Maternal mortality remains a serious public health concern in the United States, with substantial differences in pregnancy-related outcomes across racial and socioeconomic groups. Black and Indigenous women experience disproportionate risks of maternal complications and death, reflecting longstanding problems involving healthcare access, structural discrimination, and inadequate continuity of care. The New York State Department of Health (2024) documented significant racial and ethnic differences in maternal mortality, demonstrating the need for policies that address unequal healthcare experiences.
Extending Medicaid coverage throughout the first 12 months after childbirth is an important policy strategy for improving access to postpartum services. Continuous coverage can help mothers obtain follow-up appointments, behavioral healthcare, cardiovascular assessments, and treatment for complications that emerge after delivery. This policy brief examines maternal health inequities, evaluates postpartum coverage alternatives, and recommends measures to strengthen Medicaid-supported maternity care. Minnesota’s postpartum coverage expansion and the federal Black Maternal Health Momnibus Act provide relevant examples of policy approaches intended to improve maternal health equity.
Maternal health disparities arise from a combination of clinical, social, and healthcare system factors. Women experiencing financial insecurity, transportation difficulties, limited healthcare availability, or discrimination may face additional challenges obtaining appropriate pregnancy and postpartum services. These barriers can delay the identification and management of complications, particularly when patients lack continuous insurance coverage.
The New York State Department of Health (2024) reported substantial racial and ethnic disparities in maternal mortality, highlighting the unequal burden experienced by Black women. Such differences indicate that improving maternal outcomes requires attention to healthcare quality and the broader conditions affecting access to treatment.
Geographic location also influences maternity care. Rural communities may experience shortages of obstetric providers, limited transportation options, and difficulties accessing specialized healthcare facilities. Gordon et al. (2025) examined rural maternal health interventions and identified considerations relevant to improving services in underserved areas. Their findings reinforce the importance of developing healthcare policies that account for differences in community resources.
The postpartum period presents additional concerns because medical and psychological complications may continue after the initial recovery from childbirth. Conditions such as hypertension, depression, diabetes, and cardiovascular disease can require ongoing monitoring and treatment. Insurance interruptions may interfere with follow-up care and increase the difficulty of managing these conditions.
Historically, pregnancy-related Medicaid eligibility generally continued for approximately 60 days after childbirth unless an individual qualified through another eligibility pathway. Federal policy subsequently created opportunities for states to extend postpartum coverage to 12 months.
Minnesota is an important example because the state implemented 12-month postpartum Medical Assistance coverage effective July 1, 2022. Consequently, the policy priority for Minnesota is maintaining effective coverage and addressing remaining barriers to service utilization rather than seeking initial adoption of an extension that has already occurred.
The broader problem extends beyond insurance eligibility. Continuous coverage can improve financial access, but patients must also be able to obtain appointments, communicate with healthcare professionals, and receive culturally responsive services. Effective maternal health policy should address these interconnected challenges.
Several policy approaches can be considered when addressing postpartum healthcare access and maternal health disparities. Each alternative offers potential benefits but also presents implementation considerations.
The first alternative is retaining a short postpartum eligibility period for individuals who qualify for Medicaid through pregnancy-related provisions. This approach may limit immediate public expenditure on extended coverage, but it can leave some mothers vulnerable to insurance interruptions while they continue to require medical services.
Smith et al. (2025) examined Medicaid-covered healthcare visits during the postpartum year and differences associated with enrollee characteristics and state policies. Their research demonstrates the importance of examining how Medicaid beneficiaries use healthcare services after childbirth.
A limited eligibility period may create administrative challenges for individuals who need to transition to another insurance category. These transitions can be particularly difficult for patients managing chronic illnesses or behavioral health conditions.
Although shorter coverage periods may appear less expensive in the immediate term, financial savings cannot be assumed without considering potential downstream healthcare costs and changes in service utilization.
The second alternative involves maintaining or adopting 12-month postpartum Medicaid eligibility. This approach provides a longer period of insurance continuity and reduces the likelihood that eligible individuals will experience a coverage interruption solely because pregnancy-related eligibility has ended.
Extended coverage can support access to primary care, mental health treatment, chronic disease management, and postpartum follow-up. It may also improve opportunities for clinicians to identify complications requiring additional assessment.
Minnesota’s implementation of 12-month postpartum Medical Assistance coverage illustrates how this approach can be incorporated into state healthcare policy. Other states can evaluate similar coverage arrangements according to their existing Medicaid programs and applicable federal requirements.
