Oklahoma consistently ranks poorly on women’s and children’s health. While Oklahoma’s decision to expand Medicaid has significantly lowered the state’s uninsured rate, Oklahoma women have historically seen high rates of uninsurance. At 23.5 maternal deaths per 100,000 live births, the state’s maternal mortality rate is much higher than the national rate of 20.1, and Black Oklahomans face an even higher mortality rate at 40.8. When compared with national peers, Oklahoma women face comparatively high levels of frequent mental and physical distress, and the state ranks 44th worst for infant mortality.
State officials recently took an important first step towards improving some of these abysmal outcomes. In July 2022, Gov. Stitt issued an executive order creating the “Helping Every Life and Parent (HELP) Task Force” and directed the group to make recommendations about, among other things, better supporting pregnant Oklahomans. At its first meeting on Sept 13, 2022, the task force recommended that Oklahoma increase the income threshold to allow more pregnant residents to qualify for Medicaid and expand the postpartum coverage period. The Oklahoma Health Care Authority (OHCA) – which recommended the option to the task force – specified that these changes could be made immediately and within the agency’s current budget. The governor has stated his full support of these changes.
By swiftly and equitably implementing these recommendations to expand Medicaid coverage, Oklahoma will be providing thousands more pregnant Oklahomans with comprehensive prenatal and postpartum care, which will have enormous positive and rippling impacts on new parents and their families.
Increasing the income threshold to qualify for pregnancy Medicaid coverage will increase access to quality care.
Access to prenatal care is vital to improving birth, postpartum, and lifelong health outcomes. When people can see a doctor during pregnancy, they are more likely to identify potential problems, which can decrease the likelihood of complications. Women who do not have access to prenatal care are five times more likely to have a pregnancy-related death. Expanding access to prenatal care is vitally important to begin addressing Oklahoma’s high rates of maternal mortality and other harmful health outcomes.
Right now, there are two types of pregnancy coverage available through Medicaid in Oklahoma. People who are pregnant, who meet citizenship guidelines, and who make less than 138 percent of the Federal Poverty Line (FPL) – about $18,000 for an individual – qualify for full pregnancy coverage through Medicaid. This covers a wide array of medical needs, including prescription drugs, mental health treatment, and two months of postpartum coverage. The other type of coverage is available to anyone (regardless of immigration status) who makes less than 205 percent of the FPL – about $28,500 for an individual. This only includes pregnancy-related care and does not include postpartum coverage.
The recommendations passed by the task force would increase the income threshold to qualify for full pregnancy coverage from 138 percent of the FPL to 205 percent of the FPL. In practice, this will mean that each year some 2,500 to 4,000 pregnant Oklahomans will now have access to full pregnancy coverage through Medicaid, according to OHCA and OK Policy estimates. The limited coverage plan will continue to be available to Oklahomans who do not qualify for full coverage due to citizenship requirements.
Only three other states use 138 percent of the FPL as the income threshold to qualify for full pregnancy coverage, meaning that enrollees have to make less than $18,000 annually to qualify for this life-saving coverage. The median income threshold across the country is higher, at 200 percent of the FPL. Oklahoma’s historical choice to set eligibility at the lowest possible level of 138 percent of the FPL has needlessly endangered the lives of parents and children. With the proposed changes, the increase will bring Oklahoma in line with the majority of other states.
Twelve months of postpartum coverage will promote long-term maternal and child health.
Having access to health coverage during the 12 months after giving birth is crucial to achieving healthier outcomes for new parents and babies. With better and longer access to health insurance, new parents are better able to follow up on pregnancy complications, manage chronic conditions, address mental health needs such as postpartum depression, and maintain existing health care provider relationships. Their infants will also be more likely to attend well-child visits and receive necessary immunizations.
Despite advantages created by greater health care coverage, Oklahoma currently only offers 60 days of postpartum coverage to people enrolled in the full benefits pregnancy plan (those who make less than 138 percent of the FPL and meet citizenship requirements); people in the limited benefits program have no access to postpartum coverage.
The task force’s recommendations would expand the postpartum coverage period from 60 days to 12 months for those in the full benefits plan, which will have monumental impacts on the health of new moms and their babies. Additionally, during the 12 months of coverage, enrollees will be continuously eligible, meaning that they will not be disenrolled from coverage, regardless of changes in income or missed administrative requirements. Continuous eligibility is associated with more consistent access to care and improved health outcomes. This is especially important for low-income families that disproportionately experience income volatility. With continuous eligibility, new parents will spend less time and energy on administrative requirements to keep medical coverage, and they can spend more time on important responsibilities, like making and keeping appointments and getting their newborns to well-child visits.
More is needed to fully support parents and babies.
If implemented, the expanded pregnancy and postpartum care coverage recommendations approved by the HELP Task Force on Sept 13, 2022, will provide better and longer-term health coverage to thousands of Oklahomans. Prior to implementation, the OHCA has to submit these changes to the federal Centers for Medicare and Medicaid Services (CMS) for approval. CMS has already approved the 12-month postpartum extension in 26 states, suggesting that this approval could come very quickly.
Oklahomans who are supportive of these changes can contact Gov. Stitt’s office to express support for these and other changes that prioritize the health and wellbeing of pregnant people and their children. Additionally, when the proposed changes are implemented, educating all eligible Oklahomans about the new eligibility will require comprehensive outreach across the state.
By expanding access to prenatal and postpartum Medicaid coverage, the state will be taking a significant first step towards better supporting Oklahoma families. We can build on this progress by broadening our investments in the well-being of Oklahoma’s children, including increasing access to necessities like affordable housing, accessible child care, and healthy food. All of these are vital to ensuring that all Oklahomans — especially our youngest residents — can thrive.