Expand and extend postpartum Medicaid to support maternal and child health.

Most early maternal deaths are preventable, with many occurring within the first year postpartum (we use the terms "maternal" and "mother" broadly to include all individuals who experience pregnancy or postpartum and frame our recognition of need and policy recommendations in gender-neutral terms. To acknowledge limitations inherent in existing policy and the composition of samples in prior research, we use the term "women" when applicable). Black, Hispanic, and Native American individuals are at the most significant risk of pregnancy-related death. They are more commonly covered by Medicaid, highlighting likely contributions of structural racism and consequent social inequities. State-level length and eligibility requirements for postpartum Medicaid vary considerably. Federal policy requires 60 days of Medicaid continuation postpartum, risking healthcare coverage loss during a critical period of heightened morbidity and mortality risk. This policy position paper aims to outline urgent risks to maternal health, detail existing federal and state-level efforts, summarize proposed legislation addressing the issue, and offer policy recommendations for legislative consideration and future study. A team of maternal health researchers and clinicians reviewed and summarized recent research and current policy pertaining to postpartum Medicaid continuation coverage, proposing policy solutions to address this critical issue. Multiple legislative avenues currently exist to support and advance relevant policy to improve and sustain maternal health for those receiving Medicaid during pregnancy, including legislation aligned with the Biden-Harris Maternal Health Blueprint, state-focused options via the American Rescue Plan of 2021 (Public Law 117-2), and recently proposed acts (HR3407, S1542) which were last reintroduced in 2021. Recommendations include (i) reintroducing previously considered legislation requiring states to provide 12 months of continuous postpartum coverage, regardless of pregnancy outcome, and (ii) enacting a revised, permanent federal mandate equalizing Medicaid eligibility across states to ensure consistent access to postpartum healthcare offerings nationwide.

Many maternal deaths happen within the first year postpartum and can be prevented. Black, Hispanic, and Native American mothers are at more risk for many reasons, including unfair systems and insufficient healthcare coverage from government insurance (Medicaid). Rules for getting Medicaid can be very different across states and in postpartum compared to pregnancy. The US government only requires states to continue providing Medicaid for 60 days postpartum, after which it is up to each state. If mothers are required to re-qualify for Medicaid shortly after giving birth, they could lose healthcare when they are at more risk of dying or getting sick. In this policy position paper, a team of maternal health researchers and clinicians reviewed and summarized recent research and current laws related to postpartum Medicaid to propose future laws that could address these issues. Some proposed laws would expand Medicaid coverage during postpartum, but lawmakers have not recently discussed them. This position paper recommends that lawmakers (i) consider laws that require states to provide 12 months of postpartum healthcare coverage and (ii) have the US government make the same rules to qualify for postpartum Medicaid across all states.

Caring for myself while I'm growing somebody else: Mindful self-care buffers between pregnancy body disconnection and distress.

Pregnancy embodiment describes the way a pregnant individual inhabits their body, including disconnection and connection, likely influencing both distress and well-being. Emerging work indicates that acceptance of pregnancy-related bodily change may support well-being, particularly when co-occurring with self-care behaviors. Yet, specific associations of pregnant embodiment and intentional, individualized self-care practices (mindful self-care; MSC) with well-being and distress remain unexamined. The present study tested independent and interactive associations between MSC and positive embodiment (body agency), and negative embodiment (body estrangement), respectively, with maternal distress and well-being in a sample of US pregnant women (N = 179; Mage = 31.3 years, aged 21-43; 85.6 % White, 4.9 % Hispanic/Latinx). Challenge and threat/harm appraisals of the COVID-19 pandemic were included in the model to represent responses to the unique sociohistorical context. Measurement-corrected path analytic models explained a substantial proportion of variation in well-being and a smaller proportion in prenatal distress. Among those with higher MSC, the association between body estrangement and prenatal distress was weaker. Results support mindful self-care as protective for pregnancy distress in the setting of body disconnection. Future individualized health promotion might consider how high-stress contexts influence application of self-care practices and impact distress and well-being during pregnancy.