Experiences of Mothers Following the Medicaid Postpartum Extension

Key Points

Question

What are the experiences of postpartum mothers following the Medicaid postpartum coverage extension from 60 days to 12 months?

Findings

In this qualitative study of 16 mothers, many participants were initially unaware of the policy extension. When aware of coverage, mothers were able to meet their health needs, which positively impacted stress and their interactions with their infants, particularly among mothers with mental health needs.

Meaning

These findings suggest that extended Medicaid postpartum coverage is important in meeting mothers’ health needs and supporting family well-being, but there is work to be done to increase engagement with Medicaid beneficiaries and community partners to improve awareness of policy changes.

This qualitative study describes the experiences of postpartum mothers following the Medicaid postpartum coverage extension in North Carolina from 60 days to 12 months.

Abstract

Importance

The American Rescue Plan Act of 2021 extended postpartum coverage for women eligible for Medicaid for Pregnant Women from 60 days to 12 months. Understanding how mothers experienced the postpartum extension is vital in evaluating this policy change and informing policymakers on how policies aimed at one family member can improve outcomes for the family unit.

Objective

To describe the experiences of postpartum mothers following the Medicaid postpartum coverage extension in North Carolina from 60 days to 12 months.

Design, Setting, and Participants

This qualitative study used semistructured interviews of postpartum mothers conducted between April and October 2025 who delivered while enrolled in Medicaid for Pregnant Women in North Carolina. Transcripts were analyzed using thematic analysis.

Main Outcomes and Measures

Themes regarding participant experiences with extended postpartum Medicaid coverage.

Results

A total of 16 mothers (mean [SD] age, 30.0 [5.6] years; mean [SD] number of living children, 3 [1.6]; mean [SD] age of most recent child, 17.0 [4.8] months) participated. Five themes were identified: (1) confusion around Medicaid coverage, (2) Medicaid facilitates care access, (3) behavioral health services as critical during postpartum period, (4) decreased financial stress and improved family interactions, and (5) Medicaid prevents foregone care.

Conclusions and Relevance

In this qualitative study of postpartum mothers’ experiences accessing care following the Medicaid postpartum coverage extension, when mothers were aware of the extension, coverage was crucial to meet a variety of postpartum needs, especially behavioral health needs, and had positive effects on the entire family. Increasing engagement with Medicaid beneficiaries and community partners about policy changes is critical for increasing effectiveness. Access to behavioral health services is especially important beyond 12 months post partum.

Introduction

The US has the highest maternal and infant mortality rate in the developed world, largely driven by the nearly 50% of mother-infant dyads in the US insured by Medicaid, who disproportionately experience the worst outcomes.^1,2,3,4 During the COVID-19 pandemic, the Families First Coronavirus Response Act increased federal funds for Medicaid and prevented states from terminating Medicaid coverage.⁵ This policy enabling continuous enrollment effectively extended the prepandemic Medicaid postpartum coverage of 60 days through the end of the public health emergency on April 1, 2023. Beginning April 1, 2022, the American Rescue Plan Act officially extended Medicaid postpartum coverage from 60 days to 12 months for women enrolled in Medicaid for Pregnant Women (MPW) using matched federal funds.⁶ North Carolina (NC) is among 49 states and the District of Columbia that have implemented the extension.^6,7

Because health insurance enables access to preventive services and early disease intervention prior to escalation, access to health insurance generally improves population health.^8,9 Furthermore, with increasing recognition that the child health is strongly influenced by the health of their caregivers, expanding postpartum Medicaid coverage may impact family dynamics and stress, and ultimately the health of infants.^10,11,12,13 Prior work examining the effect of Medicaid expansions and COVID-19–related continuous coverage on postpartum mothers found improved outcomes, such as increased postpartum depression treatment.^14,15,16 Although recent studies examined the impact of the postpartum extension following the American Rescue Plan Act on postpartum mothers’ health care utilization, to our knowledge, no work has qualitatively described mothers’ experiences following the extension.^17,18

We describe the experiences of mothers enrolled in postpartum Medicaid coverage following the postpartum Medicaid extension from 60 days to 12 months, with particular attention to the impact of the extension on the family, as well as on their own health needs. Understanding mothers’ experiences will inform policy implementation and answer basic questions about patient-centered perceptions of health care access in an area where quality measures are underdeveloped and qualitative methods are valuable in future 2-generation strategies to promote child and parent well-being.¹⁹

