Last week, the White House released the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis, termed "a whole-of-government approach to combating maternal mortality and morbidity." In conjunction with the release, the White House called for expanded Medicaid coverage for mothers from the dozen or so states who have yet to implement the 12-month postpartum expansion.
Most of the states that haven’t fully expanded eligibility for Medicaid have extended or plan to extend the postpartum coverage window for new mothers, marking an important shift in U.S. maternal healthcare, which has historically prioritized prenatal care over postpartum.
Despite its only recent incorporation, many states are already predicting positive outcomes from expanding their postpartum care. This will be especially impactful for women of color, who make up 65% of U.S. births paid by Medicaid. Under the status quo, Black mothers are 3x more likely to die of pregnancy-related complications than their white peers. Up to 60% of Black women do not have a postpartum visit, even though there is a higher prevalence of and morbidity from hypertensive disorders of pregnancy among Black populations than White — one of the leading causes of postpartum mortality. Increased access to care through the Medicaid expansion could provide improved access to contraception, better mental health, improved access to recovery services, and consistent follow-up for medical complications post-birth. Additionally, new limits on abortion access could mean an increase in the number of women who continue their pregnancies and need postpartum care.
However, while the expansion is a clear step on the path to improving maternal health, it’s clearly not a solution on its own. For example, Kentucky has implemented the expansion but still has some of the worst outcomes in the U.S. for maternal health. Increasing eligibility for new mothers to access care is important, but if they are not engaged in that care — if they’re not attending appointments — it won’t have an effect on their outcomes.
Research has shown inconsistent postpartum attendance across states that have implemented the Medicaid expansion, with little to no changes in attendance rates since the expansion. Adherence to postpartum care is one of the key indicators of long-term health for the mother, and lack of coverage is only one of the many barriers that can prevent a mother from attending. Financial insecurity, unavailable or inadequate childcare, limited partner and social support, and reduced flexibility with employment can present insurmountable challenges to postpartum moms.
Digital health can play a critical role in overcoming these socioeconomic barriers through platforms such as telehealth and remote patient monitoring. Babyscripts has played an important role in expanding postpartum coverage by increasing patient engagement and compliance. At LCMC Health, a New Orleans health system that serves a majority Medicaid population, the use of Babyscripts resulted in:
- Babyscripts users were more than two times as likely to complete a 30-day postpartum visit than the control group
- At 60 days postpartum, 64% of Babyscripts users had completed a postpartum visit, compared to 44% of the control group.
Furthermore, mobile applications such as Babyscripts myJourney have been shown to decrease racial disparities in postpartum blood pressure management, addressing some of the barriers to care specifically facing BIPOC mothers By encouraging mothers to invest in their own health through remote monitoring of blood pressure and by giving them convenient access to educational and support resources in the postpartum period, Babyscripts, and other digital solutions, can encourage compliance to a postpartum care plan, and refocuses attention on the mother's health and wellness.
With this expansion, policymakers have opened opportunities to address critical areas for improvement in maternity care. Now is the time to harness that momentum to actually make good on the potential that Medicaid benefits can offer for mothers by incorporating digital health in postpartum care.
Judy Chen is participating in the Babyscripts Summer Internship program. She is pursuing a Master of Public Health at Yale University, with a focus in Healthcare Management. In her free time, she enjoys reading and running outside.