Maternal Health and Medicaid Expansion
North Carolina’s maternal mortality rate is too high – higher than the national average and twice as high as California, according to a recent report by America’s Health Rankings. Risks for North Carolina’s Black mothers are even worse due to many intersecting issues including differences in health care coverage and access to care, systemic racism, and implicit bias. Black women in our state currently have a mortality rate three times higher than the rate for white women.
North Carolina’s recent Medicaid expansion has the potential to decrease maternal mortality rates by increasing access to care, both prior to pregnancy and all the way through childbirth. In conjunction with MDC’s work to improve equitable birth outcomes in Forsyth County, we examined the pathways for Medicaid expansion can lead to better outcomes for NC maternal and infant mortality rates.
To fully realize the benefits of Medicaid expansion, it will be important to make other changes that help mothers and children access the health care they need to thrive. A series of proposals making their way through the House and Senate would help ensure that critical health benefits reach the mothers and families who need them most. Those proposals include increasing community-based supports like doula services, requiring implicit bias training for health care providers, increasing the reimbursement rate for obstetricians who accept Medicaid patients, and improving telehealth programs.
Beyond those mentioned in the piece, there are also economic mobility strategies that can improve maternal health outcomes. Advocating for these broader social policies would also have an indirect impact on maternal mortality rates by decreasing poverty rates, improving access to quality care, and decreasing stress:
· State Earned Income Tax Credits: Introducing a State Earned Income Tax Credit (EITC), a refundable tax credit for low-income workers also promotes healthier and more equitable birthing outcomes. Research shows that Black mothers in EITC states saw greater reductions in the likelihood of low birthweight than their white counterparts when compared to non-EITC states.
· Raising the Minimum Wage: Higher minimum wages lead to higher incomes, which makes it easier for families to access essential resources like safe housing, nutritious food, quality health care, and reliable transportation. Higher minimum wages can also decrease stress levels, which is essential for improving both perinatal and postpartum health. Research also suggests that increases in a state’s minimum wage can reduce poverty and infant mortality rates.
Medicaid expansion is one important step towards creating a North Carolina where all people thrive, starting from birth.