Leading Advocates Consider Expanding Hawaii’s Postpartum Medicaid Coverage – State of Reform

Health care advocates in Hawaii recently hailed the extension of postpartum Medicaid coverage from 60 days to 12 months. State of Reform spoke with 3 experts who helped expand on what this means for the future of maternal health in Hawaii.

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The extension comes from a $2.4 million appropriation to the Department of Social Services in the Supplementary Executive Budget for FY2023, which passed earlier this year. The credit will be matched by $3.4 million in federal funds. Hawaii was one of several states to make the change, due to a provision in the American Rescue Plan Act that allows states to expand coverage through a state plan amendment.

Rep. Sylvia Luke (D-Makiki), chair of the House Finance Committee and a strong supporter of expansion, said expanding safety net services was a top priority for lawmakers last session. .

“Cutting health benefits and postpartum care after 2 months has a significant impact not only on the mothers, but also on the child,” she said. “Mothers need to stay healthy, and extending coverage from 2 months to 12 months will significantly reduce mortality rates, address health needs and support new mothers who have given birth.”

In addition to expanding postpartum care, other Medicaid appropriations in the budget include the reinstatement of adult dental benefits and the supplier reimbursement rate increases.

Expanding postpartum coverage has been a priority in Hawaii for years, said Reni Soon, MD, president of the Hawaiian chapter of the American College of Obstetricians and Gynecologists, despite delays due to the COVID pandemic. Keys to the movement’s success included the contribution of grassroots organizations and results of the Hawaii Maternal Mortality Review Committee of the Department of Health.

“One of the things [the committee] found that half of maternal deaths actually occur after 42 days, or later postpartum,” Soon said. “If we really want to prioritize maternal health, we can’t just think that the effects of pregnancy and pregnancy-related conditions end at 42 days.”

With postpartum coverage in effect, Med-QUEST providers seek to invest state budget funds in improving care coordination services.

“As a Medicaid health plan, [the extension] also allows us to extend our care coordination services during this time,” said Paula Arcena, executive vice president of external affairs at AlohaCare. “We are in contact with the mother, helping her access the services she may need. We check on her and try to facilitate access to care, whether it’s for signs of postpartum depression, mastitis or difficulty getting an appointment. We have a shortage of vendors in Hawaii and sometimes that can be a hindrance because our vendors work as hard as they can but it’s hard to come in and see [a provider].”

Arcena added that the expansion comes at a time when Med-QUEST enrollment has increased dramatically in Hawaii, as those who lost their jobs during the pandemic also lost their employer-sponsored health coverage.

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