Virginia is expanding Medicaid coverage to all enrollees for a year after childbirth

Starting this month, Virginia Medicaid will cover enrollees for a year after childbirth — a significant expansion aimed at improving postpartum outcomes for low-income patients.

The change has been in the works since 2020, when state legislators passed budget language directing the Virginia Department of Medical Assistance Services to initiate the expansion. But the federal government, responsible for authorizing the additional spending, didn’t officially  approve the shift until November, and funding wasn’t available to states until April.

Federal law has required states to provide pregnancy-related Medicaid coverage for decades, but services previously ended for many enrollees within 60 days after giving birth if they only qualified for the program due to being pregnant. While some could re-enroll through other eligibility criteria, many others lost coverage, particularly if their income changed during or shortly after pregnancy.

Advocates say the expanded services are a first step in improving long-documented disparities in maternal outcomes. Rates of pregnancy-related death nearly doubled in Virginia between 1982 and 2018, according to data from the state Department of Health and March of Dimes, and Black women are more than twice as likely to die following childbirth than White women.

In a push to reduce maternal mortality, Virginia is expanding access to doulas

Data also show that existing health conditions and insurance coverage appear to play an outsized role. A 2019 report from the Virginia Maternal Mortality Review Team, which analyzed pregnancy-related deaths from 1999 to 2012, found that nearly 70 percent occurred among patients with at least one chronic condition.

Almost half of those who died had government-provided insurance that only lasted six months after pregnancy, and more than 60 percent of those deaths happened between a month-and-a-half to a year after giving birth. 

“The team also found that a lack of care coordination contributed to maternal mortality in a significant number of cases, particularly among women with chronic health conditions,” the state’s Department of Medical Assistance Services wrote in its application to expand postpartum care. 

The same report found that chronic conditions are more likely to contribute to maternal deaths among Black patients than they are for White patients. The hope is that continuous coverage will avoid forcing patients to leave their providers, helping more Virginians access preventive care during a particularly vulnerable time.

Nineteen other states and Washington, D.C. have implemented the 12-month extension as of July 1, according to the Kaiser Family Foundation. In Virginia, it’s part of a multi-year effort to eliminate racial disparities in the state’s maternal mortality rate by 2025 — a goal first set by former Gov. Ralph Northam. 

As part of the initiative, state legislators also voted to extend Medicaid coverage to doulas, who provide advice and support to families during pregnancy. In a Tuesday press release, the Virginia Poverty Law Center urged residents who may be eligible for expanded benefits to seek out its Enroll Virginia program, which offers assistance to anyone seeking health care coverage through Medicaid or the state exchange.

“This is a change that will really help postpartum persons maintain access to necessary health care,” Sara Cariano, a senior health policy analyst for the program, said in a statement.

“This new rule extends postpartum coverage for all enrollees and creates a more lasting system for people to get the care and support they need during this critical time,” she continued.