New report finds states that have not expanded Medicaid lag behind in maternal and child health


A new report finds that Missouri has among the highest uninsured rates for women of child-bearing age. The uninsured rate for Missouri women ages 18-44 is 13.9 percent, compared to an average of nine percent in Medicaid expansion states.

Medicaid expansion has played a key role in improving several maternal and child health outcomes, according to the report by the Georgetown University Center for Children and Families, including:

  • Reducing rates of maternal death,
  • Decreasing infant mortality rates, and
  • Improving the potential for optimal birth outcomes that can increase the promise for a healthy childhood.

States that expanded Medicaid saw a 50 percent greater reduction in infant mortality, compared to non-expansion states. Moreover, the decline was greatest among African American infants, which drove the overall decline and helped to substantially reduce the racial disparity in infant mortality rates.

“Health coverage before, during, and after pregnancy is essential to the health and well-being of both mother and child,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “Medicaid expansion is the single most effective way to help women of childbearing age get continuous health coverage during this critical stage of life.”

Missouri has one of the most restrictive Medicaid eligibility requirements in the nation, limiting Medicaid coverage to parents earning just $373 per month for a family of three. Women without any children in the home are not eligible for Medicaid in Missouri.

States that have expanded Medicaid have also decreased the likelihood that women’s eligibility for coverage fluctuates, resulting in losing and regaining coverage over a relatively short span of time. Breaks in health coverage, also known as “churn,” can disrupt care and cause existing health conditions to become more serious and more difficult and expensive to treat, according to the report.

“No mother or child’s health should suffer because she didn’t get the care she needed before, during or after pregnancy,” said Beth Simpson, MOAAP President. “Ensuring that moms and babies have healthcare is vital for Missouri families. This report shows that when Medicaid expansion increases a mother’s access to healthcare, both she and her baby do better and that child has a better chance for a healthy childhood.”

The American College of Obstetricians and Gynecologists recommends that women have access to continuous coverage prior to becoming pregnant and 12 months postpartum to reduce preventable adverse health outcomes.

“Healthy women and infants are the foundation of a thriving community. This report reinforces that continuous health coverage for women improves outcomes and is critical to lowering racial disparities in infant and maternal deaths,” said Kendra Copanas, Executive Director of Generate Health.

Research shows that health coverage prior to pregnancy helps address risk factors such as obesity, diabetes and heart disease and improves access to timely prenatal care. In Missouri, new mothers typically lose Medicaid coverage 60 days postpartum. When mothers abruptly lose health coverage so soon after giving birth, it can force women to abandon medication or other ongoing treatment they may need, including support for postpartum depression.

“Black infants in St. Louis are 3.5 times more likely to die before the age of one than White infants, and Black women are twice as likely to die around the time of childbirth as White women in Missouri,” continued Copanas. “The health and health care of women before pregnancy is a leading contributor to fetal and infant deaths. Medicaid expansion is a real opportunity to provide vital care and improve the health of Missouri moms and kids.”