{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T14:31:21Z","timestamp":1788618681119,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,8,3]]},"abstract":"<jats:p xml:lang=\"en\">Maternal mortality has been increasing in the United States over the past 3 decades, while decreasing in all other high\u2010income countries during the same period. Cardiovascular conditions account for over one fourth of maternal deaths, with two thirds of deaths occurring in the postpartum period. There are also significant healthcare disparities that have been identified in women experiencing maternal morbidity and mortality, with Black women at 3 to 4 times the risk of death as their White counterparts and women in rural areas at heightened risk for cardiovascular morbidity and maternal morbidity. However, many maternal deaths have been shown to be preventable, and improving access to care may be a key solution to addressing maternal cardiovascular mortality. Medicaid currently finances almost half of all births in the United States and is mandated to provide coverage for women with incomes up to 138% of the federal poverty level, for up to 60\u00a0days postpartum. In states that have not expanded coverage, new mothers become uninsured after 60\u00a0days. Medicaid expansion has been shown to reduce maternal mortality, particularly benefiting racial and ethnic minorities, likely through reduced insurance churn, improved postpartum access to care, and improved interpregnancy care. However, even among states with Medicaid expansion, significant care gaps exist. An additional proposed intervention to improve access to care in these high\u2010risk populations is extension of Medicaid coverage for 1\u00a0year after delivery, which would provide the most benefit to women in Medicaid nonexpanded states, but also improve care to women in Medicaid expanded states.<\/jats:p>","DOI":"10.1161\/jaha.121.022040","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T09:05:44Z","timestamp":1627549544000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Reducing Cardiovascular Maternal Mortality by Extending Medicaid for Postpartum Women"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9166-7051","authenticated-orcid":false,"given":"Janki P.","family":"Luther","sequence":"first","affiliation":[{"name":"Cardiovascular Division Washington University School of Medicine St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Y.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Cardiovascular Division Washington University School of Medicine St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-8653","authenticated-orcid":false,"given":"Karen E.","family":"Joynt Maddox","sequence":"additional","affiliation":[{"name":"Cardiovascular Division Washington University School of Medicine St. Louis MO"},{"name":"Center for Health Economics and Policy Institute for Public Health at Washington University St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8504-0006","authenticated-orcid":false,"given":"Kathryn J.","family":"Lindley","sequence":"additional","affiliation":[{"name":"Cardiovascular Division Washington University School of Medicine St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","unstructured":"Centers for Disease Control (CDC) . Pregnancy mortality surveillance system. https:\/\/www.cdc.gov\/reproductivehealth\/maternal\u2010mortality\/pregnancy\u2010mortality\u2010surveillance\u2010system.htm. Accessed May 27 2020."},{"key":"e_1_3_1_3_2","unstructured":"Centers for Disease Control (CDC) . Report from nine maternal mortality review committees. https:\/\/www.cdcfoundation.org\/sites\/default\/files\/files\/ReportfromNineMMRCs.pdf. Accessed October 22 2020."},{"key":"e_1_3_1_4_2","unstructured":"Centers for Disease Control (CDC) . Pregnancy\u2010related deaths: data from 14 U.S. maternal mortality review committees 2008\u20132017. https:\/\/www.cdc.gov\/reproductivehealth\/maternal\u2010mortality\/erase\u2010mm\/mmr\u2010data\u2010brief.html. Accessed October 22 2020."},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6818e1"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6835a3"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003243"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002357"},{"key":"e_1_3_1_9_2","unstructured":"Kaiser Family Foundation (KFF) . Expanding postpartum Medicaid coverage. https:\/\/www.kff.org\/womens\u2010health\u2010policy\/issue\u2010brief\/expanding\u2010postpartum\u2010medicaid\u2010coverage\/. Accessed May 27 2021."},{"key":"e_1_3_1_10_2","unstructured":"Kaiser Family Foundation (KFF) . Status of state action on the Medicaid expansion decision. https:\/\/www.kff.org\/health\u2010reform\/state\u2010indicator\/state\u2010activity\u2010around\u2010expanding\u2010medicaid\u2010under\u2010the\u2010affordable\u2010care\u2010act\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7D. Accessed May 27 2021."