CMS Approves IL Waiver to Support Rural, Black Maternal Health

In order to support rural and Black maternal healthcare, HHS has offered states the option to extend maternal Medicaid coverage and Illinois is the first state to receive approval for the amendment, CMS announced.

“Improving maternal health outcomes – particularly among Black women - is priority for the Biden administration and for the Department,” said HHS Secretary Xavier Becerra. “Expanding access to health insurance coverage, preventative care and investing in rural maternity care is one step forward.

As part of the American Rescue Plan, Medicaid programs can amend their section 1115 demonstrations to extend their postpartum coverage from 60 days to a full year.

The change applies to CHIP as well, according to a Kaiser Family Foundation policy watch on the subject. For states that choose to extend their coverage by adopting this option, they must commit to offering full Medicaid benefits during the pregnancy timeframe and into the extended period.

One state has already decided to extend its maternal benefits coverage using this avenue.

Illinois received approval from CMS to amend its section 1115 demonstration in accordance with the American Rescue Plan’s flexibilities.

The state expanded its population size by extending coverage to women with incomes of up to 208 percent of the federal poverty level. Eligible mothers will have full Medicaid coverage for up to 12 months, including the 60-day postpartum period.

The state has projected that the amendment to the section 1115 demonstration waiver will add 2,500 women to the population of new mothers with full, extended Medicaid coverage.

These changes went into effect on April 12, 2021 and will remain effective through December 31, 2025.

“Continuous health care coverage reduces health care costs and improves outcomes. By expanding Medicaid eligibility for a full year after delivery, Illinois is setting an important model for other states across the country to follow,” said Secretary Becerra.

Illinois’s proposal received strong support from commenters as well during the federal comment period.

“There were 28 comments about extending the postpartum eligibility period and all commenters expressed support for the state’s proposal,” the CMS approval stated.

“The commenters supported the proposal because extending Medicaid coverage to mothers for 12 months is expected to reduce mortality and morbidity for lower income women. Commenters also expressed support because the additional coverage for mothers is expected to have a positive impact on children.”

In the press release, CMS noted that the state will closely monitor the demonstration to assess patient outcomes and that the results would help inform decisions related to maternal health policy in the future.

In the private sector, payers have taken various steps to improve maternal health and reducing care disparities in maternal health.

One Illinois payer—Blue Cross and Blue Shield of Illinois (BCBSIL)—distributed $350,000 among six community-based organizations in order to reduce social determinants of health that reinforce racial care disparities. The organizations offered a variety of services including home healthcare, on-call doulas, postpartum support, and maternal health education.

While studies have shown that the Affordable Care Act achieved some success in decreasing maternal and infant health disparities, problems persist.

Even in states that have expanded their Medicaid programs, there is a significant portion of the maternal population that has experienced uninsurance before or after pregnancy or during both periods, according to an article in Health Affairs. Overall, a third of new mothers face uninsurance before or after their pregnancy.

Experts have noted that data collection is an important part of identifying and addressing these care disparities. Thus, the Illinois waiver and others like it will serve a crucial function of providing more data by which healthcare professionals and policymakers can assess future efforts to reduce maternal care disparities.