The recent anniversary of Medicare and Medicaid is the perfect time to reflect on their impact on our health care system over the past 59 years. These programs have helped to improve access to necessary health care services for a variety of historically underserved populations, including enrollees who are people of color, low-income, disabled, or live in rural areas. Medicaid also plays a significant role in women’s health, covering almost one in five adult women in the United States. It is the largest single payer of maternal and reproductive health, including prenatal and postnatal care, family planning, preventive care and chronic disease management services for conditions such as breast and cervical cancer. Medicaid is also the largest single payer to pay for long term services and support, which is relied on greatly by the elderly population who are dual-eligible and disabled populations, but has limited coverage through commercial and Medicare-only plans. For many women, Medicaid is a safety net for coverage and contrary to popular misconceptions, Medicaid serves a diverse population.
However, there are notable challenges that Medicare and Medicaid face in providing comprehensive care for women, from rising costs to evolving beneficiary demographics. The aging population and increasing health care needs demand innovative solutions to sustain these programs and combat these challenges. Many Medicaid populations, particularly in rural areas, often face barriers to care, including transportation issues and workforce shortages. This has resulted in inequities in health outcomes perpetuated by delayed access to care, making Medicaid’s support even more necessary. Interventions, such as increasing coverage of mobile clinics in rural areas or providing workforce training for providers, offer an opportunity to enhance Medicaid’s impact on women’s health.
Looking ahead, we must envision a future where Medicaid continues to lead in improving women’s health. To realize this vision, we need to encourage innovation and flexibility in program administration. Leveraging technologies like telehealth and data tools can revolutionize care delivery for women by making health care more accessible and personalized for various populations’ needs. For example, expanding telehealth flexibilities helps to increase access to health care for underserved populations with transportation issues and easier management of chronic care interventions.
States are in the process of transitioning to more value-based care models to emphasize the importance of patient health outcomes and experience over volume of services and foster a more efficient and effective health care system. Medicaid and Medicare should strive to enhance person-centered care and address social drivers of health through targeted interventions that can significantly improve health outcomes for women, such as comprehensive care coordination for chronic conditions, home visiting programs for new parents, and transportation support for medical appointments.
Positive innovations in maternal health and improved birth outcomes can be transformative, setting new standards for care around the country. Care delivery and provider payment models, such as the CMS Innovation Center’s Transforming Maternal Health (TMAH) model, are reshaping how care is provided. The TMAH model will focus on improving maternal health outcomes through delivering personalized care, increasing access to perinatal care, providing screenings, referrals, and follow-ups for behavioral health and social needs, and investing in data infrastructure. CMS should collaborate with the private sector and community organizations to further highlight these efforts, creating a comprehensive approach to health care reform that prioritizes the health and well-being of women and their families.
As we move forward, it is important to continue advocacy for policies that protect and strengthen Medicaid and Medicare. There have been numerous attacks from various administrations over the years on Medicaid in particular. These range from proposals on work requirements and time limits or lifetime caps for beneficiaries to repealing or cutting funding for Medicaid expansion, which are both listed, among others, in the Heritage Foundation’s Project 2025 proposal. Work requirements reinforce a false narrative that Medicaid enrollees do not work and do not acknowledge the barriers to employment that women face as they are more likely to be primary caregivers for their children and families. Federal funding cuts to Medicaid expansion would result in over 24.6 million Americans in the expansion group losing coverage as of 2023.
These programs are central to women’s health, supporting millions of women and families. Through embracing innovation and protecting from harmful policies, we can ensure that Medicaid continues to provide coverage for vital services and improve health outcomes for future generations. The future of these programs is in our hands and with continued efforts and forward-thinking policies, they will remain the foundation of our health care system.
