The impact of Medicaid expansion on maternal, infant health

States that have expanded Medicaid have shown greater improvements reducing maternal deaths and infant mortality, according to a new study.

According to research from the Georgetown University Health Policy Institute Center for Children and Families, Medicaid expansion helps support maternal health by increasing the number of women insured—without gaps—leading to healthier babies and mothers.

“Health coverage before, during and after pregnancy is essential to the health and wellbeing of both mother and child,” Joan Alker, executive director of the center, said in a statement. “Medicaid expansion is the single most effective way to help women of childbearing age get continuous health coverage.”

The uninsured rate for women of childbearing age is almost twice as high in states that have not expanded Medicaid, 16% versus 9%. In addition, expansion states saw a 50% greater reduction in infant mortality rates than non-expansion states.

RELATED: CDC: 9.8% of Americans uninsured in 2018

Ten of the 12 states with the highest rates for uninsured women of childbearing years have not expanded Medicaid.

“There’s no one answer to improve care, but we do have a clear place where we can start, and that is expanding Medicaid coverage in those states that haven’t expanded yet,” co-author Adam Searing said in a press call.

States with expanded Medicaid coverage for adults with up to 138% of the federal poverty level also have a decreased chance of losing and regaining coverage over a short period of time. These breaks in health coverage can ultimately disrupt care and exacerbate existing conditions.

For example, the data show that Medicaid usually covers a woman’s delivery but often not the months leading up to it. And for 55% of these new mothers, there is another coverage gap for six months after giving birth.

Other coverage unique to Medicaid expansion includes maternal depression screening and treatment—more than half of all infants raised below the poverty level have a mother with some form of depression. It also helps with tobacco cessation programs, as Medicaid enrollees are twice as likely as the general population to smoke.

RELATED: Kansas senators reject Medicaid Expansion in narrow vote

The Affordable Care Act was created to offer continuous coverage for women, Alker said in the press call. But coverage still looks like patchwork in many states, with women often only receiving coverage up to 60 days postpartum.

She went on to note that the 14 states that have not expanded Medicaid are mostly those with the highest rates of infant mortality. And the Trump administration’s call for expanding work requirements might further prohibit coverage for these women.

“Growing recognition that the U.S. faces a crisis in maternal mortality, the choice of whether a state expands Medicaid or not is the single most important decision these states face with respect to women and babies,” Alker said.

Without expansion and without the continuous affordable coverage, it will be near impossible to see improvements, she said.

The study also shows that racial disparities still exist and black women are three times as likely to die of pregnancy and childbirth complications than white women.

“States that have not expanded are really missing a clear opportunity to begin to address this unacceptable racial inequality among racial and ethnic mortalities,” Searing said in the call.

The states with the biggest decline in uninsured women between 2013 and 2017 include West Virginia, New Mexico and Kentucky. All three states have Medicaid expansion and have reduced the uninsured by more than 16 percentage points. (The national average was just over 6%.)