Current postpartum coverage leaves out some of Michigan’s most vulnerable pregnant people

We’re pleased to feature this guest blog by Alexandra Vita, MSE, and Devon Cassidy, who are medical students at the University of Michigan. A version of this column originally appeared in Michigan Advance.

Alexandra Vita

Devon Cassidy

In our training as medical students, we have had the privilege to participate in the care of new parents during postpartum visits. We were surprised to see the different types of health complications that can come after giving birth. We talked to new parents experiencing postpartum depression, saw exacerbations of high blood pressure, diagnosed new-onset diabetes, and more. In a time of many physiologic and social changes, the postpartum period can be challenging. For some, the postpartum period is life-threatening.

In Michigan, over 400 new parents passed away from pregnancy-related deaths and pregnancy-associated deaths between 2015 and 2019. A significant portion of these deaths occurred after 60 days postpartum. Many of these deaths may have been prevented with healthcare, but the ability to pay for these visits was a barrier — Medicaid only covered two months of postpartum care.

As future healthcare providers, we celebrated progress toward better maternal and child healthcare as Michigan expanded postpartum Medicaid coverage from 60 days to 12 months in April 2022. This policy change addressed the need to reduce maternal morbidity and mortality in our state.

But this expansion left behind some of Michigan’s most vulnerable pregnant people — in particular, those who are not eligible for Medicaid due to their immigration status alone.

Michigan’s Maternity Outpatient Medical Services (MOMS) program provides only two months of postpartum coverage to both undocumented immigrants and lawfully residing noncitizens (also known as “green card” holders). The latter are subject to the five-year waiting period for Medicaid and the Children’s Health Insurance Plan (CHIP).

The impact of current policy is clear, particularly to those working closely with this population. As Jeremy Lapedis, executive director of the Washtenaw Health Plan, shares, “Due to restrictions on Medicaid enrollment and gaps in the MOMS program, many parents who are immigrants are not able to afford the full year of postpartum healthcare that they need.”

In fact, The Michigan League for Public Policy recently estimated that 5,500 Michiganders will not receive this crucial 10-month postpartum coverage expansion solely due to their immigration status.

But last month, Gov. Gretchen Whitmer’s Fiscal Year 2024 budget proposal was introduced. To our excitement, it takes a step toward rectifying this coverage gap by including the removal of the five-year waiting period for children and pregnant people through a Healthy Moms, Healthy Babies expansion. The budget includes $32.1 million ($6.4 million general fund) to implement this change, which is possible through the federal Immigrant Children’s Health Improvement Act (ICHIA) option. Advocacy for this proposal allows lawful permanent residents to access healthcare sooner. Michigan is one of the last 16 states that have not yet made this impactful policy change to benefit kids and families.

However, adoption of the ICHIA option alone would exclude MOMS recipients who are undocumented. Although Michigan may be one of the last states to waive the five-year waiting period for legally residing immigrants, we can lead the path toward more equitable healthcare by being one of only a handful of states ensuring 12 months of postpartum care for undocumented immigrants.

A solution to this gap in coverage would include pairing CHIP Health Services Initiative (HSI) funding with Michigan’s existing MOMS program to provide one year of postpartum coverage to undocumented individuals. If the ICHIA option were adopted, many enrollees in MOMS would be covered under Medicaid, and using what is available in the state’s HSI budget would support 12 months of postpartum coverage for all eligible people and require limited additional state funding.

We urge you to express your support for waiving the five-year waiting period for children and pregnant people through the ICHIA option in tandem with pairing CHIP HSI funding with Michigan’s MOMS program.

Michigan has come so far in expanding access to postpartum care for those enrolled in Medicaid, making strides in equitable health care. As future physicians, we are asking Michigan to take the next step in this space, to ensure potentially life-saving postpartum care for all Michiganders, regardless of immigration status.