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States Support Postpartum Health with Medicaid Expansions astho, association of state and territorial health officials, 2023 state legislative session, medicaid expansions, postpartum health, the consolidated appropriations act, national women s health week, postpartum coverage, affordable care act, premium tax credits, affordable care, 12 weeks, united states, extended postpartum coverage, health a priority, medicaid program, national women s health, mother s day, 2023 legislative, vaginal birth, physical activity, women s health week, postpartum care, coverage for 12 months, 60 days, state plan amendment, care act, postpartum depression, health care Sowmya Kuruganti National Women’s Health Week reminds us that postpartum care is critical for the long-term health of the birthing parent and baby. National Women’s Health Week’s 2023 theme—Women’s Health, Whole Health: Prevention, Care and Wellbeing—is a reminder that postpartum care is critical for the long-term health of the birthing parent and baby. The first year after pregnancy can be full of physical, emotional, and mental health challenges that have long-term or even life-threatening health impacts without timely diagnosis and treatment. In September 2022 CDC reported that 23% of pregnancy-related deaths occur from seven to 42 days postpartum, and 30% of deaths occur 43-365 days postpartum. Among all pregnancy-related deaths occurring from 2017 to 2019, approximately 84% were deemed preventable. Black and American Indian and Alaskan Native <!--(AI/AN)--> women have two to three times higher rates of pregnancy-related death compared to white women. These disparities, like others, are driven by social and economic factors that are rooted in structural and systemic racism and discrimination. Health insurance coverage is one such factor that supports positive maternal health outcomes by facilitating access to care before, during, and after pregnancy. In the United States, 40% of births are covered by Medicaid, which is the primary source of health coverage and access to care for those of low income. Organizations like ASTHO and the Association of Maternal and Child Health Programs support extending Medicaid coverage through one-year postpartum to combat disparities in maternal health outcomes. Federal Legislation for Postpartum Coverage under Medicaid For the majority of states that have adopted Medicaid expansion under the Affordable Care Act (ACA), all people with income up to 138% of the federal poverty level (FPL) are eligible for Medicaid. In states without Medicaid expansion, pregnant people can be eligible for coverage during pregnancy and up to 60 days postpartum under federal law. After 60 days postpartum, these people may lose coverage for the rest of the year-long postpartum period based on general state Medicaid eligibility requirements. Prior to 2021, states could extend Medicaid coverage to postpartum people through a section 1115 demonstration waiver or through state funds. The enactment of the 2021 American Rescue Plan Act, gave states another option to extend Medicaid coverage to 12 months postpartum via state plan amendment for five years. So far in 2023, CMS has approved the State Plan Amendments for five states (Alabama, Arizona, Colorado, Oklahoma, and Rhode Island) implementing a 12-month postpartum expansion. To date, a total of 33 states have expanded Medicaid coverage to 12 months postpartum via Section 1115 demonstration waiver or state plan amendment. 2023 State Legislative Session Depending on states rules for modifying Medicaid coverage the legislature may need to direct the health department to submit a state plan amendment. So far in 2023, three states enacted legislation related to expanding coverage to 12 months postpartum. In Mississippi, SB 2212 authorizes the state’s Division of Medicaid to provide 12 months continuous postpartum coverage to people who qualify. Utah’s SB 133 extends coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. In Wyoming, HB 4 temporarily extends Medicaid coverage for qualifying pregnant women for 12 months postpartum, ending March 31, 2027. Other states introduced bills to extend postpartum coverage during this session. The Alaska Legislature passed legislation (SB 58) directing the Department of Health to submit a state plan amendment extending postpartum coverage to 12 months, and to raise the household income level for eligibility to 225% of the FPL. The bill is currently awaiting action by the governor. Iowa introduced legislation (SF 57) to enact postpartum coverage for 12 months postpartum by Medicaid State Plan Amendment. This would extend the current 60-day postpartum coverage for Medicaid beneficiaries. The Missouri legislature passed (SB 45) that would extend MO HealthNet postpartum coverage from 60 days to 12 months postpartum for women who are either currently receiving or eligible to receive aid to families with dependent children, or eligible to receive benefits via the income eligibility standard. Pregnant women eligible for MO HealthNet and receiving mental health treatment for postpartum depression, related mental health conditions, or substance abuse treatment within sixty days of giving birth would remain eligible for benefits for those services for an additional 12 months. The bill is currently awaiting action by the governor. Nebraska introduced legislation (LB 419) to extend postpartum coverage for 12 months postpartum that would extend the current 60 day postpartum coverage. Texas introduced legislation (HB 12) to extend postpartum coverage to 12 months; it has passed in the House and is now pending in the Senate. Its passage would significantly change the current coverage structure, which uses state funds to provide postpartum people a limited package of postpartum services through the Healthy Texas Women program under HB 133, and subsequently submitted 1115 waivers to draw down federal funds for the program and extend coverage to six months postpartum. Wisconsin introduced companion bills (AB 114/SB 110) extending postpartum coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. This action would extend coverage from the current 60 days and amend the previous 90-day Section 1115 Waiver submitted in 2021. Studies have demonstrated numerous benefits of extending Medicaid coverage for postpartum people and, given these positive impacts, ASTHO expects that more states will take action to extend Medicaid to 12 months postpartum. ASTHO will continue to monitor and report on this essential maternal public health issue. website yes

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

Recap the state legislative sessions in 2025 thus far, spanning maternal health, infectious disease, and other important public health issues.

