Maternal health advocates want Texas leaders to prioritize support for pregnant people in the 2023 legislative session. Medicaid currently pays for about half of all births in Texas, according to the . Texas leaders are , but currently, coverage only extends two months past delivery.
Educators and advocates are hopeful Texas leaders will extend pregnancy Medicaid coverage to 12 months postpartum. This coverage is associated with for parents and infants, like higher birth rates, management of chronic conditions and support for mental health issues like postpartum depression.
What does Medicaid coverage during pregnancy look like in Texas?
Pregnancy Medicaid is a program out of For people who don鈥檛 have insurance, this Medicaid coverage lasts throughout pregnancy and up to two months after delivery.
鈥淭exas Medicaid provides robust services,鈥� said Amy Raines, . 鈥淭hey cover prenatal vitamins, ultrasounds, prenatal visits, limited dental services, transportation services, substance abuse disorders, just a wide range of standard maternal health services.鈥�
Diana Forester, the , says for people who are uninsured, qualifying for pregnancy Medicaid is a 鈥済olden window.鈥�
鈥淚t's the chance to have access to health care to address issues that maybe have been building for a while, or have just appeared,鈥� she said. 鈥淭hose kinds of things that could, left unaddressed, build into something that would need surgery or more intensive intervention later. It just feels like that should be something that's accessible to everyone when they need it.鈥�
How does coverage affect maternal and infant health outcomes?
Forester says that access to timely and affordable prenatal care means better birth outcomes for parents and infants.
鈥淚 think it's the difference between having a chance at a healthy pregnancy versus not,鈥� she said.
Raines says issues like diabetes and hypertension that can happen before pregnancy can cause complications for infants and parents. Having spotty health coverage can make managing a chronic condition that much more challenging.
鈥淲e are able to hopefully manage these chronic conditions through the pregnancy, let them have a successful delivery, and then they don't have coverage again until they get pregnant again,鈥� Forester said. 鈥淵ou're not in the best position that you could be to have a successful pregnancy.鈥�
Untreated issues also can lead to pregnancy complications and death. The identified that chronic disease was a top factor in pregnancy-related deaths. Cardiovascular and heart issues, mental health disorders, severe bleeding, infections and high blood pressure were also the leading causes of death among pregnant Texans. The report stated that almost 89 percent of pregnancy deaths in Texas were preventable.
鈥淐ontinuous coverage is really important for maternal health,鈥� Raines said. 鈥淚t provides the opportunity to detect conditions, to manage them and to prevent conditions from happening.鈥�
!["There's an opportunity that we're missing to capture [pregnant people] in the preconception period that may have health conditions that if they're not addressed, would carry over and cause problems later on for the [parent] and the baby," said Amy Raines, an assistant professor in the Department of Pediatrics and Women鈥檚 Health with the University of North Texas Health Science Center at Fort Worth.](https://npr.brightspotcdn.com/dims4/default/a8c65d3/2147483647/strip/true/crop/2626x1750+0+0/resize/840x560!/format/webp/quality/90/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F5c%2F8d%2F582af83a47e3b24e3d0b36d96d32%2Fap21211813356321.jpg)
What do advocates, physicians and health policy experts think is missing?
Both Forester and Raines agree that coverage should be extended to 12 months postpartum.
鈥淭here's been a ton of research for the last eight to 10 years that show that 365 days postpartum is a really crucial period for moms, and allowing them to have access to health care prevents a lot of these pregnancy-associated deaths,鈥� Forester said. 鈥淲e know that having a mom is a great indicator of better overall health for kids and families.鈥�
In the last few years, .
鈥淲e're so behind at this point,鈥� Forester said.
Raines also adds that extending postpartum coverage should include extending healthcare for everyone of reproductive age. She also hopes that Texas eventually covers fertility services, like IVF or cryopreservation of embryos. According to a , only New York state 鈥渟pecifically requires their Medicaid program to cover fertility treatment.鈥�
鈥淭he ability for [people] to choose when they want to have children, how to grow their family, and the ability to access those services is really important,鈥� she said.
Forester adds that changing Medicaid policy for pregnant people could lead to expanded and improved services for everyone.
鈥淚f you can change the policy with Medicaid, then it's a leader and an indicator of where we're headed,鈥� she said. 鈥淚 feel like it鈥檚 the first step in getting the rest of the providers to follow suit.鈥�
How does this relate to Roe v. Wade being overturned earlier this year?
After Roe v. Wade was overturned by the U.S. Supreme Court in June, abortion became illegal in Texas except in 鈥� Abortion access was already limited in Texas due to SB 8, with people traveling to neighboring states like Louisiana and Oklahoma to receive care. This meant that abortion access was even before June, and people who couldn鈥檛 afford to travel and take time off work couldn鈥檛 get care.
Limiting abortion care also affects people disproportionately. Black people are the largest population group to receive abortions in the United States, according to a . Black people are also impacted by maternal mortality in greater numbers. They鈥檙e nationally, and .
A 2021 study from Duke University Press .
Raines and Forester say one way to prevent bad health outcomes for pregnant people is expanding access to health care like Medicaid.
鈥淧regnancy Medicaid is essential,鈥� Raines said. 鈥淸About] 50% of pregnancies are covered by Medicaid in Texas every year. It's a key part of the whole picture of maternal health, from the prenatal care quality that you receive to the hospital where you're delivering, to the level of care that's provided at that hospital. It's a key ingredient to a healthy pregnancy in Texas.鈥�
Got a tip? Email Elena Rivera at erivera@kera.org. You can follow Elena on Twitter .
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