State Policy Lever Checklist:

Access to Perinatal Health Insurance

Implementation of Medicaid and other health coverage policy options to increase access to health insurance for adults in the perinatal period varies across states. Most states have opted to expand Medicaid income eligibility for most adults with low incomes through the Affordable Care Act (ACA), which creates access to care before, during and after pregnancy, and has been associated with reductions in maternal and infant mortality. States have also expanded eligibility for pregnancy-related health insurance coverage through investments in the Children’s Health Insurance Program (CHIP), increasing income eligibility, and broadening policies to include coverage for populations that are not traditionally covered by Medicaid. States may also take action to remove barriers to participation or extend the coverage of those eligible for services for longer time periods. Below is a list of policy considerations for state leaders to help maximize the effectiveness of policies that improve access to perinatal health insurance. States should consider the implications of these policy choices and their collective impact on equitable access to health insurance for their state.

The most widely and rigorously studied policy to improve access to perinatal health insurance is Medicaid expansion under the Affordable Care Act (ACA) that includes coverage for most adults with incomes at or below 138% of the federal poverty level (FPL). As of March 2023, 10 states have not yet enacted legislation to expand Medicaid. Medicaid expansion increases families’ access to needed care and services, reduces financial burdens associated with health care costs, leads to fewer infant and maternal deaths among Hispanic and Black families, and decreases reports of child neglect.

The Prenatal-to-3 Policy Impact Center would like to thank Maggie Clark and Elisabeth Burak at The Georgetown University Center for Children and Families (CCF) for their feedback and contributions to this checklist.

This checklist covers the following components of policies to improve access to perinatal health insurance:

  • Medicaid income eligibility criteria
  • Postpartum Medicaid extension
  • CHIP and additional populations


State Policy Lever Checklist: Access to Perinatal Health Insurance (PDF)