Elizabeth Mollard, PhD, details how state-level screening and coverage impact maternal mental health

Elizabeth Mollard, PhD, WHNP, CNM, assistant professor at the University of Nebraska Medical Center College of Nursing, presented research at the 2025 ACOG Annual Clinical and Scientific Meeting exploring how Medicaid policies influence the diagnosis of postpartum depression (PPD) among underserved populations.

Mollard, whose research focuses on postpartum depression and maternal health disparities, emphasized that the study centered on Medicaid recipients, a population with unique healthcare access challenges. “Specifically, I’m here at ACOG presenting about a specific underserved population, which is Medicaid recipients, and their rates of postpartum depression,” she said.

Elizabeth Mollard, PhD, WHNP, CNM, assistant professor, UNMC College of Nursing.

Variation in screening and coverage policies

Across the United States, Medicaid policies related to PPD screening and postpartum care vary significantly. According to Mollard, “Some states have mandatory screening at either maternal or pediatric visits.” Others implement policies such as extended postpartum Medicaid coverage or broader eligibility that increases the number of recipients. The goal of the study was to understand how these differences influence diagnosis rates.

“It used to be pretty standard to try to get to six weeks postpartum, and we realized that that was not catching the women who actually were having postpartum depression,” Mollard said. Extended Medicaid coverage for up to 12 months postpartum is becoming more common, with some states mandating this expansion. This longer coverage period allows for better identification and management of mental health conditions that may emerge later in the postpartum period.

“Women continue to need health care throughout the first postpartum year and really beyond,” she said.

Impact of policy changes during COVID-19

During the COVID-19 pandemic, temporary national Medicaid expansions provided broader postpartum coverage, enabling researchers to examine its effects on PPD diagnosis rates.

“During that time period between when they started to offer more Medicaid coverage to when they called what we call wind down, where they took it away, we did see an increase in postpartum depression diagnosis,” Mollard explained. This increase was consistent with state-level findings showing that greater coverage and mandatory screening policies led to more diagnoses and subsequent access to care.

Improving screening and access to treatment

Mollard stressed the importance of both diagnosing and treating PPD, noting that not all affected individuals exhibit obvious symptoms. “Not every woman who has postpartum depression presents as somebody who is depressed, and so that’s why it’s extremely important that we actually screen them for this.”

She added that expanded coverage facilitates treatment access. “If they also have friendly Medicaid policies, they can receive treatment as well.”

One of the most recent advances in PPD care is the introduction of zuranolone, the first FDA-approved oral treatment for postpartum depression. “That is almost universally covered by Medicaid,” Mollard noted, underscoring the importance of maintaining policies that support access to both diagnosis and evidence-based treatment options.

Evolving recognition and research

Mollard emphasized that while awareness of PPD has grown, the issue is still relatively new in terms of research and treatment development. “We are still in the early phases of really recognizing that this is a thing that is happening to a lot of women, and that it’s something that needs to be addressed.”

She pointed to both pharmaceutical and non-pharmaceutical research as essential for developing comprehensive approaches. “We’re realizing not every woman is exactly the same, and not everybody’s depression is exactly the same,” she said. This includes understanding the physiological, social, and economic contributors to PPD and designing interventions accordingly.

“We’re looking at it from all areas of how we can address the whole woman, her individual experience, the community and culture that she comes from,” Mollard concluded. “Postpartum depression doesn’t exist in a vacuum, and we do need to have individualized treatments.”

Disclosure:

Mollard reports no relevant disclosures.

Reference:

Mollard E. Koch M, Joo E, Nguyen V, et al. Evaluating the Relationship between Medicaid Postpartum Depression (PPD) Screening and Coverage Policies on PPD Diagnosis Incidence in the US. Poster. Presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.