Report examines connections between expanded adult Medicaid coverage and maternal health

By the CDHP team

Every May, the U.S. celebrates Mother's Day. Across the country, there are markedly higher rates of phone calls and it was projected that, this year, Americans spent $25 billion dollars on gifts like flowers and dining out. But beyond the flowers and cards, it is worth asking, how do we care for mothers?

America’s high rate of pregnancy-related deaths, or maternal mortality, rightly continues to appear across news outlets. Officials from presidential candidates to state legislators are grappling with solutions to what has become a crisis. As this blog has previously noted, at least two bills in Congress — the MOMMA’s Act and MOMMIES Act — would tackle the problem with efforts that include expanding oral health coverage in pregnancy. 

But as we look for solutions, it is also worth looking at the broader impact of previous policy changes on the health of pregnant women, parents, and their young children. In May, the Georgetown University Center for Children and Families released a report on the impact of Medicaid expansion on maternal health. Its findings could have serious implications for policy makers. 

Expanding Medicaid increased access to health coverage across the board, and with it, increased access to preventive care before, during, and after pregnancy.

One of the most striking findings was that when states expanded Medicaid it improved the health of all women of childbearing age, including those who ultimately became pregnant. The report points out that while states have had higher income thresholds for Medicaid eligibility for pregnancies and births for some time now, about half of women who were enrolled in Medicaid when they gave birth lacked coverage before their pregnancy. Similarly, more than half of these women also experienced gaps in health coverage 6 months after giving birth. Evidence shows that expanding Medicaid increased access to health coverage across the board, and with it, increased access to preventive care before, during, and after pregnancy. In states that have not expanded Medicaid, adults who do not have a disability or who are not pregnant often have a harder time finding coverage and care than their peers in states that have expanded the program. Such gaps leave people without critical resources to achieve good health before or between pregnancies, in turn risking their health when they do become pregnant.

For example, in Alabama, a state that has not adopted Medicaid expansion, a parent in a family of three must make $320 a month or less to be eligible for Medicaid coverage. This threshold neglects many low-wage earners who will otherwise lack health coverage and subsequently struggle to afford basic care. The authors posit that greater access to health coverage allows women to address health issues with regular preventive care before a pregnancy and after the current time limit on care after birth. Today, federal Medicaid regulations only require 60 days of postpartum care. Conversely, gaps in coverage decrease access to care and have negative implications for health. Healthier women have safer, healthier pregnancies, in turn giving newborns the best chance for a healthy start.

Healthier women have safer, healthier pregnancies, in turn giving newborns the best chance for a healthy start. Evidence suggests this holds true for oral health and maternal health.

Evidence suggests this holds true for oral health and maternal health. That is why CDHP has encouraged policymakers, providers, and others in the health system to prioritize oral health in pregnancy. Studies show that women with periodontal disease may be at greater risk for complications in pregnancy, such as pre-eclampsia, gestational diabetes, preterm birth, and having low birth-weight infants. New research even indicates that periodontal disease may worsen the impact of depression on birth outcomes. A woman’s oral health status during pregnancy may also be a good predictor of her future child’s risk for developing dental caries — the disease that causes tooth decay. This is of particular concern because tooth decay can harm a child’s healthy development, school achievement, and undermine their potential yet it remains the most common chronic condition in childhood.

The report also sheds light on how Medicaid expansion could be a valuable tool to address the racial disparities in maternal and infant health. In recent years US infant mortality rates have declined overall, but racial disparities have persisted. Comparisons across states show that expanding Medicaid was associated with higher declines in infant mortality than in non-expansion states. It also significantly reduced racial disparities, especially for black infants.

Despite medical advances and improved rates of coverage during pregnancy, racial disparities in maternal health also persist. Black women are almost three times more likely to die of pregnancy or birth complications than white women. Improving women's access to health care, including oral health care, could be an important step in addressing these and related inequities, like income disparities. For example, access to oral health care is associated with higher earnings for women and increased likelihood that their children will receive dental care. Helping more women achieve good oral health could further improve the quality of life for their families.

So, how can we best care for mothers? In times when we see concerning proposals to limit Medicaid coverage, or work requirements which could cut adult Medicaid coverage, it is worth reiterating: providing low-wage women and moms with the comprehensive medical and dental coverage and care they need to thrive is probably a good start. 

For more information on CDHP's work supporting the oral health of pregnant women, read our policy brief, Oral Health During Pregnancy, and watch our webinar on maternal oral health (scroll down to the webinar section).

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