New moms in rural NC are getting better postpartum care thanks to Medicaid expansion

At her practice in Henderson, North Carolina physician Laura Ucik gets to meet new parents during those critical months following childbirth. As a family physician in a rural area of the state, Ucik connects with new families on many aspects of their health care. But especially important in those early weeks, she said, is a mom’s postpartum care.

Beyond the basic physical and psychological recovery necessary after delivering a child, Ucik sees postpartum patients for urgent issues like “persistent vaginal bleeding, for pain after a C-section, hypertension, and chronic problems.” 

Despite recovery taking anywhere from six weeks to a year, until 2022 many of Ucik’s low-income patients were only covered for two months of postpartum care under Medicaid—which made follow-up a challenge, and presented serious health risks to postpartum health for both parents and babies.

“A mother is still a person for many, many years after that two months,” Ucik said. “So it’s kind of a big deal to have two months of coverage then have it end.”

That two-month cap was extended to 12 months in November 2022, when North Carolina opted in to the American Rescue Plan’s expansion of Medicaid benefits. Low-income people in the state who are covered by Medicaid will get the extended benefits through March 2027.

That’s especially important in North Carolina, where maternal mortality rates trend above the national average. From 2018-2021, the United States had an average of 23.5 maternal deaths per 100,000 live births. In North Carolina, that number jumped to 26.5. Racial disparities are another concern: Among Black birthing parents here, the maternal mortality rate is nearly twice the state average. 

Ucik said that people often get lost in following up with postpartum care, especially when their health insurance is hard to navigate. 

“In a rural area, it’s particularly challenging because there is such a shortage of primary care providers for access,” she said. “Also just for transportation, housing, and other life stressors that get in the way of people being able to prioritize their health.”

She said many patients are directed to primary care by obstetricians after birth, receive an initial healthy report, then discontinue care—leaving a critical gap in health monitoring for postpartum parents and infants themselves. 

“Even if they do establish care and see somebody for postpartum, and they say, ‘Oh, you’re struggling with depression and you need to take medications’ or ‘You should seek counseling’ or ‘We need to follow your blood pressure because you have preeclampsia,’ that coverage ending is extremely dangerous because a lot of those conditions require follow-up and monitoring,” Ucik said. “If there’s financial barriers on top of all the structural barriers, that follow-up’s not going to happen and it can lead to serious consequences. Not just for the patient, but for their child.”

In recent years, Ucik said she’s witnessed improvements in post-birth care for patients at her practice, thanks largely to an expansion in postpartum benefits under Medicaid. Other experts agree.

“​​Extending coverage also supports women in need of treatment for chronic health conditions, mental health, or substance use disorders, allowing them to stay actively engaged in parenting,” found NC Child, a nonprofit that advocates for child welfare in the state. “Guaranteeing 12 months of continuous health coverage postpartum helps babies stay healthy during their first year of life.”

Under expanded postpartum coverage, most pregnant and postpartum people in North Carolina can keep accessing  services like prescriptions, behavioral health treatments, doctor visits, and dental, vision, and hearing care for a full year after giving birth. These postpartum benefits continue even if patients experience significant life events—like income changes or alterations to family structure—that might have previously affected eligibility. 

Over in Hillsborough, full-scope family care physician Erica Pettigrew has also seen the impact of expanded postpartum coverage. She said that trying to fit all necessary postpartum care into a 60-day period is unrealistic for most new parents. Under the 12-month provision, patients can seek care at their own pace. 

“Even though postpartum medical appointments are important, they aren’t necessarily the optimal time to discuss certain things,” Pettigrew said. “So not feeling like we have to cram everything about someone’s health care into a very short 60-day window is a huge relief.”

Just last year, nearly 273,000 NC residents qualified for automatic enrollment in the program. There’s a projected enrollment of 600,000 beneficiaries in the coming years. In the first three months of Medicaid expansion alone, North Carolina’s enrollment grew by around 1,000 people per day. 

The expansion also improved access to transportation by offering free rides to appointments—a particular need in rural areas where many people don’t own cars, and must travel long distances to attend medical appointments. Eighty of North Carolina’s 100 counties are classified as rural by the NC Rural Center.

Ucik said she sees the benefits of Medicaid’s postpartum expansion in her practice time and again. 

“Just today, I saw somebody who was coming in for a checkup who had a baby six months prior. She had had preeclampsia, she had had some depression previously, and her blood pressure’s still pretty elevated now,” Ucik said. “Because of that Medicaid expansion, she’s now able to get more consistent follow-up. We’re able to refer her out for counseling, we’re able to prescribe a blood pressure monitor to the pharmacy that she’s able to pick up, and her medications can be covered so she doesn’t have to to pay out of pocket for them while she’s trying to pay the cost of caring for a newborn.”

Pettigrew echoed that experience. She said the expanded coverage has even allowed some patients to treat non-pregnancy-related health concerns that were previously unaddressed.

“This 12 months means that, perhaps, somebody has not been getting regular medical care. They get pregnant, they decide to continue the pregnancy, we see them for prenatal care. But also, for the first time, maybe they’re having their depression treated or their asthma is being evaluated or they have high blood pressure problems,” she said. “We manage them during the pregnancy in a very specific way, but now they get to at least have 12 months of coverage where we can continue to work on those things with them.”

Physicians like Ucik and Pettigrew worry about the potentially devastating consequences of a repealed Affordable Care Act, which would leave the future of Medicaid uncertain. Projected Republican presidential nominee Donald Trump has long been supportive of cutting Medicaid enrollment and reducing federal funding for the program, on which 94 million Americans were enrolled in March 2023.

Trump also repeatedly targeted the ACA during his 2016 campaign, and has continued anti-Obamacare sentiments ahead of the 2024 election. 

Ucik said losing Medicaid coverage would be “disastrous” for her rural patients.  

“Repealing Medicaid would be devastating for so many people—I don’t even know if I can say particularly for postpartum—that would just be absolutely devastating to our communities,” she said. “Medicaid has just been so powerful, so meaningful. It’s been life-changing for countless of my patients.”

Repealing the Affordable Care Act could end protections for patients with preexisting conditions and limit access to critical preventive care, Pettigrew said.

“If we have different people in power who don’t believe that everybody deserves access to care, then we could see a huge slippage backwards of the gains we’ve made,” she said. “Definitely, the elections in November have huge implications and I think we all need to be thinking about the consequences of that.”

While Pettigrew lauded the recent Medicaid expansions and extended postpartum coverage, she sees room for growth in health care approaches in North Carolina and nationally. 

“We still have a lot of work to do in our state,” she said. “Hopefully we can see more than 12 months—and people not being defined or valued by whether or not they’ve just had a baby. Maybe we’ll get to a point where we as a society believe that everyone’s deserving of health coverage and health care.” 

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