TALLAHASSEE, Fla. – Medicaid plays an important part in maternal and child health care, and states like Florida that refuse to expand the program are missing an opportunity to address racial disparities in maternal health, according to a report released Wednesday by the Georgetown University Center for Children and Families.
Researchers relied on a Kaiser Family Foundation survey that looked at eligibility, enrollment, renewal and cost-sharing policies of the 50 states and Washington, D.C., in Medicaid and the Children’s Health Insurance Program.
The conclusions also took into account previously published research that showed states that expanded Medicaid eligibility had greater declines in infant mortality rates and that Medicaid expansion was associated with lower rates of maternal mortality, reflecting 1.6 fewer maternal deaths per 100,000 women.
“We know that the research shows that women who get coverage before they get pregnant and keep continuous quality health coverage after childbirth, their babies are healthier,” Adam Searing, an associate professor at the Georgetown center and an author of the report, said during a media conference call.
Medicaid is a jointly run state and federal program that provides health coverage for poor, elderly and disabled people. The federal government sets minimum requirements for populations that will be covered and benefits that will be provided.
States can -- and do -- add benefits, or seek exemptions from the requirements, with federal approval.
The federal Affordable Care Act, commonly called Obamacare, provided increased Medicaid funding for states that expanded eligibility in the safety-net program to adults who earn 138 percent of the federal poverty level, or $17,236 annually. While the law initially would have punished states that didn’t expand eligibility, the U.S. Supreme Court, calling it coercion, struck down the penalty, essentially making the expansion optional.
Florida’s Republican-dominated Legislature has rejected proposals to expand the program, arguing, in part, that such a move could lead to additional long-term costs for the state.
As a result of the Supreme Court decision, researchers like those at Georgetown have been able to compare Medicaid expansion states with non-expansion states.
Expanding Medicaid can help address racial disparities in maternal and child health, according to the Georgetown researchers. Seven states, including Florida, didn’t expand Medicaid and have black populations of 15 percent or greater.
The report includes findings showing that, “African American women are nearly three times as likely to die of complications related to pregnancy and childbirth compared with white women ... a gap that has not narrowed in decades.”
Florida covers four categories of people in Medicaid: children, pregnant women, aged and disabled people and family members or caretakers. The state has different income-eligibility levels for each group. For instance, pregnant women can earn 191 percent of the federal poverty level and still qualify for Medicaid.
But two months after delivering babies, the income eligibility to maintain coverage drops to 32 percent of the federal poverty level. That means women who can be suffering from postpartum depression could lose their benefits.
And since childless adults generally don’t qualify for Medicaid in Florida, the women could have been uninsured before they got pregnant.
Sal Nuzzo, vice president of policy for the conservative James Madison Institute, said better access and better health outcomes for people in need of care are laudable goals that everyone shares. But he said “market-centered reforms” are needed, rather than expansion of Medicaid.
“The more that government controls the access to health care via socialized means -- and Medicaid expansion is completely socialized health insurance -- we will see quality decline, costs explode and access reduced,” he said. “Medicaid is on a fast track to outright bankruptcy in our lifetime.”
While Florida did not expand Medicaid, the number of women between the ages of 18 and 44 who are uninsured has dipped from 29 percent in 2013 to 19 percent in 2017, due in large part to the Affordable Care Act.
Among other things, the law allowed people to access subsidized health insurance and required insurance companies to offer policies to people regardless of pre-existing conditions.
The Georgetown report was conducted with underwriting from the March of Dimes and the American College of Obstetricians and Gynecologists, which recommends that women have access to continuous coverage prior to becoming pregnant and 12 months after they give birth.
Joan Alker, executive director of the Georgetown center, said it’s important that current Medicaid eligibility requirements are not altered to become more restrictive.
The Florida House this year voted 71-44 to place work requirements on Medicaid beneficiaries in order for them to maintain coverage. The bill died when the Senate refused to consider it.
The proposal would have been the “worst Medicaid work requirement I have seen around the country,” Alker told reporters, noting that it would have resulted in 100,000 people, mostly women, losing coverage.
“Making that linkage to understand how the state of Florida could take a giant step backward on its already poor performance in this area, I think is important,” Alker said.