Methods

Study Population and Setting

For this qualitative study, we conducted semistructured interviews with postpartum mothers who were insured by NC Medicaid. Potential participants’ demographic and contact information were obtained from the Carolina Data Warehouse, a central data repository from UNC Health that provides care to patients in all 100 NC counties.^20,21 Participants were eligible if they had Medicaid or Medicaid pending as the payer at delivery, a live delivery between September 1, 2023, and May 31, 2024 (approximately 9 to 18 months post partum at the time interviews began), were at least 18 years old, lived in NC as identified by zip codes, had a primary language of English identified by the electronic medical record, and their most recent child resided with them. Carolina Data Warehouse specifies whether NC Medicaid is the payer but cannot differentiate between types of Medicaid. Women were eligible if they specifically recalled that their Medicaid type was MPW, if they started Medicaid during pregnancy or immediately after delivery, or if they were enrolled in Medicaid before their most recent pregnancy because of a previous pregnancy and remained enrolled following continuous enrollment on April 1, 2020. Maternal race and ethnicity were obtained from the Carolina Data Warehouse and as self-reported during the interview. We included data on race and ethnicity here to better characterize the cohort. We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines to guide the report of our research.²² This study was approved by the institutional review board at the University of North Carolina at Chapel Hill (No. 24-1213). Verbal consent was obtained from participants. Participants were made aware that they were taking part in a research study and that the interviews would be audio recorded, transcribed, and deidentified.

Data Collection

Two authors (B.J.R. and I.H.) with experience in qualitative research conducted semistructured interviews by Zoom dial out between April and October 2025. The interview guide (eAppendix 1 in Supplement 1) was developed on the basis of prior literature and feedback from the North Carolina Translational and Clinical Sciences Institute Qualitative Research Service Team and was iteratively adapted to explore experiences in enrolling and accessing health care, with attention to specific kinds of care, such as behavioral health and emergency care, and its impact on their relationship with their child and other family members. Interviews were audio-recorded and transcribed, and data collection was guided by reaching sufficient information power, such as how the interview content addressed the study aim, described a variety of participant experiences, and quality of dialogue.²³

Data Analysis

We used directed qualitative content analysis.²⁴ The codebook was informed by the interview guide and analytic memos. Using the qualitative software Dedoose, 2 authors (B.J.R. and I.H.) with experience in qualitative analysis double-coded 6 transcripts making iterative changes to the codebook until consensus in codes and coding application was achieved, and then 1 author (I.H.) coded all 16 transcripts. Narrative summaries of interviews and summaries of codes were completed, and authors met regularly to discuss main ideas and potential themes until consensus was reached on final themes.

Results

Sixteen mothers participated. Their mean (SD) age was 30.0 (5.6) years at delivery, the mean (SD) number of living children was 3.0 (1.6), and the mean (SD) age of the most recent child was 17.0 (4.8) months. Mothers resided in primarily urban counties in central NC (Table 1; see eAppendix 2 in Supplement 1 for the standard plan regional map). We identified 5 overlapping themes: (1) confusion around Medicaid coverage, (2) Medicaid facilitates care access, (3) behavioral health services as critical during postpartum period, (4) decreased financial stress and improved family interactions, and (5) Medicaid prevents foregone care (Table 2).

Table 1. Participant Characteristics.

Characteristic	Participants, No. (%) (N = 16)
Age, mean (SD), y	30.0 (5.6)
Race and ethnicitya
Black	7 (44)
Black, Native American	1 (6)
Hispanic	3 (19)
White	5 (31)
No. of living children, mean (SD)	3.0 (1.6)
Age of most recent child, mean (SD), mob	17.0 (4.8)
Residency
Urban	13 (81)
Rural	3 (19)
North Carolina Medicaid managed care regionc
Region 1	0
Region 2	1 (6)
Region 3	0
Region 4	10 (63)
Region 5	2 (13)
Region 6	3 (19)

^a Race and ethnicity were self-reported during interviews.

^b Ages are approximate as some participants stated their child’s age in years and others gave months.

^c See eAppendix 2 in Supplement 1 for Standard Plan Regional Map.

Table 2. Quotations Illustrating Participant Experiences With Extended Postpartum Medicaid Coverage.

