The United States is currently facing a maternal health crisis. Nearly two out of every three adult women enrolled in Medicaid are in their reproductive years (ages 19-44), and Medicaid currently finances about 42% of all births in the United States. With the rising maternal mortality rates and significant racial and socioeconomic disparities, now is the time to prioritize solutions that will advance maternal health outcomes. One promising solution is making sure new moms have adequate postpartum coverage.  

Before recent policy advancements, women with pregnancy-related Medicaid coverage would lose their benefits 60 days after the end of their pregnancy. With previous federal leadership there was a strong commitment to addressing the growing maternal mortality crisis by implementing policies to improve the overall experience of pregnancy, birth, and postpartum for women across the country.  

One of the many tools for addressing the current maternal health crisis is utilizing Section 1115 of the Social Security Act, known as 1115 Medicaid waivers. In recent years the federal government has encouraged the use of 1115 waivers to increase patient access to and coverage of comprehensive, high-quality maternal health services from 60 days to 12 months postpartum. to address the maternal health crisis.

Medicaid 1115 waivers allow states to tailor coverage to their needs

A 1115 waiver is a policy tool used by states to expand Medicaid coverage in a way that best fits their state residents. It allows states to test new approaches in Medicaid to expand access to services for certain populations to improve health by providing preventive and primary care services that are tailored to meet the unique needs of each patient that is served.   

Community Health Centers (CHCs) serve a diverse set of populations, including one in four racial and ethnic minorities, with over one in three health center patients identifying as Hispanic, 13% as Black, 6% as Asian, and 59% as White and non-Hispanic. It is important to note pregnancy-related mortality rates among Black and Asian, Indian, and Alaskan Native women are over three and two times higher, respectively, compared to the rate for White women. Black, Asian, Indian, Alaskan Native, Native Hawaiian, and other Pacific Islander women also have higher shares of preterm births, low birthweight births, or births for which they received late, or no prenatal care compared to White women.  

Under the Biden Administration, the American Rescue Plan of 2021 gave states the option using a 1115 waiver to extend Medicaid postpartum coverage from 60 days, a period often inadequate for addressing complications that arise later, to a full 12 months. This is crucial as common pregnancy-related complications can require care over a longer period such as postpartum depression, which can sometimes take six months or more to appear after giving birth.

Nearly all states offer postpartum coverage through Medicaid 1115 waivers

Currently, many states have embraced this opportunity: 47 states have extended postpartum coverage, two states have pending state actions, and one state has a pending federal action. Arkansas remains the only state that has not taken any action toward extending postpartum care coverage. In contrast, Virginia is a leading example by utilizing this opportunity to offer continuous postpartum care to its residents.  

Virginia’s implementation includes coverage, population, and benefits under its postpartum extension through the Section 1115 waiver regardless of change in income which ensures continuous eligibility. In addition, the state of Virginia offers increased access to medical and behavioral health care services and treatments for women in the postpartum period that address health-related social needs for postpartum Medicaid and CHIP-enrolled women. This unrestricted coverage in Virginia ensures that mothers have access to essential healthcare services that address postpartum complications and lead to improved maternal health. Comprehensive healthcare coverage without limitations can help reduce maternal deaths by providing timely access to necessary care.  

The maternal health crisis in the United States demands immediate and sustained action, with extending postpartum coverage being a crucial step toward improving maternal health outcomes. It is important for each state to maximize 1115 waivers to its full capabilities to address the ongoing issue of our maternal health crisis. Expanding health care coverage allows health centers to provide the best service for their patients. Having comprehensive health insurance allows the ability to receive preventative services and treatments that reduce health risks during the postpartum period. With health centers leading in primary care and being trusted providers, they are positioned to cater to postpartum needs and overall wellbeing of mothers.

Community Health Centers rely heavily on Medicaid funding to serve millions of patients. As Congress moves forward with the budget reconciliation process, cuts to Medicaid funding could impact their patients’ access to primary care.

Budget reconciliation provides a fast track for certain legislation

The budget reconciliation process allows for expedited consideration of certain tax, spending, and debt limit legislation. Reconciliation allows bills to pass the Senate with a simple majority, bypassing the filibuster. To proceed, the House and the Senate must adopt the same budget resolution that sets spending goals and directs committees to produce spending or savings.  