However, the benefits of coverage expansion depend partly on healthcare service availability. Patients living in communities with limited provider capacity may continue to experience difficulties obtaining care despite having insurance.
The third alternative involves combining postpartum coverage with broader investments in maternal health services. These investments may include community health programs, telehealth, behavioral healthcare, patient navigation, and workforce development.
The Black Maternal Health Momnibus Act of 2023 proposed a coordinated approach to maternal health disparities through multiple legislative measures addressing healthcare delivery and social conditions. Although that version of the legislation did not become law during the 118th Congress, its policy objectives remain relevant to discussions about maternal health reform.
Carvalho et al. (2021) reviewed federal and Massachusetts maternal health policy proposals and examined approaches to addressing concerns affecting Black maternal health. Their analysis demonstrates the importance of considering legislative strategies that extend beyond individual clinical interventions.
Comprehensive programs may address barriers that insurance expansion alone cannot resolve. However, they require coordinated funding, administrative oversight, workforce capacity, and mechanisms for evaluating outcomes.
The three alternatives differ in their potential effects on continuity of care, health equity, and implementation feasibility.
|
Policy alternative |
Potential advantages |
Major limitations |
|---|---|---|
|
Limited postpartum coverage |
Restricts the duration of pregnancy-related eligibility and associated program spending |
May result in coverage interruptions and delayed postpartum treatment |
|
Twelve-month Medicaid coverage |
Supports insurance continuity and access to postpartum medical and behavioral healthcare |
Does not independently resolve provider shortages or transportation barriers |
|
Comprehensive maternal health programs |
Addresses insurance, healthcare delivery, workforce capacity, and social barriers |
Requires broader coordination, sustainable funding, and implementation oversight |
Among these alternatives, 12-month postpartum Medicaid coverage provides an important foundation for improving access. Nevertheless, combining continuous insurance with targeted service improvements offers a more comprehensive response to maternal health inequities.
Carty et al. (2022) examined federal legislation addressing racial disparities in pregnancy-related deaths. Their analysis supports the importance of considering policy interventions aimed at reducing inequities, although the effectiveness and financial impact of individual proposals must be evaluated separately.
The preferred policy approach is therefore to preserve and expand postpartum coverage while strengthening community-based maternal health services. This strategy addresses insurance continuity without assuming that coverage alone will eliminate disparities.
State policymakers should support 12-month postpartum Medicaid eligibility for qualifying individuals and establish administrative procedures that minimize unnecessary coverage interruptions. States that have already implemented extended coverage should focus on maintaining eligibility continuity and ensuring that beneficiaries understand their available services.
For Minnesota, the recommendation is to strengthen the implementation of its existing postpartum coverage policy. Healthcare organizations and Medicaid administrators should provide accessible information about eligibility, covered benefits, and procedures for obtaining follow-up services.
Continuous coverage should support access to treatment for postpartum depression, hypertension, diabetes, cardiovascular conditions, and other medical concerns that may require care beyond the early postpartum period.
Insurance coverage must be supported by adequate healthcare infrastructure. Policymakers should consider investments in community health centers, rural maternity services, telehealth, and care coordination programs.
Gordon et al. (2025) examined interventions intended to improve maternal health in rural settings. Their work highlights the importance of evaluating service delivery approaches according to the needs and resources of individual communities.
Community-based programs can help connect patients with healthcare providers and reduce practical barriers to treatment. Patient navigation and coordinated referral systems may be particularly useful for individuals managing multiple healthcare needs.
Implementation should prioritize communities experiencing limited provider availability and substantial maternal health disparities.
Reducing maternal health inequities requires attention to communication, discrimination, and patient experiences within healthcare organizations. Policies should support professional education that strengthens cultural responsiveness, respectful communication, and awareness of structural barriers affecting healthcare access.
Ličen and Prosen (2023) examined the development of cultural competence among nursing students and its relevance to professional practice. Their findings support the importance of educational preparation for providing care to diverse populations.
Healthcare organizations should combine education with institutional accountability, patient feedback, and evaluation of care quality. Training alone is unlikely to eliminate structural disparities without corresponding improvements in organizational practices.
Federal policymakers should consider legislative measures that strengthen maternal healthcare access, improve research and data collection, support workforce development, and address social determinants of health.
The Black Maternal Health Momnibus Act of 2023 provides an example of a comprehensive legislative approach, although advocacy should focus on currently active proposals rather than treating the 2023 bill as pending legislation.
Carvalho et al. (2021) demonstrate the relevance of examining maternal health policy proposals as part of a broader effort to address racial inequities. Federal legislation should therefore complement state Medicaid initiatives by supporting programs that respond to both clinical and social barriers.
