Expanding postpartum Medicaid coverage is necessary, but not sufficient

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Aug 16, 2022

Losing health insurance, regardless of when or why, is a negative experience. But right after delivering a baby is an especially stressful time to suddenly lose coverage. The time after giving birth is filled with a variety of emotional and physical needs and changes that often require medical attention. 

That’s why it’s harrowing that hundreds of thousands of women in the United States lose health coverage after giving birth. In 2018, this number was around 610,000. Medicaid covers about 40% of all births in the United States, and in some states, it covers the majority of births. While Medicaid is required to provide coverage for women up to 60 days postpartum, many women lose their coverage after those 60 days end. This happens because their income, while not high enough to afford individual plans on the marketplace, is too high to qualify for Medicaid. 

To address this loss of coverage, many states are now expanding their postpartum Medicaid offering, providing coverage for women up to a year after giving birth. This expansion is part of the American Rescue Plan, and promises to grant Medicaid and CHIP coverage to 720,000 women. States began to implement this new coverage expansion as early as April 2022.

This plan to provide expanded coverage for new mothers makes strides in advancing access to postpartum care. However, access is only part of the equation of effective postpartum care. Improved access is not sufficient if the care available does not meet women’s needs, or does not target women’s postpartum Jobs to Be Done. 

Jobs Theory

People don’t simply buy products or services; they pull products or services into their lives to make progress. We call this progress the “job” they are trying to get done, and those jobs are dictated by a person’s lived experiences and current circumstances. 

Jobs have three different components, or dimensions, that help explain why people make the decisions they do. They are as follows:

  • Functional, or the physical need the consumer sets out to accomplish,
  • Social, or how the solution impacts perception by others, and
  • Emotional, or how the solution will make the consumer feel

In health care, people “hire” different medical care services—from primary care, to specialist care, to urgent and emergency care—depending on their specific circumstances and desired progress at a given time. 

Women’s postpartum Jobs to Be Done

There is no question that a lack of health insurance makes health care difficult, if not impossible, to access and afford. Currently, 40% of women in the United States do not attend any postpartum appointments, and they list cost of care as one factor in their decision 

But of the women who do attend, less than half report believing they received adequate information to remain healthy. This is startling: less than half of women receiving some form of postpartum care feel that it is meeting their needs. That means the majority of women who are accessing postpartum health care are getting care that doesn’t help them in the way they are seeking. 

Why is it that women seem so dissatisfied with current postpartum care services? A possibility is that current postpartum care offerings do not adequately address women’s Jobs to Be Done. Postpartum care is not traditionally a care specialty, unlike prenatal and pediatric care. Instead, new mothers are forced to either address their postpartum health concerns when seeing the doctor for other reasons or to diagnose and treat themselves at home. If women feel that their postpartum concerns are simply an afterthought, or must be handled on their own, then it makes sense that they skip out on care—the care that currently exists does not fully address the functional or emotional dimensions of their jobs.

To increase postpartum care usage, health care leaders and innovators designing care need to uncover, understand, and design for postpartum women’s Jobs to Be Done. Instead of following the same processes and designs as other care offerings, postpartum care needs to be developed with new mothers’ unique needs and challenges in mind. 

This is not to say that the Medicaid expansion under the American Rescue Plan is not a move in the right direction. It is. Medicaid coverage in particular is associated with decreases in concerns about a host of financial needs, such as housing, food, bills, credit card and loan payments, and health care costs. But in order to truly make postpartum care options better for women, health care leaders need to address all dimensions of their jobs. 

The Medicaid postpartum care expansion is one step forward in improving women’s access to and experiences with postpartum care. In this scenario, the financial burden of care access will be significantly lessened for new moms, easing a major concern. But until postpartum care addresses not just cost, but what women truly need and want from their care experience, women’s postpartum needs will not be effectively met. 

Jessica is a research associate at the Clayton Christensen Institute for Disruptive Innovation, where she focuses on business model innovation in healthcare, including new approaches to population health management and person-centered care delivery.