Opinion: Medicaid cuts put Arizona mothers' postpartum care at risk

Three months after she gave birth, one of my patients came in for a postpartum visit. She shared that she'd been having thoughts of suicide. Because she was still covered by AHCCCS, Arizona's Medicaid program, she was able to see me that day, and I was able to get her into inpatient psychiatric care immediately.

She is alive today because Arizona extended Medicaid postpartum coverage from 60 days to a full year. Had her symptoms happened prior to this extension, she may not have had insurance to see me at all. I think about how many other patients wouldn't have shown up, wouldn't have been asked the right questions, wouldn't have been seen in time.

Now that coverage — and the program that provides it to nearly half of all Arizona mothers — is under direct threat.

Roughly 450,000 to 500,000 Arizonans are projected to lose AHCCCS coverage under Medicaid cuts in the federal budget bill (HR 1) signed last year through new work requirements, twice-yearly eligibility checks instead of annual ones and reduced federal subsidies. The state can’t make up the shortfall by asking hospitals to pay more; that tax is already at its legal limit. There is no realistic plan to replace close to $1 billion a year in lost federal funding, and the state's Republican-controlled Legislature has shown little appetite for finding one.

This isn't an inconsequential budget line. AHCCCS pays for over half of all births in Arizona, including prenatal and postpartum care. Federal funding allowed the state to extend postpartum coverage to a full year in 2023 — a policy adopted explicitly to mitigate rising maternal mortality. It is exactly the kind of coverage, modest in cost, high in impact, that the current cuts put back at risk.

Arizona's maternal mortality rate is 30 deaths per 100,000 live births, well above the national rate of 23.2 — the 11th-highest in the country. Pregnancy-related deaths have risen sharply over the last decade, and Black and indigenous mothers die during and after pregnancy at a rate three to five times that of white mothers. A 2024 state report determined that 90% of these deaths were preventable.

Nationally and in Arizona, mental health conditions — including suicide and overdose — are now the leading underlying cause of pregnancy-related death, ahead of hemorrhage and cardiac conditions. Most of those deaths happen not in the delivery room but in the months afterward, which is exactly why extended postpartum coverage matters. A mother who loses her insurance at 60 days doesn't stop being at risk. She just stops being visible to the people who might catch it.

That's what more frequent eligibility checks mean in practice. Every redetermination is a chance for a new mother — sleep-deprived, overwhelmed and sometimes in crisis — to lose coverage at the exact moment she needs it most. Work requirements layered on top will do the same to women in the fragile weeks after childbirth who cannot yet return to a job.

Our own congressman, Juan Ciscomani, voted for these cuts and has continued to defend them, telling constituents at a recent roundtable that the new work and eligibility requirements target "waste" in the program and won't touch the people who need coverage most. As a physician who has watched a new mother's coverage determine whether she gets seen at three months postpartum, I don't think that claim holds up. His challenger, Joanna Mendoza, has made reversing these cuts a central part of her campaign — and on this issue, she has the better read of what's at stake for mothers in this district.

We can agree that Medicaid needs reform, but cutting the program that covers half the births in this state, while our maternal mortality rate already outpaces the nation's, is not reform. It is a policy choice that will show up as a rise in Arizona's maternal death numbers — numbers that are already too high.

Arizonans should ask their legislators and their members of Congress a direct question: what is the plan to keep AHCCCS whole for pregnant and postpartum women if these cuts go through? So far, I haven't heard one.