Medicaid Policy

Uninsured pregnant women have a harder time accessing healthcare pre- and postpartum. These women receive fewer prenatal care services, making them and their infants more predisposed to worsened outcomes, including delivery complications, low birthweights, and infant mortality compared to women with access to health insurance.⁷ In 2023, 1 in 10 women of childbearing age was uninsured.⁹ Research has also found that there is a higher rate of uninsured pregnant women living in rural areas compared to those living in urban areas.⁸ 

Sources: IPUMS-USA, University of Minnesota, ipums.org. American Community Survey, US Census Bureau. Retrieved July 2, 2025, from www.marchofdimes.org/peristats.

Similarly, uninsured children have a more difficult time obtaining healthcare, including regular primary care visits. As such, these children often receive care later in disease progression, putting them at a higher risk for hospitalization, worse health outcomes, and higher out-of-pocket costs.¹⁰ One in 19 children is uninsured in the United States, with higher uninsurance rates for children living in rural areas. ¹¹

Sources: IPUMS-USA, University of Minnesota, ipums.org. American Community Survey, US Census Bureau. Retrieved July 2, 2025, from www.marchofdimes.org/peristats.

Insurance coverage offered by Medicaid enables previously uninsured women and children the opportunity to access the healthcare they need. For pregnant women, Medicaid increases access to and utilization of prenatal services, improving health outcomes for themselves and their babies.¹² The program also allows eligible babies and children to obtain regular health screenings and care to timely address health concerns to avoid preventable advanced disease. Medicaid is vitally important to eligible mothers and babies to ensure they experience the positive health outcomes associated with increased healthcare access from being insured.

Medicaid is the primary source of coverage for pregnant women in the United States.¹³ At the time of birth, newborns to mothers enrolled in Medicaid are also enrolled. Across all states, 41% of all births are financed by Medicaid.¹⁴ Louisiana reported the highest number of births financed by Medicaid at 63.5%.¹⁵ Overall, 38.8% of children aged 18 years and younger are insured through the Medicaid program.¹⁶

Source: CMS

Medicaid covers moms and babies that are disproportionately impacted by higher maternal and infant mortality and morbidity rates, especially those living in rural areas. There’s a larger share of women of childbearing age with Medicaid coverage in rural areas than in metro counties. Maternal mortality in rural areas can be nearly twice as high as metro areas.¹⁷ Medicaid coverage allows women to receive the necessary prenatal and postpartum care they need to mitigate health risks associated with pregnancy. Further, maternity care deserts, or areas without adequate access to maternal health providers and resources, are more common in rural areas, putting women and their children at greater risk.¹⁸ Funding from the Medicaid program supports rural health systems in ensuring maternity care deserts do not grow in rural areas. If rural moms and babies lose access to Medicaid coverage, health outcomes for these vulnerable populations may worsen.

Source: March of Dimes Maternity Care Desert Report

Black individuals and American Indian and Alaska Natives (AI/AN) are also disproportionately vulnerable to experiencing worse health outcomes. Maternal mortality rates among Black and AI/AN women are almost three times higher than those of white women.¹⁹ These women are also at greater risk for preterm birth and low birthweight births.²⁰ Notably, Medicaid covers significantly more Black and AI/AN moms and infants compared to private insurers, ensuring these women and their babies receive the care they need.²¹ Since Black and AI/AN moms and their children are at greater risk of maternal and infant mortality, access to healthcare through Medicaid is indispensable to ensure good outcomes.

Source: March of Dimes 2024 Report Card

Moms enrolled in Medicaid have lower Earned Income Tax Credit (EITC) payments and subsequently, increased wages. Not only that, but individuals enrolled in Medicaid are more likely to attend college. Women enrolled in Medicaid have higher cumulative wages by their late twenties, showing an estimated $656 increase in wages for each additional year of Medicaid eligibility.²²

Research also indicates that children enrolled in Medicaid are more likely to be successful academically and financially. Children covered by Medicaid miss fewer school days, are less likely to drop out of high school, earn higher wages, and pay taxes as adults.²³ As such, Medicaid-financed births lay the foundation for strong babies enabled to succeed from childhood to adulthood. Access to Medicaid for eligible moms and babies enables these individuals to be more successful financially and academically, and a decrease in Medicaid access will reduce or even eliminate these benefits.

