Medicaid plays a critical role in maternal health, covering over 40 percent of all births in the United States. For Black women and birthing people—who face over two and a half times the risk of maternal mortality when compared to white women—this proportion is even higher, at 65 percent. Addressing the Black maternal health crisis, then, requires ensuring Medicaid coverage is robust and comprehensive—before, during, and after pregnancy.

Expanding Medicaid (closing the gap in coverage that leaves individuals with incomes too “high” for Medicaid but too low for ACA marketplace subsidies) and extending Medicaid coverage to one-year postpartum are two necessary and evidence-based reforms: both have demonstrated their positive impacts on maternal health outcomes. Despite federal incentives for both, though, many states have not taken up these live-saving options.

Even more concerning, many of the remaining states have higher maternal mortality rates, some of the highest populations of Black residents, and high proportions of births financed by Medicaid. The Medicaid coverage gap in particular disproportionately impacts people of color—and Black adults especially.

In President Biden’s budget for the upcoming fiscal year, the administration not only doubled down on its commitment to investing in maternal health equity, but it also named these Medicaid policies specifically. The budget proposed a mechanism for providing expansion-like coverage to states who have not yet expanded Medicaid, as well as for requiring extension of postpartum Medicaid coverage to one full year. Although this budget—particularly with a GOP majority in the House of Representatives—largely serves as a messaging document, it lays out proven and attainable improvements to Medicaid coverage for pregnant and birthing people in the states that need it most. Regardless of what progress is possible at the federal level, it is past time for every state to expand Medicaid and extend comprehensive postpartum coverage to a full year.

Regardless of what progress is possible at the federal level, it is past time for every state to expand Medicaid and extend comprehensive postpartum coverage to a full year.

The maps below denotes states who have not yet implemented these reforms. Although most states have implemented at least one of these policies, Texas and Wisconsin currently have neither expanded Medicaid coverage nor extended postpartum coverage to a full year. Notably, some states have proposed or adopted Medicaid 1115 waivers for extension of postpartum coverage for less than twelve months, or to provide care that is not comprehensive or complete (see an earlier comment letter on Texas’ proposal to extend coverage for only six months, which would also exclude people who receive abortion care). For this map’s purposes, only states that have adopted (or are planning to adopt) comprehensive, full-year postpartum coverage are categorized as having fully implemented the policy; as more states consider extending postpartum coverage, it should be achieved through the option for a state plan amendment, rather than a Medicaid waiver.

Figure 1

Figure 2

Table 1
Medicaid Status, State by State
State Has the State Expanded Medicaid? Has the State Extended Comprehensive Postpartum Coverage to a Full Year?
Alabama No Yes
Alaska Yes No
Arizona Yes Yes
Arkansas Yes No
California Yes Yes
Colorado Yes Planning to implement
Connecticut Yes Yes
Delaware Yes Planning to implement
District of Columbia Yes Yes
Florida No Yes
Georgia No Yes
Hawaii Yes Yes
Idaho Yes No
Illinois Yes Yes
Indiana Yes Yes
Iowa Yes No
Kansas No Yes
Kentucky Yes Yes
Louisiana Yes Yes
Maine Yes Yes
Maryland Yes Yes
Massachusetts Yes Yes
Michigan Yes Yes
Minnesota Yes Yes
Mississippi No Planning to implement
Missouri Yes No**
Montana Yes No
Nebraska Yes No
Nevada Yes No
New Hampshire Yes No
New Jersey Yes Yes
New Mexico Yes Yes
New York Yes Planning to implement
North Carolina Adopted, planning to implement Yes
North Dakota Yes Yes
Ohio Yes Yes
Oklahoma Yes Yes
Oregon Yes Yes
Pennsylvania Yes Yes
Rhode Island Yes Planning to implement
South Carolina No Yes
South Dakota Adopted, planning to implementˆ No
Tennessee No Yes
Texas No No¹
Utah Yes No³
Vermont Yes Planning to implement
Virginia Yes Yes
Washington Yes Yes
West Virginia Yes Yes
Wisconsin No No²
Wyoming No Planning to implement

*North Carolina Medicaid expansion adopted; will go into effect when the budget is passed.
**Missouri has legislation pending to extend postpartum Medicaid, but includes limitations as written.
ˆSouth Dakota Medicaid expansion adopted; will go into effect 7/1/2023.
¹Texas postpartum extension proposal would extend coverage to only six months, with limited coverage.
²Wisconsin extended postpartum Medicaid coverage to only ninety days.
³Utah has proposed a limited Medicaid postpartum coverage extension.