Postpartum Medicaid Extension (PME): The Emergence of a National Policy and the Illinois Experience in Adopting the PME

Abstract: The U.S. faces a maternal health crisis. In response, the Postpartum Medicaid Extension (PME), giving states the option to provide Medicaid coverage through 12 months postpartum, arose as a central policy solution. Using the policy streams framework of Kingdon, we provide an overview of the history of the federal action to pass the PME. A case study of PME adoption in Illinois follows. Given increased attention to the maternal health crisis, maternal mortality was identified as a problem on the federal agenda. Dozens of bills were introduced across multiple sessions of Congress and Presidential administrations. Policy entrepreneurs, including advocates from the Black Maternal Health movement, seized a window of opportunity, leading to the passage of the PME. As of February 2026, virtually all states have adopted the PME with many lessons to be learned. Ultimately, the success of the PME will depend upon a commitment to protecting Medicaid.