},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201402-072PS"},{"key":"e_1_3_1_12_2","unstructured":"National Conference of State Legislatures . Affordable Care Act Medicaid expansion. https:\/\/www.ncsl.org\/research\/health\/affordable\u2010care\u2010act\u2010expansion.aspx. Accessed April 12 2021."},{"key":"e_1_3_1_13_2","unstructured":"National Academy for State Health Policy . View each state\u2019s efforts to extend medicaid coverage to postpartum women. https:\/\/www.nashp.org\/view\u2010each\u2010states\u2010efforts\u2010to\u2010extend\u2010medicaid\u2010coverage\u2010to\u2010postpartum\u2010women\/. Accessed April 12 2021."},{"key":"e_1_3_1_14_2","unstructured":"Kaiser Family Foundation (KFF) . Analysis of federal bills to strengthen maternal health care. https:\/\/www.kff.org\/womens\u2010health\u2010policy\/fact\u2010sheet\/analysis\u2010of\u2010federal\u2010bills\u2010to\u2010strengthen\u2010maternal\u2010health\u2010care\/. Accessed January 21 2021."},{"key":"e_1_3_1_15_2","unstructured":"The American College of Obstetricians and Gynecologists . Extend postpartum Medicaid coverage. https:\/\/www.acog.org\/advocacy\/policy\u2010priorities\/extend\u2010postpartum\u2010medicaid\u2010coverage. Accessed April 12 2021."},{"key":"e_1_3_1_16_2","unstructured":"Texas Health and Human Services . HHSC\u2019s Healthy Texas Women Program launches enhanced postpartum care services. https:\/\/hhs.texas.gov\/about\u2010hhs\/communications\u2010events\/news\/2020\/08\/hhscs\u2010healthy\u2010texas\u2010women\u2010program\u2010launches\u2010enhanced\u2010postpartum\u2010care\u2010services. Accessed May 27 2021."},{"key":"e_1_3_1_17_2","unstructured":"Kaiser Family Foundation (KFF) . Medicaid postpartum coverage extension tracker. https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/medicaid\u2010postpartum\u2010coverage\u2010extension\u2010tracker\/. Accessed May 27 2021."},{"key":"e_1_3_1_18_2","unstructured":"Kaiser Family Foundation (KFF) . Medicaid income eligibility limits for parents 2002\u20102021. https:\/\/www.kff.org\/medicaid\/state\u2010indicator\/medicaid\u2010income\u2010eligibility\u2010limits\u2010for\u2010parents\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7D. Accessed April 12 2021."},{"key":"e_1_3_1_19_2","unstructured":"Kaiser Family Foundation (KFF) . Medicaid and CHIP income eligibility limits for pregnant women as a percent of the federal poverty level. https:\/\/www.kff.org\/health\u2010reform\/state\u2010indicator\/medicaid\u2010and\u2010chip\u2010income\u2010eligibility\u2010limits\u2010for\u2010pregnant\u2010women\u2010as\u2010a\u2010percent\u2010of\u2010the\u2010federal\u2010poverty\u2010level\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7D. Accessed April 12 2021."},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002633"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003363"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.01835"},{"key":"e_1_3_1_23_2","unstructured":"Kaiser Family Foundation (KFF) . High rates of perinatal insurance churn persist after the ACA. https:\/\/www.healthaffairs.org\/do\/10.1377\/hblog20190913.387157\/full. Accessed October 24 2020."},{"key":"e_1_3_1_24_2","unstructured":"Urban Institute . Uninsured new mothers\u2019 health and health care challenges highlight the benefits of increasing postpartum Medicaid coverage. https:\/\/www.urban.org\/sites\/default\/files\/publication\/102296\/uninsured\u2010new\u2010mothers\u2010health\u2010and\u2010health\u2010care\u2010challenges\u2010highlight\u2010the\u2010benefits\u2010of\u2010increasing\u2010postpartum\u2010medicaid\u2010coverage_0.pdf. Accessed October 24 2020."},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2020.01.005"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.1651"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0293"},{"key":"e_1_3_1_28_2","unstructured":"American Rescue Plan Act of 2021. H.R.1319. Sec 9812. 117th Congress. https:\/\/www.congress.gov\/bill\/117th\u2010congress\/house\u2010bill\/1319\/text. Accessed May 27 2021."},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00547"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.022040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:51:35Z","timestamp":1715601095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.022040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,3]]},"references-count":28,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2021,8,3]]}},"alternative-id":["10.1161\/JAHA.121.022040"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.022040","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,3]]},"assertion":[{"value":"2021-07-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e022040"}}