New Medicaid Funding Boosts Maternal Care: States Get 90% Match to Cover Doulas, Home Visits, and a Full Year of Postpartum Care

The “Advancing Maternal Health Equity Under Medicaid Act” is essentially a massive federal incentive program designed to get states to spend more on better maternal health care through Medicaid. Think of it as a huge discount coupon for states: if your state increases its spending on specific maternal health services above what it spent in 2019, the federal government will pick up 90% of that increase. That 90% match is a big deal, especially since the average federal match (FMAP) is usually much lower.

Expanding the Care Team: Doulas and Community Workers Get Covered

This bill doesn’t just throw money at the existing system; it redefines who provides care and what counts as essential. For the first time, states can use this enhanced funding to cover services provided by a broad range of “Perinatal Health Workers.” This means the 90% federal match can apply to services from doulas, community health workers, lactation counselors, and nutritionists. This is a game-changer for access, particularly in underserved communities. For a new parent struggling to breastfeed or needing mental health support, having a covered lactation counselor or social worker involved makes a huge difference that traditional doctor visits often miss.

The Full Year Postpartum Guarantee

One of the most critical changes is the redefinition of the “postpartum period.” Under this bill, that period is extended to the full year following the end of a pregnancy. Previously, many states only covered the first 60 days. This extension means that new parents—who often face the highest risks of serious health complications, including mental health crises, months after birth—will have continuous access to covered care, including mental and behavioral health services and telehealth, for a full 12 months. This is a major step toward addressing the national maternal mortality crisis.

The “Supplement, Not Supplant” Catch

While the 90% federal match sounds great, states have two major hurdles to clear to get the money. First, they must adhere to a “Supplement, Not Supplant” rule. This means the state cannot just replace the money it was already spending on maternal health (as of January 1, 2023) with these new federal dollars. They must use the federal funds to add to their current spending. This ensures that the money truly leads to an expansion of services, rather than just budget relief for the state treasury. Second, the state must use the funds to actively improve the quality and capacity of care, such as increasing efficiency or expanding services.

What This Means for Your State Budget

This is where things get tricky for state finance departments. While the federal government is offering a huge discount, the state must still find the initial money to increase its spending baseline to qualify. This could put pressure on state budgets, forcing them to prioritize maternal health over other state programs to unlock the 90% federal match. However, the requirement that the funds be used to improve quality—meaning increasing capacity or efficiency—is a bit vague. States will have a lot of discretion in defining what “improving quality” means, and taxpayers will need to watch closely to ensure this money goes into direct care, like hiring more doulas or expanding mental health access, rather than just administrative overhead.