NURS 6050 Week 11 Policy Advocacy Synthesis Example

A Policy Advocacy Synthesis: Twelve Months of Postpartum Medicaid Coverage, Who It Serves, Where It Stands, and What I Will Do Next

Student Name

College of Nursing, Walden University

NURS 6050: Policy and Advocacy for Improving Population Health

Instructor Name

Month Day, Year

A Policy Advocacy Synthesis: Twelve Months of Postpartum Medicaid Coverage, Who It Serves, Where It Stands, and What I Will Do Next

The Policy in Three Sentences

The bill before our composite state's legislature would direct the Medicaid agency to keep people who were enrolled during pregnancy covered for a full year after delivery, instead of ending coverage at 60 days. Federal law allows every state to make this change through a state plan amendment, an option first offered in 2021 (Pub. L. No. 117-2) and later made permanent (Pub. L. No. 117-328), with the federal government paying its usual share. The bill passed its policy committee this session and now waits on the appropriations committee, which must fund the state's share.

Populations With Different Needs

Speaking of "mothers" in general hides the reasons this policy matters differently to different groups. Four populations stand out, and each has its own reason for needing coverage past 60 days.

People enrolled in Medicaid because of pregnancy. Many qualify only under the higher income limit for pregnancy and lose eligibility when the postpartum period ends, even though their income has not changed. Before the federal option existed, research found that postpartum coverage loss was common and that many people cycled into uninsurance within months of delivery, particularly in states that had not expanded Medicaid for adults (Gordon et al., 2020). For this group, the policy is the difference between continuous care and a coverage gap.

People managing chronic conditions after delivery. Hypertension that began or worsened in pregnancy, gestational diabetes that signals later type 2 diabetes, and perinatal depression all need care beyond six weeks. Maternal mortality review committees have found that cardiovascular conditions, including cardiomyopathy, and mental health conditions, including overdose and suicide, are leading causes of pregnancy-related death, and a substantial share of deaths occur after the traditional postpartum visit (Centers for Disease Control and Prevention [CDC], 2022). For this group, the policy is about keeping medication, monitoring, and treatment going.

Rural residents. Many rural counties have no obstetric unit, and patients travel long distances for care. Continuity of coverage lets them keep the clinicians they already have, which matters more when the next option is an hour away.

Groups facing higher pregnancy-related mortality. CDC data show that Black and American Indian and Alaska Native people die of pregnancy-related causes at higher rates than White people. Disparities in coverage compound this: research on perinatal insurance has found that Black and Hispanic birthing people experience more insurance instability around childbirth than White people (Daw et al., 2020). For these groups, continuous coverage is one of the few policy levers that addresses a known contributor to the gap.

Where the Bill Stands

The bill was filed before the January deadline, heard in the House Health and Human Services Committee in February, where nurses, physicians, and a maternal mortality review committee member testified in support, and passed that committee with a bipartisan vote. It then moved to the Appropriations Committee, because the state must fund its share of the new coverage. The fiscal note estimates the state cost in the first full year; the federal government pays the larger portion. The appropriations subcommittee chair has not yet scheduled the bill, and the session's appropriations deadline is six weeks away. If it is not heard, the bill dies for the session. If it passes, the agency must file a state plan amendment with CMS and implement enrollment changes, including updating eligibility systems so that postpartum enrollees are not automatically dropped at 60 days. That implementation stage is where a policy can be weakened even after it passes, through slow system changes or notices that confuse enrollees.

Evidence, Arranged by Population

For people who would otherwise lose coverage, the evidence on Medicaid expansion shows that continuous eligibility increases postpartum coverage and use of outpatient care (Gordon et al., 2020). For people with chronic conditions, the question is whether coverage translates into better health. A study of Medicaid expansion found reductions in postpartum hospitalizations, consistent with outpatient care preventing acute episodes (Steenland & Wherry, 2023). The mortality evidence works differently: review committees judge most pregnancy-related deaths preventable, and many of the contributing factors they identify, missed follow-up, untreated hypertension, and gaps in mental health care, are ones continuous coverage is designed to address (CDC, 2022). That is an argument from mechanism rather than a measured effect of the 12-month extension itself, whose effects are still being studied. For groups facing disparities, the evidence of greater insurance instability among Black and Hispanic birthing people (Daw et al., 2020) supports the expectation that continuous coverage would narrow a gap, though that too requires evaluation after implementation. A useful evaluation would track, for each of the four populations, continuous enrollment through the first year, attendance at postpartum and primary care visits, blood pressure control among those with hypertensive disorders, treatment for depression, and severe maternal morbidity after discharge, reported by race, ethnicity, and county so that the disparities the policy is meant to narrow are visible in the results.

Two Commitments

First, I will testify before the appropriations subcommittee if the bill is scheduled, or submit written testimony if time does not allow. Written for a fiscal committee, my testimony will address cost directly: the federal share, the fact that most people covered are already enrolled, and the lower cost of outpatient care compared with the emergency and intensive care that untreated postpartum hypertension and depression can lead to. I will ask the state nurses association to coordinate with the hospital association and the obstetric and pediatric societies so that the committee hears from several professions.

Second, if the bill passes, I will work on the implementation stage through an outreach plan. Its audience is postpartum patients and the nurses who discharge them. At my hospital, I will propose adding a line to postpartum discharge teaching and to the six-week visit checklist explaining that Medicaid coverage now continues for 12 months, and I will ask our case management team to track whether patients receive incorrect termination notices at 60 days, reporting problems to the Medicaid agency's advisory committee. A policy that exists on paper but not in patients' understanding will not reach the people it was written for. I will report what the tracking shows to the nursing practice council after six months, so that the unit can see whether its teaching is reaching patients.

References

American Rescue Plan Act of 2021, Pub. L. No. 117-2, 135 Stat. 4 (2021).

Centers for Disease Control and Prevention. (2022). Pregnancy-related deaths: Data from maternal mortality review committees in 36 US states, 2017-2019. U.S. Department of Health and Human Services. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc-2017-2019.html

Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, 136 Stat. 4459 (2022).

Daw, J. R., Kolenic, G. E., Dalton, V. K., Zivin, K., Winkelman, T., Kozhimannil, K. B., & Admon, L. K. (2020). Racial and ethnic disparities in perinatal insurance coverage. Obstetrics & Gynecology, 135(4), 917-924. https://doi.org/10.1097/AOG.0000000000003728

Gordon, S. H., Sommers, B. D., Wilson, I. B., & Trivedi, A. N. (2020). Effects of Medicaid expansion on postpartum coverage and outpatient utilization. Health Affairs, 39(1), 77-84. https://doi.org/10.1377/hlthaff.2019.00547

Steenland, M. W., & Wherry, L. R. (2023). Medicaid expansion led to reductions in postpartum hospitalizations. Health Affairs, 42(1), 18-25. https://doi.org/10.1377/hlthaff.2022.00819