Theme	Quotation
Theme 1: Confusion around Medicaid coverage	“There wasn’t any communication as far as how long I would have it after her, or if I would even be able to receive any, like as far as, you know, just that checkup after pregnancy, that postpartum period. Yeah, they didn’t, they didn’t even really tell me, as far as me having the pregnancy Medicaid after her…. Honestly, I think I was, I didn’t hear anything as far as my Medicaid like changing until, until last year, when she turned one....” (ID 43) “So, when I was initially told that I needed to enroll, they just stated that it was going to cover the pregnancy, like throughout during the whole length of the pregnancy. But I just didn’t get informed about afterwards…. So I didn’t, like I said, I, I was not really aware of that. So, I only got my regular 6 week postpartum checkup, and that’s it since then.” (ID 61) “And me and the doctor are having to get on the phone almost every time I go into an appointment and go, yes, she is still pregnant…. There was points where I was going to the doctor every two weeks, and every two weeks, we were calling the same person, and she would have the same conversation with us, and we would be like, we talked to you two weeks ago. And she would be like, oh, and we were like, this is not a scam. This woman is really pregnant.” (ID 46) “[T]hey [Department of Social Services office staff] would say, ‘Oh, well, we need to prove that you’re, you know, you’re pregnant.’ And not already having it in the system, being that I did find out through the hospital that I was um pregnant. Also, they were like, ‘Well, you don’t live in this county. So we can’t really assist you with this right now.’ It did take like a couple of months. When I say a couple of months, I mean, like it took like 2 to 3 months before I got approved for Medicaid, instead of like instantly being that I get approved…. I had to tell them that I was homeless, because being at the time I was homeless. So, I didn’t have like proof of income. So that was kind of like a little tough spot for me, spot as well for me. And also like showing them proof, like having proof, that I was tested positive for being pregnant.” (ID 35)
Theme 2: Medicaid facilitates care access	“I went to the ER one time because I was having issues with, blood, the blood clots…. After the birth. It was a couple days after, I was still bleeding pretty heavy, like severely heavy.” (ID 46) “Honestly, I love having Medicaid. It’s easier to go to a doctor now. Not worrying about having to pay a hundred dollars just to get seen at a doctor.… I mean, honestly, it’s just, all in all, it’s a lot easier now that I’m able to go to the doctor. I feel a lot more healthier and stuff being checked out, because before I got Medicaid, I’m being honest with you, from the time I was 19 to the time I was 20, when I got Medicaid I didn’t go to the doctor. So once I got pregnant, it was the first time in a long time that I went to a doctor, being seen and got a physical and all that.” (ID 28) “It was great. So we had one [postpartum visit] over the phone, and then one in person, and, I mean, they were constantly calling to check up on me and the twins, making sure I had everything that I needed, and that we settled in at home okay. And, that I was, healing properly. And they screened me for postpartum depression.” (ID 149)
Theme 3: Behavioral health services as critical during postpartum period	“I’m just happier in general [on medication for anxiety]. Everybody could tell. I’m happier, so it doesn’t, it’s, there’s not as many arguments, because before I was just always snappy and grumpy. Now, I’m not grumpy and snappy all the time, so it helps out a lot, and I don’t get an attitude with people, so they don’t get an attitude back. There’s not as many arguments.” (ID 28) “I probably would have lost my child [without Medicaid], and I wouldn’t have been able to, you know, be able to, you know, like have the things that I have now because of that. I wouldn’t have been able to afford anything. As far as the doctor’s visits and the pre-, you know, post doctor’s visits and stuff like that for my birth.” (ID 42)
Theme 4: Decreased financial stress and improved family interactions	“It made everything easier when I had health insurance. We wouldn’t have like a financial burden or anything. And honestly, it was really nice having Medicaid. And my partner, he was also more chill, you know, when I was able to get my Medicaid, ‘cause when I didn’t have Medicaid he was the one paying for everything.” (ID 7) “[J]ust the knowing that we would be able to go to a doctor, or we would be able to afford to go to the emergency room in case there was something happening. I guess that is, first time we ever experienced, like, preeclampsia, so just knowing that, hey, if my blood pressure just spiked in the middle of the night, if we went to the ER, you know, we would be okay.” (ID 46)
Theme 5: Medicaid prevents foregone care	“Because without Medicaid, seeing a therapist is $75 per visit and that’s just, I mean, I wouldn’t have paid $75 just to speak about my feelings and all that. But now that you know I got Medicaid, it’s easier to do it….” (ID 28) “I mean, definitely, when I had Medicaid it was an easy decision, you know, to go, um, into [clinic name] because I wasn’t worried about any hospital bills. But if I didn’t have health insurance, I would, I would have, I don’t know, I would think twice before going to the doctor.” (ID 7) “I think it’s [having postpartum health insurance] extremely, like, I think it should be, it definitely should be, like, a mandatory when it comes to health coverage. There shouldn’t be any reason why women shouldn’t have any type of healthcare after going through something as traumatic as having a baby removed from their body. I think 2 months is, that’s pretty insulting. You might as well not give them anything at all at that point. But yeah, I think, like, it, it is, it makes, I think it can make a huge difference in the health of women…especially impoverished women.” (ID 46) “I, honestly, I think it should be up to 2 years, because that’s supposedly how long it takes for the brain to change back to normal functions. I feel, it’s, it’s important to acknowledge that that change is real. It, it’s there, it’s happening. There is no question about it. And I don’t think, you know, 6 months, a year, or so after giving birth is enough time to help a mom that’s going through a whole change, not just outside of her body, but inside of her body. It, it’s, it’s something I don’t feel gets talked about enough.” (ID 144)

