Pregnancy has never been easy. Although maternal mortality and negative long-term effects have steadily declined worldwide, pregnancy-related deaths in the United States have increased since 1987. Within this negative trend, socioeconomic disparities are significant. Understanding and reducing these differences in outcomes, and bringing down the odds of complications for any pregnant person deserves focus from both a medical and public policy lens.

This month, researchers published findings in the journal Health Affairs that pointed to the Affordable Care Act’s expansion of Medicaid as key to delivering improvements in the health outcomes of low-income pregnant women.

The study showed that low-income women in Medicaid expansion states are more likely to:

• Receive preconception health counseling
• Increase folic acid intake to safely deliver healthy babies
• Access effective birth control after delivery

Medicaid expansion has provided free or low-cost state-sponsored health coverage to over 12 million previously uninsured Americans. This makes it one of the most impactful and under-reported features of the ACA. While much of the coverage and criticism of Obamacare focused on newly created health insurance exchanges, in states that have accepted federal funding to expand Medicaid, it is this decades-old program that has provided insurance to people earning under 138% of the Federal Poverty Level (about $36,000 gross annual income for a household of 4).

However, a lesser-known intricacy of Medicaid eligibility, is that pregnancy further expands the incomes at which people can enroll. While state-by-state levels differ, pregnant women can access Medicaid at higher incomes nearly everywhere, with some states providing coverage at or above 300% of the poverty level (about $78,500 gross annual income for a household of 4). However, this is an unfortunately little-known fact, the ignorance of which leads many low-income people to remain on expensive employer insurance plans or uninsured throughout pregnancy.

We see the impact of this every day at BeneStream. Why? Although the rules around Medicaid eligibility during pregnancy are often generous, they are also complicated. Our team is trained to understand the needs of our client’s employees who are pregnant and eligible for Medicaid, and we have a special protocol to support their enrollment and ensure that eligibility.