29 Organizations Signed a Letter Urging the KanCare Oversight Committee to Support Extending Postpartum Coverage to 12 Months

Today, the Health Fund and its partners sent a letter to the Robert G. Bethell Joint Committee on Home and Community Based Services and KanCare Oversight urging the committee to support extending postpartum KanCare coverage to 12 months.

A PDF of the letter is available and the full text is below.

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December 6, 2021

Dear Chair Hilderbrand, Vice Chair Landwehr, and members of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight,

As organizations that represent thousands of Kansans, we are writing to you to support the extension of postpartum KanCare coverage to 12 months.

As a result of the ongoing public health emergency, Kansas cannot currently discontinue coverage for new mothers after 60 days. Kansas has seen the benefits of this temporary policy change. Extending Medicaid coverage postpartum from 60 days to 12 months has enabled mothers to access critical health care and mental health services, ensuring mothers and their babies have the healthiest start to life. This coverage will end when the public health emergency expires, meaning someone who gets pregnant today may have worse postpartum care than people who recently gave birth.

Extending postpartum coverage for new mothers enrolled in KanCare would have a significant impact in Kansas, where nearly 40% of births are covered by KanCare.[1] Prior to the COVID-19 pandemic, each year most mothers covered by KanCare—9,000 women—lost coverage 60 days after giving birth.[2] The Kansas Maternal Mortality Review Committee found that between 2016 and 2018 nearly one-quarter of all Kansas pregnancy-related deaths occurred between 43 days and one year postpartum. Nearly half of all pregnancy-associated deaths (while pregnant or within one year of pregnancy regardless of cause) occurred in the same period. Non-White minority women were nearly twice as likely to die within a year of pregnancy as non-Hispanic White women.[3]

In Kansas, between 2016 and 2018 casesrevealed that women covered by Medicaid during pregnancy and delivery were more than three times as likely to die within one year of pregnancy when compared to women covered by private insurance, in part this is because of women who died after losing their coverage. Extending postpartum Medicaid coverage to 12 months creates opportunities to improve access to quality health care for high-risk populations, before, during, after and between pregnancies, potentially reducing pregnancy-associated deaths and closing the disparity gap.[4]

As highlighted by the Kansas Department of Health and Environment’s impact paper, with many of the pregnancy-associated deaths involving health care and occurring months after delivery, the data suggest that a Medicaid postpartum coverage extension will help more women access care necessary to address critical, potentially fatal health concerns. National data published in February 2019 by the American Journal of Managed Care (AJMC) reveals that extending Medicaid coverage to 12 months postpartum is associated with 1.6 fewer maternal deaths per 100,000 women compared to rates for states that only provide coverage for the required 60-day time period.[5]

Recent federal policy change creates the opportunity for Kansas to extend coverage. Already, other states like Indiana and Tennessee are taking advantage of this opportunity. Extended postpartum coverage is predicted to lead to a decrease in long-term Medicaid costs through the provision of early medical interventions and coordinated care, preventing postpartum complications and worsening chronic conditions due to a delay in early identification and intervention.[6]

Before the pandemic, pregnant Kansans were eligible for Medicaid coverage through the duration of their pregnancy and 60 days postpartum if their household income was at 171% or less of the federal poverty level. Although their newborn remained covered by Medicaid through their first year of life, the postpartum mother lost coverage on day 61 unless her household income was at 38% or less of the federal poverty level (FPL).[7] A married woman with a single child would lose coverage on day 61 if her combined annual household income was above $8,345.

Extending KanCare coverage to a continuous 12 months postpartum can improve health outcomes for mothers, children, and families across the state. It is important to note that a child’s health is tied closely to their parent’s health and access to health care. Parental enrollment in Medicaid is associated with a 29% higher probability that a child will receive an annual well-child visit.[8] Therefore, it is important for the health of the mother and child during the critical 12-month postpartum period that both mother and child can access health care.

Nearly 20% of Kansas women below 200% of the federal poverty level experienced postpartum depression in the year after giving birth. In addition, according to KDHE, between state fiscal years 2012 and 2017, parental substance use was the primary reason that 70% of children under the age of one entered foster care.[9] Extending postpartum coverage would enable mothers to get substance use services that could prevent interaction with the child welfare system. For these reasons, it is vital that mothers have access to mental health and substance use services beyond 60 days.

We urge you to support expansion of postpartum KanCare coverage to 12 months in order to save lives, improve health outcomes for mothers and babies, increase health coverage for kids, prevent interaction with the child welfare system, reduce disparities and save the state money. We welcome the opportunity to work with you to strengthen the health of our state.

Sincerely,

United Methodist Health Ministry Fund

Alliance for a Healthy Kansas

American College of Obstetricians and Gynecologists

American Heart Association

Behavioral Health Association of Kansas

Build Your Village

Child Advocacy and Parenting Services

Community Care Network of Kansas

Community Health Center in Cowley County, Inc.

Community Health Council of Wyandotte County

KanCare Advocates Network

Kansas Action for Children

Kansas Birth Equity Network

Kansas Breastfeeding Coalition

Kansas Chapter, American Academy of Pediatrics

Kansas Head Start Association

Kansas Infant Death and SIDS Network, Inc.

Kansas State Nurses Association

Metro Organization for Racial and Economic Equity

Motherhood Redefined (TJZ Therapy, LLC)

Nurture KC

Oral Health Kansas

Postpartum Support International Kansas Chapter

REACH Healthcare Foundation

Russell Child Development Center

Success By 6 Coalition of Douglas County

The Holding Space KC

Thrive Allen County

Wichita Birth Justice Society

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[1] Kaiser Family Foundation. 2019. Births Financed by Medicaid. October. https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/.

[2] Governor’s Commission on Racial Equity & Justice. 2021. Social Determinants of Health – First Report. Topeka: State of Kansas.

[3] Kansas Maternal Mortality Review Committee. 2020. “Kansas Maternal Mortality Report 2016-2018: Including Severe Maternal Morbidity, 2016-2019.”

[4] Kansas Maternal Mortality Review Committee. 2020. “Kansas Maternal Mortality Report 2016-2018: Including Severe Maternal Morbidity, 2016-2019.”

[5] Rosenberg, Jaime. 2019. Medicaid Expansion Linked to Lower Maternal Mortality Rates. February 6. https://www.ajmc.com/view/medicaid-expansion-linked-to-lower-maternal-mortality-rates.

[6] Members of the Equitable Maternal Health Coalition. 2020. “Making the Case for Extending Medicaid Coverage Beyond 60 Days Postpartum: A Toolkit for State Advocates.” The American College of Obstetricians and Gynecologists Web site. June. https://www.acog.org/-/media/project/acog/acogorg/files/advocacy/state-white-paper-making-the-case-for-extending-medicaid-coverage-beyond-60-days-postpartum-a-toolkit-for-state-advocates.pdf.

[7] Ranji, Usha, Ivette Gomez, and Alina Salganicoff. 2021. Expanding Postpartum Medicaid Coverage. March 9. https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/.

[8] Venkataramani, Maya, Craig Evan Pollack, and Eric T. Roberts. 2017. “Spillover Effects of Adult Medicaid Expansions on Children’s Use of Preventive Services .” PubMed.gov. November 13. https://pubmed.ncbi.nlm.nih.gov/29133576/.

[9] Kansas Department of Health and Environment. 2021. “Extending Kansas Medicaid Postpartum Coverage to 12 Months.” Topeka.

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