Abbreviations: ER, emergency room; ID, identification.

Theme 1: Confusion Around Medicaid Coverage

Many mothers were unaware how long their Medicaid coverage would last and described confusion around Medicaid processes during the perinatal period. There was little standardization in enrollment experiences and how mothers were informed of coverage duration. A few participants discovered that they had coverage upon receiving a letter from Medicaid around the time of their child’s first birthday. Another mother was incorrectly told by her managed care plan that her postpartum coverage lasted 6 months. One participant described being disenrolled several months after her delivery and feeling confused about why her coverage was terminated: “I figured it was because I wasn’t pregnant anymore. Maybe it was because I was unemployed. I don’t know what they were taking into account” (identification [ID] 27). She then reapplied and received coverage. Mothers also expressed confusion around the different types and names of Medicaid. For instance, one mother was told she had to switch from standard Medicaid to MPW because she was pregnant. An unhoused mother experienced difficulty enrolling during pregnancy because of multiple documentation requirements, including proof of pregnancy, income, and residency.

Formal support staff, or paid, trained workers, such as social workers and case managers, were crucial in supporting mothers as they navigated Medicaid. Of the 4 participants who were told the coverage duration when enrolling, 3 were informed by a social worker, case manager, or Department of Social Services staff, and 1 was told in the approval letter. The clinic case manager of 1 of these participants with postpartum depression and anxiety advocated throughout her perinatal period, switching her to a tailored Medicaid plan that offered expanded mental health coverage, informing her Medicaid case manager of needed resources, and accompanying the participant and her infant to appointments. Another participant who had been denied Medicaid coverage multiple times during pregnancy eventually enrolled with the help of her substance rehabilitation case manager.

Theme 2: Medicaid Facilitates Care Access

Mothers reported that Medicaid enabled them to receive care for medical concerns they otherwise would not have addressed due to being uninsured and inability to pay health care costs. Mothers were seen in the postpartum period for a range of issues, including emergencies, such as postpartum bleeding; postpartum and preventive visits, including contraceptive care; specialty visits, such as with cardiologists and pulmonologists; acute visits; and behavioral health care. One mother with a genetic condition described how she was able to see a hematologist and cardiologist, whom she had not seen previously due to cost: “I have a genetic disorder, so I actually went back and saw my hematologist. And I went back and saw my heart doctor…. I should see my heart doctor at least once a year, because I have a genetic disorder. But I hadn’t seen my heart doctor since I was pregnant with my [older] son” (ID 149).

Most mothers had positive experiences with Medicaid. One mother described, “…before I got Medicaid, I didn’t have money to go get seen at the doctor, and if I did have money it had to go towards the bills. Now that I have Medicaid, it’s just a lot easier to be able to go to the doctor, because I don’t have to pay for a ride [because of Medicaid transportation], and then on top of that, I don’t have to [pay] to be seen at a doctor” (ID 28). Although most mothers were able to get the care they needed, a couple were dissatisfied with their in-network options, particularly for dental and mental health practitioners.

