpartum Care as U.S. Maternal Mortality Rates Rise

In the U.S., the maternal mortality rate continues to rise, jumping from 23.8 deaths per 100,000 live births in 2020 to 32.9 deaths per 100,000 live births in 2021. That’s a 38% increase across the entire U.S. population, and the maternal mortality rates are even higher for women of color. A study published in the Journal of the American Medical Association (JAMA) in July 2023 corroborates earlier findings that indicate American Indian, Alaska Native and Black women face significantly increased maternal mortality risk. As we celebrate Women’s History Month, this is akin to a backward step in time: The last time maternal deaths were at this level was in 1964.

However, there is some positive news for pregnant people and new mothers at a time when it is truly needed: Many state Medicaid plans have or are expanding postpartum care. In this article, SKYGEN explores the maternal mortality crisis, the connection between oral health and overall health, and the expansion of postpartum care in Medicaid plans.

Rising Concern: The Maternal Health Crisis

For state Medicaid programs, the maternal health crisis is of special concern:

• Delivery costs for just over 40% of babies born in the U.S. are covered by Medicaid
• Nearly one third of pregnancy-related deaths happen in the period six weeks to one year after delivery.  
• Of the underlying causes for maternal mortality, among the top three are mental health conditions and cardiac and coronary conditions.

In 2021, the American Rescue Plan Act gave state Medicaid programs the opportunity to extend Medicaid postpartum coverage to 12 months. This became a priority for states committed to enhancing care quality and health equity. As of January 2024, 38 states have amended their state Medicaid plans to extend coverage for new mothers. See the map.

Expansion of Post-Partum Dental Benefits 

As of October 2022, all 50 states and the District of Columbia are providing dental coverage for Medicaid enrollees through at least 60 days after pregnancy. However, coverage of oral health care services beyond that period can vary by state. 

The state of Maryland was a frontrunner in expanding post-partum dental benefits. Starting April 1, 2022, the state’s Department of Health extended full benefits to Medicaid-eligible pregnant individuals for the duration of their pregnancy and the 12-month postpartum period. Dental care coverage included dental X-rays, teeth cleaning, and fillings. The state also launched an education campaign about the importance of dental care and good oral health habits for both parents and their newborns. One of the main messages: Seeing a dentist is just
as important as seeing your doctor.

“There is no question that extending postpartum Medicaid dental benefits to cover the critical first 12 months post pregnancy is absolutely essential,” said Dr. Shirley Spater, DMD, MPH, Clinical Director, Benefits Management at SKYGEN. “The strong correlation between poor oral health, an increased risk for tooth decay and periodontal disease, and heart disease is well established.  Advocating for extended comprehensive equitable dental benefits within each state, while educating pregnant and postpartum people on self-care, is paramount to reducing maternal mortality and improving oral health for whole the family. ”
   
This is important because pregnant people are at greater risk for oral disease during pregnancy. In addition, with the connection between oral health and overall health, poor oral health can increase the risk of negative health outcomes during pregnancy and postpartum, including worsening mental health and cardiac conditions.

In December 2023, the Centers for Medicare & Medicaid Services unveiled an initiative to increase pregnancy and postpartum care access. Starting in January 2028, up to 15 state Medicaid agencies will receive technical and financial assistance for the Transforming Maternal Health (TMaH) model, which aims to develop a whole-person approach to pregnancy, childbirth, and postpartum care, and improve health equity. Expansion of oral health care is an option in the TMaH model.

How SKYGEN Can Help

Improving health equity is a top priority for a large majority of states in 2024. SKYGEN partners with state Medicaid programs and Managed Care Organizations (MCO) to delivers high levels of dental benefits management automation that enable programs to allocate more dollars to providing better access and quality care. SKYGEN’s dental benefits automation software is highly configurable, allowing programs to tailor benefits to the needs of specific populations, including pregnant and post-partum people, to improve health outcomes. 

If you’d like help navigating Medicaid postpartum coverage in the face of the maternal mortality crisis, set up a conversation with one of SKYGEN’s dental benefits administration experts today.