ASPEN, Colo. — The White House’s top Medicaid official said 46 states have implemented policies providing Medicaid coverage 12 months postpartum. Now, Chiquita Brooks-LaSure says she’s laser-focused on seeing the four remaining states follow suit.

“This is pretty fast adoption of a new program,” said Brooks-LaSure, the administrator for the Centers for Medicare and Medicaid Services, during an interview with CQ Roll Call on Saturday during the Aspen Ideas: Health conference. 

The fiscal 2023 omnibus appropriations law made permanent a program providing an extension of Medicaid postpartum care. Currently, Idaho and Iowa are close to having their policies take effect, while Wisconsin is awaiting feedback on a three-month coverage waiver. Only Arkansas has not taken additional action.

Brooks-LaSure acknowledged that implementing the change in the remaining states may take time, in part because of differences in how states seek changes to their Medicaid programs.

The holdouts will come on board, she said, by “really helping people to see the difference in maternal health and also how it’s good not just for the women, not just for the children, but also for providers to make sure they get the reimbursement for the care they deliver.”

Brooks-LaSure emphasizes the same approach of the benefits to patients and doctors when referring to the Medicaid expansion implemented under the 2010 health care law. More than a decade after that law’s passage, 10 states have yet to expand Medicaid. 

She said expanding coverage is key to achieving the administration’s goal of improving maternal health and reducing deaths. 

Centers for Disease Control and Prevention data released last month showed significant drops in the maternal mortality rate between 2021 and 2022, but the United States is still an outlier in its rate compared with peer nations.

An upcoming Supreme Court ruling could also affect next steps for the agency to prevent maternal deaths. The court could decide this week whether federal law requiring emergency abortions does or does not override state abortion bans. States that accept federal Medicare funding must provide emergency care.

On Wednesday, Bloomberg News reported that the court briefly posted an opinion suggesting that would for now prevent Idaho from enforcing its abortion ban in emergency rooms. The court has not officially issued a ruling the case, however.

“I’m trying to make sure that hospitals have clarity” on what they are expected to do, said Brooks-LaSure, who added that she has spoken with people in many states about understanding the distinctions. “If they have a woman come to the emergency department who’s in distress … there may be points where an abortion is necessary.

“I think CMS is working hard to provide clarity in instances that we have authority, but this is bigger than us,” she said.

In the works

At least one change that CMS thinks could curb the maternal mortality rate is nearing completion.

The agency announced a funding opportunity for states interested in its Transforming Maternal Health Model, known as TMaH on Wednesday. The model seeks to improve maternal care through Medicaid and the Children’s Health Insurance Program, and if adopted it would increase beneficiary access to midwives, doulas and other perinatal workers.

Brooks-LaSure said Saturday “there’s been a lot of state interest” in the notice for states to apply to participate. Applications are due Sept. 20.

“The health policy world is really talking about the role of doulas, and so that’s also an important part of our models,” she said.

Other initiatives are more of a work in progress.

Since March 2023, more than 23 million individuals have been disenrolled from Medicaid, as states resumed verifying eligibility for the program. About 69 percent of those disenrolled were booted for procedural reasons.

Medicaid does not have federal requirements regarding nonhospital maternity care, and pregnancy-related coverage varies among states. Only Medicaid expansion states are required to cover pregnancy-related preventive services recommended by the U.S. Preventive Services Task Force.

That gap worries Brooks-LaSure, who emphasized its importance to maternal health outcomes. 

“One of the key drivers to adverse maternal health outcomes is that women don’t get care until the third trimester, which is late,” she said, adding that nonexpansion states limit access to preventive care and having a relationship with a provider before becoming pregnant.

There’s also work to be done on the qualifications for birthing-friendly hospitals, a designation spearheaded by the Biden administration to help pregnant individuals choose a provider. Some advocates have argued that the designation doesn’t require much effort from hospitals to achieve.

Brooks-LaSure agrees there is improvement to be made. “The bar is not high enough,” she said. 

She sees it as a twofold process. The agency will continue to raise the metrics for the label while hospitals adapt to maintain the birthing-friendly designation. They’re still seeking input on other measures to include.

“We wanted to start and launch it with data that we had and felt like that was an important step,” said Brooks-LaSure. “I actually think it’s a strength that we have gotten so many hospital systems to commit to having a birthing-friendly designation to commit to these best practices.”

Last month, the administration unveiled its maternal mental health plan, which includes actions for agencies as well as policies that would require congressional action.

Brooks-LaSure wouldn’t say whether CMS was discussing any of these initiatives with Congress.

“CMS is really focused on executing what we have authority for,” she said. “Addressing maternal health is broader than our agency, and I think that we as a country need to do more to support mothers.”