Theme 3: Behavioral Health Services as Critical During Postpartum Period

Almost all mothers (n = 13) described behavioral health conditions, such as anxiety, depression, or substance use disorders. Most participants were able to meet their behavioral health care needs and described this as crucial for their own health and their relationship with their children. Multiple mothers received support through therapy and medication. Some mothers contrasted their experience with 12 months of postpartum coverage with the shorter coverage duration they had with older children prior to the policy change. For example, 1 mother described with her older son she could not afford the cost of her antidepressant but after her most recent child she was able to continue her medication.

Mothers also described how receiving care for their own mental health improved their interactions with their children. For instance, one mother recounted how after starting medication for her anxiety and depression she was “not as worried about everything” and this enabled her to go on more outings: “But now that like I’m on medication for it. I take the baby to the park. I’ll take her to walk around [store]. I’m just more out in the open and taking her places rather than sitting inside and making her play inside, because I didn’t want to be around people” (ID 28).

Another mother whose daughter had spent time in the neonatal intensive care unit described how treating her own mental health needs allowed her to play with and give more attention to her daughter. She recounted, “I was having less panic attacks and able to give her that energy that would have been used during a panic attack to playing with her, to feeding her, and giving her the attention that a, any child really, deserves” (ID 144).

Several mothers received care for substance use disorders, including participating in a live-in rehabilitation program. One mother described how the treatment program improved relationships with other family members, stating “They got our relation, me and my mother’s relationship, back together through the therapy” (ID 39). Another described how it allowed her daughter to remain in her custody.

Theme 4: Decreased Financial Stress and Improved Family Interactions

Mothers described that postpartum Medicaid coverage decreased financial stress. They were less worried about costs of care and not being able to meet their own health needs. One participant described, “When I didn’t have health insurance, I was constantly worried, you know, and whenever I felt sick or something, I wouldn’t go to the doctor ‘cause I didn’t have health insurance.” However, once she enrolled in Medicaid, “If I was feeling sick, I was able to go to the doctor. I didn’t have to worry about anything, you know, like a hospital bill that I couldn’t afford. And, I mean that allows me to just focus on my baby without having to worry about hospital bills” (ID 7).

Medicaid coverage of health care costs positively impacted the whole family. This translated into decreased stress for other family members, especially those working to pay medical costs. There was discussion that acute illnesses affected multiple family members and it was important they could all seek care: “I have Medicaid, and knowing if I don’t feel good, and something’s wrong with me, I can go to the doctor after I take her to the doctor, or go before I take her, and if something’s wrong with me, then something, if I’m sick 9 times out of 10, she’s gonna get sick” (ID 28).

Having postpartum coverage was depicted as one less stressor in the setting of many challenging social stressors. Families experienced multiple other pressures, including homelessness, domestic violence, death of other children, preterm infants, and job loss. One mother summed it up as, “So being that you do have Medicaid is, take a little relief off your shoulders, relief off your back” (ID 35).

Theme 5: Medicaid Prevents Foregone Care

Mothers described that without Medicaid coverage they would have foregone needed care. One mother with a history of hypertension, postpartum hemorrhage, and postpartum depression after giving birth to twins explained how without Medicaid she would probably be “dead, or in a hospital, not doing well” (ID 46) due to unaffordable costs of care and resultant foregone care. She went on to contrast her experiences with this pregnancy to her prior pregnancy during which she had a strong sense of urgency to get seen before her coverage cut off. Mothers who were unaware they had postpartum coverage described how they would have sought care had they known they were covered, such as for mastitis and postpartum depression.

Another mother shared her story about how her older child, born before the policy change, had been born premature and died shortly after birth, and, because her Medicaid cut off, she was unable to afford mental health support and, after the birth of her most recent child, became addicted to substances. She described how her experiences with that pregnancy may have been different with postpartum coverage: “I would have continued my therapy, and I probably wouldn’t have been addicted to drugs” (ID 28).

Multiple mothers felt postpartum coverage should last 2 years rather than 1, while others expressed the need for longer coverage or for it to be a standard that everyone has health insurance coverage. They described that there are physical and mental changes that occur surrounding childbirth and repeatedly expressed that it takes time get back to “normal.” Another mother described how the postpartum period “is one of the most vital, crucial, emotional, vulnerable moments of your life” (ID 27).