Policymakers should require regular evaluation of postpartum coverage and maternal health initiatives. Relevant indicators include postpartum insurance continuity, follow-up visit utilization, access to behavioral healthcare, preventable complications, and differences in outcomes across demographic groups.
Evaluation should distinguish between increased insurance enrollment and meaningful improvements in healthcare access. For example, a rise in coverage rates does not necessarily indicate that patients are receiving timely treatment.
Collecting and reviewing appropriate outcome data can help policymakers identify implementation gaps and determine whether additional interventions are necessary.
Nursing professionals are well positioned to contribute to maternal health policy because they participate directly in patient education, clinical assessment, care coordination, and the identification of barriers to treatment.
Nurses can communicate the importance of postpartum healthcare continuity to policymakers through evidence-based correspondence, participation in legislative hearings, and collaboration with professional associations. Their clinical perspectives can help explain how insurance interruptions or inadequate service availability affect patients.
Nursing advocacy should also emphasize the needs of populations experiencing disproportionate maternal health risks. Partnerships with community organizations and patient representatives can help ensure that policy recommendations reflect the experiences of affected populations.
Professional education is another important responsibility. Ličen and Prosen (2023) highlight the relevance of cultural competence development in nursing preparation. Such education can complement advocacy activities by strengthening nurses’ ability to provide respectful care and recognize barriers affecting diverse patient populations.
Nurses should also contribute to policy evaluation by identifying changes in healthcare access, reporting implementation challenges, and supporting quality improvement activities.
Through these responsibilities, nursing professionals can help connect legislative decisions with the practical requirements of safe and equitable postpartum healthcare.
Expanding postpartum Medicaid coverage is an important policy strategy for addressing maternal healthcare access and reducing barriers that contribute to unequal maternal health outcomes. Black and Indigenous women continue to experience significant maternal health disparities, demonstrating the need for coordinated interventions that consider healthcare quality, insurance continuity, and social determinants of health.
Twelve-month postpartum coverage provides an opportunity to improve access to follow-up appointments, behavioral healthcare, and treatment for medical complications. However, insurance expansion should be combined with investments in community health services, culturally responsive care, and effective program evaluation.
Minnesota’s existing postpartum Medicaid extension demonstrates a state-level approach to improving insurance continuity, while federal maternal health proposals illustrate opportunities for broader policy development. Nursing professionals can contribute to these efforts through legislative advocacy, patient education, stakeholder collaboration, and evidence-based recommendations.
A comprehensive approach that combines continuous coverage with accessible healthcare services offers a stronger foundation for advancing maternal health equity and improving postpartum care.
Carty, D. C., Mpofu, J. J., Kress, A. C., Robinson, D., & Miller, S. A. (2022). Addressing racial disparities in pregnancy-related deaths: An analysis of maternal mortality-related federal legislation, 2017–2021. Journal of Women’s Health, 31(9), 1222–1231. https://pmc.ncbi.nlm.nih.gov/articles/PMC10949966/
Carvalho, K., Kheyfets, A., Maleki, P., Miller, B., Abouhala, S., Anwar, E., & Amutah-Onukagha, N. (2021). A systematic policy review of Black maternal health-related policies proposed federally and in Massachusetts: 2010–2020. Frontiers in Public Health, 9, Article 664659. https://doi.org/10.3389/fpubh.2021.664659
Gordon, R. D., Kishi, A., Brown, J. A., Voisin, C., Thomas, N., Riley, S. R., Fareed, N., Bunger, A., Gillespie, S. L., Venkatesh, K. K., Juckett, L., & Brill, S. B. (2025). Rural maternal health interventions: A scoping review and implications for best practices. The Journal of Rural Health, 41(1), Article e70007. https://pmc.ncbi.nlm.nih.gov/articles/PMC11874679/
Ličen, S., & Prosen, M. (2023). The development of cultural competences in nursing students and their significance in shaping the future work environment: A pilot study. BMC Medical Education, 23(1), 1–9. https://pmc.ncbi.nlm.nih.gov/articles/PMC10621240/
New York State Department of Health. (2024, March 14). New York State Health Department releases maternal mortality reports detailing stark racial, ethnic disparities. https://www.health.ny.gov/press/releases/2024/2024-03-14_maternal_mortality.htm
Smith, L. B., O’Brien, C., Wei, K., Waidmann, T. A., & Kenney, G. M. (2025). Medicaid-covered health care visits during the postpartum year: Variation by enrollee characteristics and state. Health Affairs Scholar, 3(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC11823106/
