Medicaid Initiatives to Improve Maternal and Infant Health and Address Racial Disparities

Recent trends in maternal and infant health and persistent racial disparities in these measures have led to a growing focus on improving health and reducing disparities in these areas, which has been heightened by the COVID-19 pandemic and growing racial justice movement. As a primary source of coverage for pregnant women and children, particularly among people of color, Medicaid can play a key role in helping to improve maternal and infant health and reducing racial disparities. This brief provides a summary of Medicaid’s role for pregnant women and infants and current Medicaid initiatives to improve maternal and infant health. It finds:

Medicaid, along with the Children’s Health Insurance Program (CHIP), provide a nationwide base of coverage for low-income pregnant women and children. Reflecting this coverage, nearly half of births (45%) are covered by Medicaid and nearly half of all infants (46%) are covered by Medicaid or CHIP. The programs play an even larger role for people of color given that they have more limited access to private coverage and lower incomes compared to their White counterparts. For example, Medicaid covers about two-thirds of births among Black, American Indian or Alaska Native (AIAN), and Native Hawaiian or Other Pacific Islander (NHOPI) women and over six in ten Black, Hispanic, and AIAN infants are covered by Medicaid or CHIP.

The Affordable Care Act (ACA) Medicaid expansion has led to improvements in and narrowed racial disparities in maternal and infant health. Through the ACA Medicaid expansion to low-income adults, states have increased coverage options for pregnant women who would otherwise lose eligibility at the end of the 60-day postpartum period, although some still may lose coverage at the end of the period. Studies show that the Medicaid expansion has had positive impacts on maternal and infant access to and use of care and health outcomes and narrowed racial disparities in certain measures including health coverage, maternal mortality, infant mortality, low birthweight, and preterm birth.

There are a range of Medicaid initiatives underway at the state and federal level to improve maternal and infant health. There has been interest at the state and federal level in extending the postpartum Medicaid eligibility period to further reduce coverage losses for women at the end of the period. In addition, there are efforts to expand benefits and implement new payment and delivery models. These efforts may not only contribute to improvements in maternal and infant health but also reduce racial disparities in these areas due to the large role the program plays for people of color.