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Medicaid Expansion: A Step Forward, But Not Enough for Black Maternal Health Equity



In 2022, The U.S. Department of Health and Human Services (HHS) recently gave the green light to California, Florida, Kentucky, and Oregon, allowing them to extend Medicaid and Children's Health Insurance Program (CHIP) coverage to 12 months after childbirth (Assistant Secretary for Public Affairs (ASPA), 2022). Through the Medicaid expansion.


Postpartum coverage now includes a wide range of Medicaid services, such as:

  • Reproductive services, including up to two postpartum visits, family planning, and testing for sexually transmitted diseases.

  • Primary care for conditions like asthma, high blood pressure, or diabetes, as well as general illnesses.

  • Specialty care for chronic health conditions like cardiovascular disease.

  • Dental services cover evaluations and procedures to address pain or infection.

  • Mental health services for depression, anxiety, substance use disorder, and other mental health conditions, including assessments, therapy, and rehabilitation.

  • Doula services

  • Emergency care

  • Prescription drug benefits

  • Transportation to medical services (Florida Medicaid Providers, n.d.)

However, after attending Dr. Venessa Walker's Black Maternal Health Week event, I learned that for black mothers, the issues that black women experience go beyond lack of services, access to services, or coverage for the cost of services. It's deeper than that; instead, it's more superficial. It's the color of your skin. Unfortunately, for some women, life and death during pregnancy or labor are dependent on your skin tone. 


Furthermore, in Women's health, black women still receive poor quality care. For women and racial and ethnic minorities, the risk of misdiagnosis is significantly higher, with a 20-30% increased likelihood compared to white men. When it comes to heart attacks, women and minority patients are often discharged without diagnosis or treatment (Szabo, 2024). Research also reveals that Black women experiencing childbirth-related heart failure are typically diagnosed later than their white counterparts (Szabo, 2024). This delay in diagnosis can lead to further health deterioration, reducing the likelihood of full recovery and increasing the chances of long-term heart issues for Black women (Szabo, 2024). Check out my previous blogs about women's health and alarming maternal health mortality rates here.


Racism and discrimination in healthcare contribute to poor quality care for Black women, exacerbating existing disparities in maternal health outcomes. These systemic issues extend far beyond access to services or coverage costs; they permeate through interactions with healthcare providers and institutions, often resulting in biased treatment based on skin color. For Black mothers, this reality introduces life-threatening risks during pregnancy and childbirth that should be preventable.



The urgency to address racism and discrimination in maternal healthcare is paramount to ensure that Black mothers not only survive childbirth but also have the opportunity to witness their children grow. It's about preventing unnecessary loss and ensuring that every mother receives the care and attention she deserves, regardless of her race or ethnicity. By paying closer attention to signs and symptoms, addressing biases, and providing equitable care, healthcare providers can play a crucial role in reducing maternal mortality rates among Black women.


Closing Thoughts

While recent expansions in Medicaid coverage represent a step forward in improving access to maternal healthcare services, they alone cannot address the underlying issues of racism and discrimination that persist in the healthcare system. It's imperative that we continue to advocate for comprehensive reforms and cultural competency training within healthcare institutions to ensure equitable and dignified care for all mothers, regardless of their race or background.


Peace,

Audrey L.




References


Assistant Secretary for Public Affairs (ASPA). (2022, May 25). HHS applauds 12-Month postpartum expansion in California, Florida, Kentucky, and Oregon. HHS.gov. https://www.hhs.gov/about/news/2022/05/25/hhs-applauds-12-month-postpartum-expansion-in-california-florida-kentucky-and-oregon.html


Florida medicaid providers. (n.d.). March of Dimes. https://www.marchofdimes.org/florida-medicaid-providers



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