Discussion

In this qualitative study, we explored the experiences of mothers enrolled in postpartum Medicaid coverage in NC following the extension from 60 days to 12 months as part of the American Rescue Plan Act. Many mothers were initially unaware that they had extended Medicaid coverage. When mothers were aware of coverage, they were able to meet their health needs. This was particularly important for participants who experienced behavioral health needs, who described how services improved their own mental health and interactions with their children. To our knowledge, this is the first qualitative work examining mothers’ experiences with extended Medicaid postpartum coverage, explicating patient-centered perceptions of postpartum health care access. These findings suggest major implications of policy implementation and 2-generation approaches to maternal and child health. These findings are consistent with and expand on prior work examining the importance of postpartum coverage in seeking care.^{14,15,17,18,25,26,27,28,29,30} Mothers’ descriptions of seeking care for medical conditions when enrolled in Medicaid is consistent with quantitative work that observed substantial utilization of postpartum care for contraception, primary and behavioral health care, and treatment of substance use disorders following the extension in NC.¹⁷ It is also consistent with prior studies showing that increased Medicaid enrollment through the Patient Protection and Affordable Care Act improved access to outpatient visits during the 6 months post partum²⁵ and led to increased detection and treatment of perinatal mood and anxiety disorders.^15,26 Similarly, continuous Medicaid coverage from the Families First Coronavirus Response Act increased use of postpartum, preventive, contraceptive, and behavioral health services in the first year post partum.¹⁴

In this study, behavioral health services were utilized by multiple participants and described as crucial in meeting their own health needs and promoting positive parent-child interactions. This is consistent with substantial research on the effect of postpartum depression on caregiving interactions and short- and long-term child outcomes, as well as the effectiveness of postpartum treatment on interactions, underscoring the importance of access to behavioral health services.^31,32,33,34 Furthermore, multiple mothers described the need for longer postpartum coverage duration. This is particularly important for preventing relapses and ensuring ongoing access to services for mothers with behavioral health treatment needs.

Most mothers were unaware that they would receive 12 months of postpartum Medicaid coverage. Among participants aware of coverage, they often were informed by formal support staff, such as case managers and Medicaid workers. However, at times staff were misinformed, resulting in the dissemination of incorrect information. One interpretation of these findings is that there was inadequate training surrounding the policy change among staff and ineffective collaboration with community partners and Medicaid beneficiaries. Policy interventions require more robust implementation plans: staff need adequate training about policy changes, intentional collaboration with community-based organizations is necessary to increase policy awareness and execution, and direct communication with beneficiaries impacted by policy changes is required, such as through social media, newsletters, and emails. Importantly, engaging Medicaid beneficiaries in future policy change processes will increase the effectiveness of Medicaid planning and implementation.³⁵ For instance, federal law requires states to have a Medicaid advisory committee with a dedicated beneficiary advisory committee to advise state Medicaid agencies on policy-related issues.³⁶ However, states’ use of Medicaid advisory committees and beneficiary advisory committees varies widely, and participation is uncommon among vulnerable groups, highlighting the need for intentional inclusion of beneficiaries in policymaking processes.^35,37

Limitations

Our study has limitations. First, participants were asked to reflect on events that happened in the past, which could lead to recall bias. Second, because of the multiple names for Medicaid, including managed care plan names, standard Medicaid, and MPW, there is the risk that mothers included in the study were not enrolled in MPW. However, we minimized this risk by asking questions to understand whether Medicaid enrollment was owing to pregnancy and whether participants had postpartum coverage. Third, most participants resided in central NC, which may reflect different experiences than those in other regions. Fourth, we limited participants to English speakers, and non-English speakers may have had unique experiences that are not reflected in the interviews. Fifth, our study occurred in NC, where transferability of Medicaid enrollment experiences and mothers’ information about duration coverage may be different from other states.

Conclusions

In this qualitative study of postpartum mothers following the Medicaid postpartum coverage extension, when mothers were aware of coverage, Medicaid was important for meeting a variety of postpartum needs, particularly behavioral health needs. The ability to meet these needs improved interactions with children and decreased family stress in the setting of multiple challenges. Policymakers should increase engagement with community partners and Medicaid beneficiaries to increase policy effectiveness. Maternal health needs, especially behavioral health services, are especially crucial, and access is important beyond 12 months.

Supplement 1.

eAppendix 1. Interview Guide

eAppendix 2. Standard Plan Regional Map

Supplement 2.

Data Sharing Statement