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RELEASE: State Benchmark Health Insurance Plans Fall Short in Advancing Maternal Health

Washington, D.C. — Today, the Women’s Initiative at the Center for American Progress released a new column spotlighting an analysis of the Affordable Care Act (ACA) benchmark plans’ maternity care coverage for all 50 states and the District of Columbia. The authors find wide variations in how state benchmark plans cover a variety of pregnancy-related services, including coverage of ultrasounds, birth center or home-based care, midwifery care, and pregnancy care for plan dependents—putting pregnant people’s physical and financial well-being at risk and states potentially in violation of federal law. The column’s release comes a week before states must submit amended ACA benchmark plan proposals to the Centers for Medicare and Medicaid Services for the 2023 plan year.

Key findings from the analysis include:

  • At least eight states include home birth coverage beyond emergencies or complications, whereas six states explicitly exclude elective home birth coverage, including Arizona, Arkansas, Massachusetts, Michigan, Minnesota, New Mexico. Connecticut covers elective home birth coverage only in the event of pregnancy complications.
  • At least 17 states include coverage of pregnancy care at birth centers, whereas Michigan is the only state in the country whose benchmark plan explicitly excludes birth center coverage.
  • At least five states include midwifery coverage beyond certified nurse midwives, including Florida, Alaska, New Hampshire, New Mexico, and Rhode Island.
  • Two states limit ultrasound coverage, including Arkansas (one ultrasound) and North Dakota (two ultrasounds).
  • Four states exclude pregnancy coverage for plan dependents, including Alabama, Idaho, Louisiana, Mississippi. Two more states, North Carolina and South Carolina, only cover dependents for pregnancy complications.
  • While no states explicitly include coverage of doula services, Connecticut is the only state in the country to explicitly exclude doulas.

“The Affordable Care Act requires coverage for maternity-related care, but our analysis indicates that there is substantial variation among states in what services are actually included—putting pregnant and postpartum people at significant physical and financial risk. Given that maternal health outcomes in the United States continue to lag behind much of the rest of the world, particularly among Black and Indigenous people, we encourage all states to comply with federal law and advance health equity by broadening pregnancy-related services covered under their benchmark plans. But the federal government shouldn’t wait for states to act; it should standardize maternity care coverage requirements to protect all pregnant and postpartum people,” said Jamille Fields Allsbrook, director of women’s health and rights at CAP.

Please click here to read “States’ Essential Health Benefits Coverage Could Advance Maternal Health Equity” by Jamille Fields Allsbrook and Nora Ellmann.

For more information or to speak with an expert, please contact Colin Seeberger at or 202.741.6292.