Gov. J.B. Pritzker announced on Tuesday that Illinois is the first state in the nation to extend full Medicaid benefits from 60 days to 12 months postpartum, following the federal Centers for Medicare & Medicaid Services (CMS) approval of Illinois’ 1115 waiver allowing for the extension.
The extension of Medicaid postpartum benefits to 12 months will strengthen continuity of care to improve health outcomes for new mothers in Illinois and is aimed at reducing the rate of maternal morbidity and mortality, including significant health disparities for Black women during the postpartum period.
Women with incomes up to 208% of the federal poverty level will have continuous Medicaid eligibility through 12 months postpartum, an increase in coverage from the standard 60-day postpartum period.
“This enhanced period of care for Illinois mothers is vital for them, their babies and their families, and is critical to reducing maternal morbidity and mortality rates and the alarming disparities in health outcomes for Black women and all women with Medicaid coverage across the state,” Illinois Department of Healthcare and Family Services Director Theresa Eagleson said. “Healthy moms equate to healthy babies and families and we are so grateful for this approval.”
Current Medicaid postpartum coverage is 60 days for women with incomes up to 208% of the federal poverty level (FPL). Beyond that point, women can continue coverage with incomes up to 138% FPL.
Without this newly approved 1115 waiver, women between 139-208% FPL would be left uncovered in the event they develop a serious pregnancy-related illness beyond the 60-day postpartum timeframe and haven’t enrolled in new coverage yet. For women who have enrolled in new coverage, they may have to find new in-network doctors who are not familiar with their medical history during a vulnerable time.
Research shows that disruptions in Medicaid coverage are common and often lead to periods of lack of insurance, delayed care and less preventive care for beneficiaries. For women who have enrolled in new coverage, they may have to find new in-network doctors who are not familiar with their medical history during a medically vulnerable time.
The continuity of coverage available through this waiver approval will help mothers manage chronic conditions like hypertension and diabetes and provide important access to behavioral health and other mental health care services.
An October 2018 Illinois Maternal Morbidity and Mortality Report, developed by the Illinois Department of Public Health (IDPH), recommended extending continuous coverage to women for 12 months postpartum. The report found that Non-Hispanic Black women are six times as likely to die of a pregnancy-related condition as non-Hispanic white women.
IDPH also found that poor continuity of care and a lack of care coordination are factors contributing to death in 93% of preventable pregnancy-related deaths during the late postpartum period (61-364 days postpartum).