OPINION

Treat opioid use disorder and reduce maternal deaths by extending Medicaid postpartum

Navid Roder
Your Turn

As a family medicine physician in the city of Philadelphia, I support families through some of their most vulnerable times in life, including through childbirth and parenting.

In our Family Medicine Department at the University of Pennsylvania, we recently initiated a comprehensive program to support the care of pregnant and postpartum patients with opioid use disorder. We engage support doulas, certified recovery specialists, behavioral health specialists, local drug treatment programs, and specialists who care for pregnant people and infants.

Navid Roder

What is the goal of our work? To cultivate the growth of healthy family units through recovery. But first, birth parents need to survive so they can care for their children.

Heroin stock image.

Anyone who has been around a birth parent and a newborn infant knows that taking care of a baby is hard. Under the best of circumstances, it is exhausting, draining, frustrating, scary, messy, fulfilling, joyful, and beautiful all at the same time.

It is also a vulnerable time, and for a parent in recovery there is an added layer of complexity. Recovery is not linear, and major life changes can be destabilizing. That is why giving birth is a risk for recurrence of opioid use or relapse, and the moment someone uses opioids again after a long time, they are at extremely high risk for overdose and death.

In Philadelphia, the majority of maternal deaths in the last several years occurred in the postpartum period, and 58% of those deaths were among patients enrolled in Medicaid. Accidental drug overdose has accounted for almost 40% of pregnancy-associated deaths, and this is on the rise, according to the 2021 Pennsylvania Maternal Mortality Review Report. Most of these deaths occurred after the six-week postpartum time-point, with Medicaid coverage currently ending after 60 days postpartum.

If our goal is to reduce maternal mortality, then we need to do a better job providing access to care for pregnant and postpartum patients with opioid use disorder.

In the recently enacted American Rescue Plan, Congress included language providing states the option to extend postpartum coverage for new birthparents enrolled in Medicaid from the current period of 60 days to 12 months.

The Commonwealth of Pennsylvania has the opportunity to be a part of the foundation to support the medical treatment we know works to keep families safe and together by extending access to Medicaid for a full year in the postpartum period.

We owe it to a generation of children affected by the scourge of the opioid epidemic to support them so they can grow and thrive in healthy families. We can do that by treating their parents.

I have witnessed many incredible parents in recovery. If we support their recovery, they can be the best possible parents to their children. We can do that by providing access to life-saving medical care through extended postpartum Medicaid access.

Navid Roder, M.D., is an assistant professor of clinical family medicine and community health at the University of Pennsylvania. He has been working as a family physician with obstetrics privileges at the University of Pennsylvania for four years, where he provides general primary care, addiction care, HIV and viral hepatitis care, and is the director of perinatal opioid use disorder services in the Department of Family Medicine.