Improving maternal outcomes with extended coverage in Missouri

Maternal mortality rates in the U.S. have been rising since 2000 and are currently the highest among developed countries.¹ Poor maternal outcomes are attributed to a variety of factors including limited health care access (including pre and postnatal care) and underlying chronic conditions. Significant disparities exist as well with the mortality rate for Black women at 55.3 per 100,000 live births compared to the average of 23.8 for all U.S. women.²

Missouri maternal mortality statistics

Specifically in Missouri, mortality rates for Black women are three times higher than mortality rates for white women during the 12-month postpartum period.³ Missouri’s Pregnancy-Associated Mortality Review (PAMR) Board found that the maternal mortality rate increased from 25.2 deaths per 100,000 live births in 2018 to 32 deaths per 100,000 live births in 2020. 84% of these pregnancy-related deaths were classified as preventable.

Mental health conditions, including substance use disorder (SUD), were the leading cause of pregnancy-related deaths, followed by cardiovascular disease.⁴ All pregnancy-related deaths due to mental health conditions, including SUD, were determined to be preventable.

The Missouri Department of Health and Senior Services’ annual maternal mortality report includes recommendations made by the PAMR Board. One of these recommendations was to:

“Extend Medicaid coverage to one year postpartum for all conditions (including medical, mental health and SUD), even if the woman did not start treatment prior to delivery, to aid women whose condition is exacerbated in the postpartum period.”

Postpartum care extension

Given that most maternal and infant deaths occur in the first month after birth, postpartum care is imperative for improvement in health outcomes for mothers and their newborns.⁵ Several medical complications can occur after childbirth including persistent bleeding, inadequate iron levels, blood pressure, pain, emotional changes and infections.⁶ During the first week of the postnatal period, severe hypertension, bleeding and infection are the leading causes of death, while cardiovascular complications are the leading cause of death later on.

Given that Medicaid covers almost half of births nationally, UnitedHealthcare Community & State is well-positioned to address maternal health challenges.⁷ As of November 14, 2023, 41 states including Missouri have extended their maternal care benefits.⁸ UnitedHealthcare Community Plan of Missouri is committed to ensuring that pregnant members receive full Medicaid benefits for the duration of their pregnancy and one year postpartum. Research suggests that the coverage extension could prevent hundreds of thousands of enrollees nationally from losing coverage in the months after delivery.⁷

Extended postpartum coverage will provide members with 12 months of access to services including⁹:

• Physical recovery support, screening and care for conditions that lead to chronic disease or death
• Management of chronic health conditions, behavioral health needs and family planning service access
• Supportive services and counseling on key challenges such as nutrition, breastfeeding and drug use
• Support in retaining Medicaid/CHIP coverage or successfully transitioning to other types of coverage
• Development and expansion of person-centered models of care such as doula services and home visiting

The extended coverage offering is well-positioned to improve outcomes for families and address the widening gap for people of color.¹⁰ Specifically, extended coverage allows for increased care for conditions that disproportionately impact people of color in the postpartum period including hypertension and behavioral health conditions.⁹

Given the role of managed care in supporting individuals who are pregnant or have given birth, UnitedHealthcare Community Plan of Missouri is committed to working with state partners, providers and community-based organizations to implement full-year postpartum coverage.