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Health equity means healthy babies and healthy moms. Why every state should follow Maryland’s lead


By Karla Madera Tejada and Thomas J. Rachko, Jr. 


Today marks Pregnancy and Infant Loss Remembrance Day, an urgent reminder that we need to do everything we can to protect pregnant people and children, including undocumented mothers and their unborn babies. A new policy solution gives this often-overlooked part of the population hope. Last year, Maryland enacted a new law — the Healthy Babies Equity Act — that provides comprehensive health care coverage to pregnant people regardless of immigration status.


Introduced by Del. Joseline A. Peña-Melnyk, an immigrant mother of three from the Dominican Republic herself, this legislation allows pregnant individuals with income up to 250% of the federal poverty level to receive full benefits from Medicaid or the Maryland Children’s Health Program, including prenatal, delivery, and postpartum care for up to four months. It covers care for the child as well, up to one-year-old. The coverage also includes dental, lab work, prescription drug services and notably, mental health care.


The bill went into effect on July 1, and the impact has already been tremendous. In its first two months, more than 3,700 pregnant people have been enrolled. The Maryland Department of Healthestimates up to 6,000 people will be eligible for the program in its first year.


The bill represents not only a significant investment in community health but also a cost savings for state taxpayers: Del. Peña-Melnyk says the bill could save Maryland upwards of $120 million — the costs associated with pregnant people having to give birth in the emergency room. In cases where undocumented pregnant people give birth in an emergency room, costs are typically covered by emergency Medicaid funds.


A study conducted in California in 2000, following the approval of a 1994 state proposition that required all publicly funded health care facilities to deny nonemergency care to undocumented immigrants, sought to assess the economic costs of eliminating prenatal care for undocumented immigrants. The study found that the cost of postnatal care without prenatal care was $2,341 more initially and $3,247 more when longer-term costs were factored in. For every dollar cut from prenatal care, they expected an increase of $3.33 in the cost of postnatal care and $4.63 in incremental long-term cost. Elimination of publicly funded prenatal care for undocumented women was estimated to save the state $58 million, but could cost taxpayers as much as $194 million more in postnatal care, resulting in a net cost of $136 million initially and $211 million in long-term costs.


Stories are already emerging about the life-changing effects of Maryland’s law. It has been celebrated as a victory by immigrants’ rights advocates for public health.


Immigrant mothers who previously had limited access to health care can now safely access prenatal care, give birth in a hospital instead of an emergency room, and get medical attention in the critical postpartum period — drastically reducing risks of complications and death.Studies show significant racial disparities in infant and maternal health for Black, brown, Latina, and indigenous populations. For example, women in majority Hispanic communities have a 32% higher rate of severe maternal morbidity than women in white communities. The analysis also shows that Black and Hispanic women have a substantially higher prevalence than white women of the most common factors that put women at risk of severe maternal morbidity. This highlights the incredible need for more nation-wide legislation like Maryland’s law to bridge the gap that communities of color face in maternal health.


Medical bills disproportionately affect Latino communities even more compared to other racial and ethnic groups, with the exception of African Americans. The U.S. Census Bureau found that households with a member of Hispanic origin were more likely to hold medical debt (21.7%) than households without (18.6%). The Consumer Financial Protection Bureau found that past-due medical debt is more prevalent among Black (28%) and Hispanic (22%) individuals than white (17%) and Asian (10%) individuals. Medical debt is also more common in the Southeastern and Southwestern U.S., in part because states in those regions have not expanded Medicaid coverage, demonstrating the need for increased access across the board.


The Healthy Babies Equity Act sets a model every state should emulate. Enacting such policies upholds the right to health for all while reducing long-term costs. It is the morally right thing to do and fiscally responsible as well. Health care should not be determined by immigration status. Everyone benefits when children get a healthy start to life.


State lawmakers around the country should take action to pass their own laws. At the federal level, Congress should incentivize states to provide equitable pregnancy coverage by increasing Medicaid funds. Another possibility is to expand the State Plan Amendment to the Children’s Health Insurance Program, which states can use to cover pregnant individuals through the unborn child option; regardless of the mother’s immigration status. Currently, only 20 states provide this option.


As Del. Peña-Melnyk shared with us: “Healthcare should know no borders when the lives of mothers and children are on the line. The Healthy Babies Equity Act in Maryland sets a model every state should emulate. It’s the morally right thing to do and fiscally responsible as well. On Pregnancy and Infant Loss Remembrance Day, let us remember that everyone benefits when children get a healthy start to life.”


Maryland has taken a stand for health care as a human right for everyone in the state — not just a privilege for some. Pregnancy and Infant Loss Remembrance Day serves as a poignant reminder that the United States should put forth lifesaving solutions that prioritize the health and well-being of pregnant people and children, with equity at the fore.


Karla serves as a policy intern at the Im/migrant Well-Being Scholar Collaborative. Thomas serves as a research-to-policy implementation specialist for the same organization. This article was originally published on Maryland Matters on October 15, 2023.

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