State Legislatures Moving to Increase Rural Health Care Access How States Are Incentivizing Health Care Providers to Practice in Rural Areas Lana McKinney Hospital closures and fewer care options in rural areas cause worse health outcomes for Americans in those areas. Read about state policies aimed at bringing providers to back to rural America. People living in rural areas face greater health risks than those living in urban areas. Rural populations not only experience increased poverty and higher rates of chronic disease; they are also older and have less access to both health care providers and health insurance. States are exploring several strategies to improve health care access for rural residents, including recognizing a new hospital type, exploring alternative methods or sources of health services, and offering financial support for health care facilities and the rural health workforce. Access to Care Among many factors contributing rural areas accessing health care, hospital closures are a major one. Almost 200 rural hospitals have closed since 2005. When rural hospitals close, people living in those communities must travel farther for care. Rural areas may also experience shortages of and less access to health care professionals, including specialty care, as compared to urban areas. To reduce the number of hospital closures and provide support for existing hospitals in rural areas, the Consolidated Appropriations Act of 2021 created a new Medicare provider type known as the Rural Emergency Hospital (REH). These facilities offer a more limited scope of services than acute care or critical access hospitals and have their own conditions of participation and Medicare reimbursement structure. There have been 36 REH conversions in 16 states since 2023. Jurisdictions continue to explore legislation to formally recognize REHs under state law, State recognition of REHs is crucial for establishing licensure, defining service scope, and enabling participation in state health care programs like Medicaid, ensuring these facilities can legally operate and provide necessary care. with Florida (SB 644) enacting legislation in 2024, and Hawaii (HB 1179) considering legislation so far in 2025. A number of other jurisdictions have recently received approval to amend their Medicaid State Plans and define the payment methodology for REHs serving Medicaid recipients, including Iowa, Kentucky, Nebraska, Nevada, New Mexico. States are also exploring other policies to financially support rural hospitals during the 2025 legislative session. Alabama (HB 86) is considering a rural hospital investment program that would create tax credits to incentivize donations to those hospitals that could support service delivery. And bills to establish grant programs to support rural hospitals are before the legislatures in both Oklahoma (HB 2754) and Indiana (HB 1274). States are also exploring the role of technology, and community needs and resources, to support rural access to care. In 2024, Colorado enacted at least two bills with a rural population focus, including SB 24-168 to invest in remote patient monitoring to support rural health facilities and requires reimbursement. SB 24-055 creates an agricultural and rural community behavioral health program to understand the relevant issues and improve access to care. So far in 2025, at least two states are exploring ways to better serve people in rural communities. Hawaii (SB 1004) is considering legislation that would establish a pilot program to utilize community health workers in rural areas, while North Dakota (HB 1567) is proposing a legislative management study focused on improving access to oral health care, and would require review of telehealth options for reaching rural areas and workforce incentives for dental providers. Rural Health Care Workforce Jurisdictions are also using financial supports—including scholarships, tax incentives, and loan cancelation programs—to increase the number of health care providers in rural areas. At least three states modified financial support programs for practitioners working in rural and underserved areas in 2024. Mississippi’s S 2729 expanded the scope and responsibilities of its rural physician and dentist scholarship programs and their respective governing commissions. And Georgia (HB 872) amended its cancelable loan program to include dental students. California (SB 909) amended the requirements for its physician corps program, which provides financial assistance to those who practice in underserved areas, removes the limit on the amount of loan repayment available, and reduces the duration of service obligation from three to two years. Jurisdictions have also pursued tax policy changes aimed at supporting rural health care providers, including state tax credits for individual practitioners working in rural areas. In 2024, Georgia (HB 82) amended its rural physician tax credit to include dentists living and working in rural areas. In 2025, at least two states are considering expansion of tax credits for providers serving rural communities. In New Mexico, HB 52 would expand the state’s rural health care practitioner tax credit to include additional provider types, including speech language pathologists and occupational therapists. And Oregon is considering several bills to expand existing rural provider income tax credits, including HB 2549 to add pharmacists and HB 2204 to add podiatrists. Finally, legislatures are continuing to consider other policy initiatives to bolster the rural health care workforce in 2025. Acknowledging a shortage of nurses in rural communities and barriers for rural nursing students, Washington SB 5335 would establish a rural nursing education program in the state health department with a goal of improving nursing care in rural areas of the state. And in Nebraska, LB 119 would formally enact the state’s rural health opportunity program, which provides tuition waivers for students from rural areas pursuing health care careers, into law. ASTHO will continue to monitor this issue and provide any necessary updates. article yes