Extended Postpartum Coverage

A bill passed by the Wyoming legislature went into effect July 1, 2023, extends Medicaid coverage for women from the federally mandated 60 days postpartum (post-birth) to 12 months following pregnancy. Backed by federal funding, the bill will support extended postpartum benefits until 2027. 

Part of a national initiative to support postpartum care, you may wonder, what does extended postpartum benefits look like for Wyoming patients? We asked Samantha Herriott, DO an OB/GYN at Ivinson Medical Group. Dr. Herriott has been delivering babies and providing women’s health at Ivinson for the past four years. 

“It’s going to help patients get the access to mental health screenings and resources, it’s going to help them have better access to contraception and its going to help support moms that are being forgotten about after they have a baby,” Dr. Herriott said of extended Medicaid benefits. 

Nationwide, Medicaid is the largest payer of pregnancy related services, covering over 42 percent of births in the U.S. In the state of Wyoming, 33 percent of births are covered by Medicaid. Before House Bill 4 and temporary exceptions made due to the COVID-19 pandemic, 70% of mothers in Wyoming would lose their Medicaid eligibility at the end of their 60 day postpartum period.

The Maternal Mental Health Hurdle

At 60 days, a mom is just over 8 weeks postpartum. If she was able, she has had her two postpartum appointments covered by the insurance. At 2 weeks and 6 weeks, postpartum appointments check in on the healing process following birth, provide education and breastfeeding/​bottle feeding support as well as screen for postpartum mood disorder. 

“You do nine to ten months of pregnancy, you go from being seen every four weeks, to every two weeks, to every week because that is how important it is in pregnancy that we see you,” explains Dr. Herriot of the prenatal visit process. ​“Then you go to being seen only twice once the baby is born and we know that the postpartum time frame is filled with things that often can be more stressful than the pregnancy itself, plus there is a baby. I think that it’s a huge misunderstanding that once the baby is out, moms are fine.”

One in five mothers will experience postpartum depression. While symptoms often begin between two to six weeks, they can start anytime after the birth of a baby and may last up to two years. For mother’s whose insurance lapse, seeking mental health resources is even farther out of reach.

“When patients come in at their two week postpartum appointment, we’re screening for postpartum mood disorder,” explains Dr. Herriot. ​“Patients fill out an Edinburgh Postnatal Depression Screening and they also fill out a generalized anxiety disorder screening. They fill out both and hopefully they fill it out honestly.”

Tools like the depression and anxiety screenings are used by women’s health and pediatricians to screen new mom’s for postpartum mood disorders and can be used as indicators to find moms that may need additional help. 

“I think there are a lot of complicating factors beyond those six weeks so that is why it is so important that screening for mental health is there,” said Dr. Herriott. ​“Theres so many layers to this but i think that it primarily boils down to the first six weeks are tough. I remember the first six months being tough. I remember the first year being tough. My oldest is 13 now and it’s still tough. Raising a child is so much more than the first six weeks.”

Time, Travel and Contraception

For a growing number of Wyoming mothers, prenatal and postnatal care can be few and far between. At Ivinson, it is common for a snow storm to be the cause of cancellation for several out of town patients. When it comes to the roads, the snow and scheduling, it can sometimes be tricky to ensure that a 6 week appointment and all your postpartum needs are wrapped up before the 60 days runs out. 

“I think that healthcare in Wyoming can be hard to access due to long distances between where a patient might actually live to where a provider is located. Living in Wyoming is the first time that I have ever said that the closest town is 60 miles away,” Dr. Herriott said. ​“Living in Wyoming with this weather we expect that we will have road closures, obviously that is problematic, but even when there is not road closures, finding the gas money and the time to make that trip, it is a lot to ask of people.”

During COVID, Dr. Herriott and the Ivinson women’s health team, like many healthcare providers, learned to adapt. They used their resources to ensure patients were being cared for regardless of how far away they were, what the road conditions were or if they could make it into the office.

“Telehealth has been great to get moms some access to us because they often do have to cancel their appointments,” Dr. Herriott said. ​“We travel to Carbon county as a group, primarily Dr. Ewell, once to Rawlins and once to Saratoga. But sometimes we can’t make it to them either because the roads close. So we have worked really hard to establish a way for the patients to still come into the office to meet with the local nurse who will listen to the baby’s heartbeat, measure their stomach, check their urine, do their blood pressure check and then they meet with us over a telehealth monitor.”

Beginning at 28 weeks, Dr. Herriott asks expecting moms a question that raises a lot of eyebrows, ​“What are your plans for contraception?” Only a little more than halfway through their pregnancy, thinking about birth control is often not something most new moms are thinking about at that time, but Dr. Herriott insists it is an important time to have these conversations. 

“The first barrier for contraception is you have to talk about it. You have to talk about contraception and give them time to decide. Because if they show up for their six week postpartum visit and you ask ​‘what do you want for contraception’, they may leave that visit without anything.”

For mom’s at risk of losing their insurance, another appointment at a later date to make that decision is almost out of the question. WIth extended Medicaid postpartum coverage, they are not locked into a 60 day window to make that decision. 

“If it’s an implantable device like an IUD or a Nexplanon it may need to be prior authorized,” explained Dr. Herriott. “ If they want surgical interventions such as vasectomy or tubal litigation it has to be scheduled, it has to be planned. I am really happy that with Medicaid expansion that women who want it will be able to get their tubal litigation in a reasonable timeframe, not within six weeks to have major surgery after just having a baby.” 

Wyoming is one of more than 30 states to approve or have pending state action to expand postpartum Medicaid. It is expected to impact between 1,000 to 2,000 women in any given month. 

women’s health clinic

The Women’s Health clinic at Ivinson Medical Group is dedicated to guiding and supporting women through all stages of their lives; from adolescence through menopause and beyond.