While 92% of those enrolled in Medicaid work or meet exemptions such as serving as a caregiver, some states have instituted work requirements in past Medicaid programs.²⁴ Some policymakers are supportive of work requirements for Medicaid enrollees, requiring them to regularly submit work or exemption documentation to maintain coverage. Exemptions from proposed work requirements may include those caring for dependents, pregnant women, disabled individuals, those with extreme sickness, and students.²⁵ However, the Congressional Budget Office estimates that up to 5.2 million adults could lose access to Medicaid without significant employment gains with the implementation of work requirements.²⁶ Instituting work requirements would prove overly burdensome for states as well, drawing additional funds from state budgets. The Government Accountability Office has estimated that the cost to implement work requirements would vary from under $10 million to $270 million, a shift that prioritizes spending on administrative procedures instead of critical patient care for moms and babies.²⁷

Work requirements have been instituted in states’ Medicaid programs before, including those in Georgia in 2023 and Arkansas in 2018. Georgia’s work requirement policies apply to individuals who are newly eligible for Medicaid, but do not exempt individuals with disabilities or those caring for young children—populations that may find it disproportionately difficult to find employment. ²⁸In the program’s first year, only 4,231 people enrolled in Medicaid compared to an estimated 100,000, suggesting the requirements have significantly precluded individuals from enrolling in the program and gaining coverage, including those with disabilities.²⁹ In Arkansas, individuals whose working or exemption status was not available through data matching were required to self-report their statuses monthly.³⁰ If an individual failed to report their status for three months, Medicaid coverage was terminated. While it was estimated that 95% of the Medicaid population worked or met an exemption, 28% of individuals subject to Arkansas’s work requirements lost coverage between August and December 2018.³¹ These losses in coverage were largely due to failures in reporting instead of individuals not meeting the policy requirements and led to adverse consequences, including higher medical bills and worse access to care. Further, the Government Accountability Office reported that the cost to implement the requirement technology infrastructure was over $26 million.³² Ultimately, Arkansas’s work requirement policies resulted in administrative burden for both the state and individuals covered by Medicaid, high implementation costs, and inaccurate coverage loss leading to likely worse health outcomes.

Although disabled and pregnant women are exempt from work requirements under most proposed work requirement policies, they would still need to submit documentation multiple times a year to retain coverage from Medicaid, putting increased administrative burden on these individuals. If a mistake is made in completing the documentation, submission is delayed, or administrative errors by the state occur, a pregnant or disabled woman might lose coverage, leading to care delays and worsened health outcomes. Due to the low number of individuals that are on Medicaid, not working, and are not exempt coupled with the projected limited impact to state employment rates, work requirement policies may not be effective in curbing program abuse while potentially harming women and their children.

State Medicaid programs have the ability to charge premiums or implement other cost sharing policies to fund program costs.³³ Some policymakers have proposed mandated cost sharing in Medicaid programs, requiring Medicaid beneficiaries to pay out-of-pocket for at least part of the cost of care covered by the program. For example, pregnant women would pay a portion of the cost of prenatal visits under cost sharing policies. Requiring cost sharing disproportionately impacts those that utilize the healthcare system frequently, such as pregnant women, infants, and children with chronic disease. Under these policies, pregnant women might be discouraged from visiting the doctor for prenatal visits due to cost concerns.³⁴ Women who don’t receive consistent prenatal care are more likely to experience complications, threatening their own health and the health of their babies. Forgoing or delaying care, including prenatal visits, can also lead to higher cost emergency treatment. Research has shown that higher co-payments are associated with negative health outcomes in low-income populations, like moms and babies on Medicaid, especially.³⁵

Research indicates that one of the most effective ways to ensure healthy pregnancies is by improving the health of birthing individuals before they become pregnant.³⁶ Expansion of Medicaid coverage to include individuals with incomes up to 138% of the Federal Poverty Level (FPL) have demonstrated reductions in uninsured women of childbearing age and improved maternal and child health outcomes. The federal government finances 90% of the cost of the expansion population in expanded states, while states are responsible for funding the remaining 10%. However, policymakers have discussed lowering the federal rate, which would activate some states’ trigger laws, causing state legislatures to reevaluate or revoke expansion status, alter eligibility criteria, and decrease offered benefits to account for higher Medicaid costs at the state level.³⁷ As such, maintaining sufficient funding for Medicaid expansion populations at the federal level ensures more pregnant women and children can obtain the care they need.

