The people closest to the problems are closest to the solutions
It’s Black Maternal Health Week (BMHW)—a time for awareness, activism, and community building to deepen the national conversation about the Black maternal mortality and morbidity epidemic and commit to community-driven solutions. NHeLP joined Black Mamas Matter Alliance, the National Birth Equity Collaborative, and over 120 organizations in endorsing a BMHW resolution cosponsored by 77 members of the U.S. House of Representatives and Senate. The resolution calls out the overlapping systems of oppression, such as structural racism and gender oppression, that drive Black maternal health inequities and reproductive injustice. It highlights intersecting human rights, such as fair treatment within the criminal justice system and freedom from violence, that Congress must enforce to save lives. It also stresses that Black birthing people** should be able to actively participate in the policy decisions that impact their lives.
This post highlights vital community-driven federal legislative solutions and some of the Black-led entities leading the charge.
Securing 12-Month Postpartum Medicaid Coverage Nationwide
Ensuring health coverage for at least a year postpartum is critical to promoting maternal health equity and reproductive justice for Black birthing people. Black people are disproportionately likely to experience disruptions in perinatal insurance coverage. These disruptions leave them unconscionably vulnerable to pregnancy-related complications and mortality. Extending Medicaid and CHIP’s postpartum coverage will help reduce inequities, increase access to care, and improve outcomes for Black birthing people.
Last month, we wrote about how the American Rescue Plan Act of 2021 authorized a landmark new state plan amendment (SPA) option for states to extend continuous Medicaid or CHIP coverage from the current cutoff of 60 days postpartum to 12 months postpartum. While the SPA option marks an important step and a few states are close to adoption, it is not enough to ensure that Black birthing people across the country will have adequate and continuous health coverage postpartum. Several factors are leading some states to reject this option:
- The option is temporary. It is available to states beginning April 1, 2022 and will sunset after 5 years.
- The SPA is optional. Black birthing people will be left behind in states that reject the option.
- The financial incentives for adoption may be insufficient. Federal Medical Assistance Percentages (FMAPs) determine the amount of Federal payments to a state for health care services. The FMAP formula provides higher reimbursement to states with lower incomes per capita relative to the national average, reflecting states’ differing capacities to fund Medicaid services from their own revenues. There is a statutory minimum of 50% and maximum of 83% for increase in payments from the federal government. There are several exceptions for some services, populations, and providers, such as costs for individuals newly eligible through Medicaid expansion. The ARP Act did not create an enhanced FMAP for the 12 month postpartum option. Without an enhanced FMAP, some states may lack the financial resources to adopt the option.
In order to ensure continuous coverage for Black postpartum people, Congress must act to make full Medicaid coverage mandatory for at least a year postpartum. For example, in 2019, U.S. Senator Cory Booker (D-NJ), Congresswoman Ayannah Pressley (D-MA), and colleagues introduced the Maximizing Outcomes for Moms Through Medicaid Improvement and Enhancement of Services (MOMMIES) Act. The MOMMIES Act would extend full Medicaid coverage (rather than coverage of limited pregnancy-related services) to 12-months postpartum nationwide. It would also increase access to primary care and reproductive health providers, including community-based doula care. We are hopeful that the new Congress will pass this critical legislation.
Dismantling Root Causes
The Black Maternal Health Caucus recently reintroduced the Black Maternal Health Momnibus Act (Momnibus). The Momibus is a package of 12 bills designed with, by, and for Black women and birthing people to comprehensively address gaps in policy solutions to the Black maternal mortality epidemic. The legislation addresses some of the root causes of the epidemic by making critical investments in social determinants of health, such as housing, transportation, and initiatives to reduce levels of and exposure to climate change-related risks for birthing people and babies. It promotes access to quality pregnancy-related health care by growing and diversifying the perinatal workforce and creating protections for culturally and linguistically appropriate health care, investing in maternal mental health, and promoting payment models to incentivize continuity of postpartum health coverage and high-quality maternal health care.
Notably, several states (e.g., NC, CA, OH, CO) have introduced bills that follow in the federal Momibus’ footsteps. For example, California’s Momnibus bill (S.B. 65), which NHeLP co-sponsors and helped to draft, would provide Medi-Cal coverage for doula services and extend postpartum coverage to one year, provide guaranteed minimum income to pregnant people at or below 300% of the Federal Poverty Level, codify the state’s maternal mortality review board, and expand access to midwifery training programs.
Recognizing Black Maternal Health Champions
The people closest to the problems are closest to the solutions. While there are many phenomenal Black-led entities who are crafting and championing equitable and community-driven policy solutions to the Black maternal mortality epidemic, here are four to get started:
- National Birth Equity Collaborative
- Black Mamas Matter Alliance
- Black Women for Wellness Action Project
- Black Maternal Health Caucus
To learn more about BMHW, visit https://blackmamasmatter.org/bmhw/.
* Helen Mun is a J.D. candidate (2022) at Georgetown Law School and intern (Spring 2021) in NHeLP’s Washington, DC office.
** NHeLP recognizes that not all pregnant and postpartum people identify as women. We use the more gender inclusive terms “pregnant people,” “postpartum people,” or “birthing people” as much as possible in our work. We use the term “women” when necessary to conform with the language used in legislation and regulations. We do the same to conform with non-gender inclusive research findings. We recognize that more inclusive research, statutory text, and regulatory text is needed.