A sweeping new national survey of people who gave birth in 2023 and 2024 finds a troubling pattern among those covered by Medicaid. Respondents on the public insurance program reported worse health outcomes, more barriers to care, and a recurring feeling that their concerns were brushed off during pregnancy and delivery. All of this is happening even as states have moved to expand postpartum coverage, raising hard questions about whether those policy wins are actually landing where they are supposed to.
According to the National Partnership for Women & Families, the Listening to Mothers IV study drew responses from 3,857 people who gave birth in 2023 and 2024. The report found that 61% started prenatal care by eight weeks of pregnancy, 19% between nine and 11 weeks, and 21% not until after 12 weeks. About 1% reported getting no prenatal care at all. One in four respondents said they were unable to get prenatal care as early as they wanted, most often because there were no earlier appointments available or because they were still waiting for Medicaid enrollment to go through.
Medicaid Patients Face Steeper Barriers
As reported by Seattle's Child, which republished coverage from Stateline, respondents on Medicaid were more likely to say they experienced pregnancy complications such as high blood pressure and gestational diabetes, along with higher rates of depression and substance use disorders. About one-third of those who could not secure early prenatal care were on Medicaid, and many others said they struggled to find clinics that were accepting new patients or accepting Medicaid at all. Advocates quoted in that coverage argue that these access problems go a long way toward explaining why Medicaid-covered births often carry higher risks.
Many Mothers Say They Were Dismissed
The survey also paints a stark picture of how people felt treated in the exam room. Forty-three percent said they received less than optimal care because their own knowledge and experiences were not taken seriously. Forty-two percent said providers did not respond in a timely way when they asked for help. Forty percent said they generally felt unheard.
About 6% of respondents reported that discrimination affected their care, most often racial discrimination, according to the National Partnership. American Indian and Alaska Native respondents were the most likely to say their culture was not respected in maternity care settings, the report found.
Policy Gains Are Fragile
On paper, there has been real progress. The report notes that 49 states and Washington, D.C., have extended Medicaid postpartum coverage from 60 days after birth to a full 12 months. Yet those gains are now under pressure from hospital maternity unit closures and proposed cuts to Medicaid programs, Seattle's Child reports. Advocates quoted in that coverage point out that extended coverage matters only if patients can actually find timely, respectful care in their communities. The survey's authors urge policymakers to protect and expand coverage while tackling the structural barriers that still keep people from getting the care they need.
Where To Turn If You Are Struggling
If you or someone you know is pregnant or postpartum and needs immediate emotional support, the National Maternal Mental Health Hotline is available 24 hours a day at 1-833-TLC-MAMA (1-833-852-6262), according to HRSA. Advocates and the Listening to Mothers IV report have called for stronger Medicaid reimbursement for perinatal mental health services, more team-based care that includes doulas and midwives, and better accountability for respectful care in order to turn coverage into meaningful support, the Policy Center for Maternal Mental Health notes.
For all the encouraging coverage statistics and policy headlines, the Listening to Mothers IV findings are a reminder that insurance is only the first step. Advocates say the real test will be whether people can get care that is both accessible and respectful. State and federal policymakers will be watching closely to see whether expanded Medicaid benefits translate into better, timelier care for the families the program is meant to serve.