Source: Medicaid.gov

By providing more accessible and equitable healthcare coverage under Medicaid expansion, more women can access essential prenatal care and preventive services, which promotes healthy pregnancies and reduces risks for both moms and babies. Other benefits of Medicaid expansion have been seen throughout the US. A nationwide study found that among low-income women who recently gave birth, Medicaid expansion was linked to significant improvements in three key preconception health indicators: more women reported receiving preconception health counseling from a healthcare provider, an increased number reported taking folic acid before pregnancy, and more women reported using effective contraception after pregnancy.³⁸ Research has also shown that Medicaid expansion leads to reductions in postpartum hospitalizations.³⁹

Further, states that have expanded Medicaid have realized savings to their state budgets due to savings from increased federal investment and revenue gains. Kentucky and Arkansas estimate savings, net of costs, from FY 2014-2021 of $820 million and $370 million respectively.⁴⁰

The Federal Medical Assistance Percentage, or FMAP, is the percentage of Medicaid costs that the federal government will reimburse each state, and is based on the per capita income of the state.⁴¹ Each state has an FMAP for Medicaid costs that is at least 50%, but states that have expanded Medicaid have an additional FMAP for their Medicaid expansion population. The FMAP for the expansion population is 90%, significantly higher than the traditional FMAP, to encourage states to adopt Medicaid expansion with financial assistance from the federal government. Federal funding levels are vital to maintain, since states are required to balance their budgets annually.⁴² As such, any loss of federal funding needs to be replaced at the state level, or cost-saving actions will need to be taken at the state level. Given that states operate on thin margins, cuts in federal funding would likely mean cuts to Medicaid.

However, some policymakers have still discussed lowering both the 50% floor for the FMAP in addition to eliminating the higher 90% FMAP for expansion populations as a method of reducing the cost of the Medicaid program for the federal government. While reducing the FMAP may decrease federal spending, states will need to identify alternate funds to cover their traditional and expanded Medicaid populations, limit eligibility, or cut covered benefits. Many states have policies, or trigger laws, in place to automatically end Medicaid expansion or require significant changes to Medicaid for their expanded populations if the federal match rate is decreased, putting coverage for vulnerable populations at risk. Eliminating the expanded FMAP could reduce Medicaid enrollment by as much as 49% in some states, and an estimated 20 million Medicaid enrollees would lose coverage. As such, maintaining FMAP levels safeguards access to the care that moms and babies need.

Medicaid provider taxes are health-related taxes for which 85% of the burden of the tax falls on healthcare providers.⁴³ Provider taxes are leveraged by nearly every state across the US to aid in funding the state share of their Medicaid programs and supplement other forms of federal funding. Thirty-nine states, including Washington, DC, leverage three or more provider taxes to raise Medicaid payment rates for providers and supplement their Medicaid programs. By increasing state Medicaid spending through provider taxes, states in turn receive more federal funding.

However, some policymakers are considering limiting provider taxes, which will reduce federal Medicaid spending and shift additional Medicaid costs to states. Because states need to balance their budgets each year, limiting provider taxes will require states to forgo Medicaid services, lower reimbursement rates, or route state revenue away from other important priorities like education to make up for the loss in federal funding.

Research shows that 53% of all pregnancy-related deaths happen one week to one year after delivery.⁴⁴ Medicaid finances over 41% of births in the US.⁴⁵ However, without extension, Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist. Under the American Rescue Plan (2021), states were given the option to extend postpartum healthcare coverage under Medicaid to 12 months.⁴⁶ Medicaid extension to a minimum of 12 months postpartum should be required for all states in order to ensure that every mom gets the coverage needed to stay healthy—and alive—after their babies are born. Legislators and policymakers must take the next step and make one year of Medicaid coverage after birth a permanent policy across the nation.