Congressional Republicans aim to use reconciliation to pass President Trump’s priorities, including extending the 2017 tax cuts, increasing border and defense funding, and reducing federal spending. However, the chambers are currently divided on the strategy to pass the budget: House leaders and President Trump prefer bundling everything into one large bill, while Senate leaders favor splitting them into two smaller bills. 

Senate advances its two-bill strategy

On February 21, the Senate moved forward with its preferred two-bill strategy, passing the first budget resolution mostly along party lines 52-48, except for Sen. Rand Paul (R-KY), who voted no. The resolution, championed by Senate Budget Committee Chairman Sen. Lindsay Graham (R-SC), focuses on national security and immigration. Senate Republicans have said their resolution would have minimal impact on Medicare, Medicaid, and the Community Health Center Fund. 

House advances one-bill strategy

Separately, the House began moving forward with its one-bill strategy. The resolution, championed by Budget Committee chairman Rep. Jodey Arrington (R-TX), includes tax cuts and instructs the House Committee on Energy and Commerce to produce at least $880 billion in savings over 10 years. Reaching such a large amount would almost certainly require cuts to Medicaid, which is in the committee’s jurisdiction. 

The House floor vote on February 25 was a nail-biter. Speaker Mike Johnson (R-LA) could only afford to lose a handful of votes while balancing concerns from moderate Republicans about possible cuts to Medicaid and opposition from conservative Republicans that the proposed cuts did not go far enough. After an intense whipping operation, the House adopted the resolution narrowly along party lines, 217-215, with only conservative Thomas Massie (R-KY) opposing. 

House and Senate must agree on one budget resolution

While both chambers have adopted resolutions, they still must agree on an identical resolution before they can begin to consider an actual bill. Senate Majority Leader John Thune (R-SD) said that Senate Republicans “will want to do some things” with the House’s resolution, which did not provide any instructions to Senate Committees. This means each Chamber will have to vote again on whatever compromise their leadership agrees to. 

Growing resistance to Medicaid cuts

Concerns about changes to Medicaid through reconciliation are real for all Community Health Centers because Medicaid is such an important payor for our patients. In 2023, Medicaid accounted for 43% of health center revenue and covered 50% of health center patients, compared to 19% of the overall U.S. population. Cuts to Medicaid could result in health center patients losing access to cost-effective primary care. 

There is clear political reluctance within the Republican party to make significant Medicaid cuts through the reconciliation process. President Trump has repeatedly said there will be no cuts to Medicaid. Speaker Mike Johnson and Energy and Commerce Chairman Brett Guthrie (R-KY) downplayed the extent of cuts his Committee would allow in the eventual reconciliation legislation. Instead, they said Congress would focus on eliminating waste, fraud, and abuse in the program.

NACHC and health centers mobilizing to protect Medicaid

Health centers are working hard to protect Medicaid. Earlier this week, NACHC posted a statement urging lawmakers to oppose any cuts to Medicaid that would impact access to essential health services for millions of Americans. NACHC is also hosting a fly-in on March 11 to continue educating lawmakers about Medicaid’s importance to health centers and their patients. More details on the fly-in and policy papers focusing on Medicaid can be found on NACHC’s fly-in page. 

Legislators return to their districts the week of March 17, which presents another opportunity for advocacy on health center priorities. NACHC has developed a toolkit to support these efforts, which is available on the Health Center Advocacy Network website.

Budget negotiations continue in Washington, D.C., with all federal funding for Community Health Centers expiring this month. At this critical time, we must let Congress know how important health centers are to 32.5 million patients nationwide!

NACHC is encouraging advocacy to urge Congress to work together to pass a budget before the March 14 deadline and to make sure full annual funding for health centers is included in the final legislation. Take action by calling or emailing your members of Congress:

Last week, NACHC’s Joe Dunn, Chief Policy Officer, and Peter Shin, MPH, Ph.D., Chief Science Officer, appeared on C-SPAN’s Washington Journal to discuss the benefits Community Health Centers (CHCs) bring to local communities, how the funding freeze affected CHCs, and answer questions from callers regarding CHCs role in our nation’s health system.

Watch the interview: https://cdn.jwplayer.com/players/IWKbLJTt-xS4RtpB7.html