Medicaid is the largest single-payer of maternity care in the United States, financing an estimated forty percent of births and playing a critical role in addressing the current maternal mortality crisis. Cuts to Medicaid threaten maternal and infant health in every state.
Traditionally, policymakers have recognized the importance of Medicaid for pregnant people by making it easier for them to qualify for Medicaid coverage during pregnancy through at least 60 days postpartum.
Federal law also requires states to cover certain pregnancy-related services as essential health benefits without cost sharing. However, some pregnancy-related services – such as extension of coverage up to one year postpartum, certain midwifery care, and birth doula support – are optional, so states can choose to include them in their Medicaid program via state plan amendments and other policy levers.
These optional benefits – proven to improve maternal health outcomes – are sure to be on the chopping block as states grapple with unprecedented budget constraints imposed by Medicaid spending cuts. Additionally, states not yet offering these optional benefits will be less incentivized to do so.
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At Risk: Critical Maternal Health Benefits
Postpartum Extension of Medicaid Coverage
Continuous Medicaid coverage up to one year postpartum is essential to the health of women and families, as the majority of maternal deaths and many other threats to health occur in the postpartum period. As of January 2025, 48 states and the District of Columbia (with the exception of Wisconsin and Arkansas) have expanded Medicaid coverage from 60 days to 12 months postpartum. An estimated 47 percent of maternal deaths occurred from 7 days to 365 days postpartum, including from causes of mental health and substance use disorder (SUD).
Research shows that compared to women without extended coverage in the postpartum period, women with one year of postpartum Medicaid coverage are:
- Three times more likely to use mental health and SUD services;
- Ten times more likely to use contraceptive services;
- Less likely to experience maternal mortality and morbidity; and
- More likely to seek preventive care.
Midwifery Care
Midwives are health care professionals dedicated to providing high-quality maternity care that prioritizes meeting the holistic needs of childbearing families. Research shows that midwifery care provides equal or better care and outcomes compared to physician care on many key indicators, including higher rates of spontaneous vaginal birth, higher rates of breastfeeding, higher satisfaction with care, and lower overall costs.
There are three nationally recognized midwifery credentials: (1) Certified Nurse Midwife (CNM), (2) Certified Midwife (CM), and (3) Certified Professional Midwife (CPM). Federal law requires states to provide Medicaid coverage for the work of CNMs. The services of CMs and CPMs are optional benefits determined on a state-by-state basis. Four state Medicaid programs and the District of Columbia reimburse CMs, and 21 states and the District of Columbia reimburse or partially reimburse CPMs.
Doula Support
Doulas are trained, non-clinical health workers who provide emotional, physical and informational support for pregnant people and their families before, during, and after birth. Birth doula support leads to fewer cesareans, less use of pain medications, and less dissatisfaction with the childbirth experience. Doula support during pregnancy and the postpartum period is associated with lower rates of preterm birth and mental health conditions and higher rates of breastfeeding. As of March 2025, 23 states and the District of Columbia reimburse doulas through their Medicaid program, and others are in the process of implementing reimbursement.
Conclusion
Medicaid cuts have the potential to upend health care for millions of moms and babies. As states are faced with the threat of federal Medicaid cuts, continued coverage of these critical maternity services is in jeopardy. Learn more about mandatory vs. optional benefits in Medicaid related to maternal health and Medicaid mandatory vs. optional services in general.
