Clancy trial spotlights postpartum mental health: So, what does Medicaid cover?

The recent declaration of a mistrial in the case of Lindsay Clancy, the former labor-and-delivery nurse who strangled her three young children in 2023, has pushed postpartum mental health into the national spotlight.

Her defense argued she was in the grip of postpartum psychosis so severe that she couldn't distinguish right from wrong. Prosecutors countered that she planned the killings and understood what she was doing.

Right now, Medicaid pays for nearly half of all U.S. births. That raises a practical question that matters for millions of American families: what mental health support does Medicaid offer women after they give birth?

Why It Matters

Medicaid, a joint federal-state program, plays a huge role in maternity care and finances more than 41 percent of all births in this country. It is also the single largest payer of behavioral health care nationwide, according to a January 2025 brief from the Medicaid and CHIP Payment and Access Commission (MACPAC).

Given the large number of women using Medicaid benefits, it’s important they understand what services are available to them. In fact, the report found that roughly 20 percent of postpartum women experience a mental health condition such as depression, anxiety, or bipolar disorder. Postpartum psychosis is much rarer, but it is the most severe condition and requires immediate medical intervention.

The stakes are life and death. Maternal mental health and substance use disorders were the leading underlying cause of pregnancy-related deaths in 2020, accounting for more than 22 percent of postpartum deaths. Maternal suicide now outpaces hemorrhage and hypertensive disorders as a cause of maternal mortality overall, according to MACPAC.

In addition, the analysis found that about one-third of postpartum Medicaid beneficiaries reported a mood disorder diagnosis specifically during the perinatal period, the period in the later stages of pregnancy and the weeks following birth.

What does Medicaid cover?

When it comes to postpartum mental health, Medicaid coverage in all states falls into four categories — screening, providers, therapy, and medication.

Screening. Nearly every state Medicaid program covers depression screening using validated tools like the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire-9 (PHQ-9), quick questionnaires that take under 10 minutes and flag depression, anxiety, and suicidal thoughts.

Screening happens at more than one touchpoint: at the mother's own postpartum visit, and again at the baby's pediatric well-child checkups through six months, billed under Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. This is one of the more consistently covered pieces nationwide, since federal EPSDT rules require screening at children's visits, and almost all state Medicaid agencies already cover postpartum depression screening and treatment as a matter of course.

Providers. Treatment isn't limited to psychiatrists. OB-GYNs and midwives, the clinicians already seeing a new mother at her postpartum visit, are permitted and encouraged to diagnose and prescribe medication for postpartum depression themselves, according to the American College of Obstetricians and Gynecologists' clinical guidelines, without requiring a psychiatric referral.

Pediatricians play a role too, since they're often the ones administering the screening at the baby's checkup. Beyond that, Medicaid covers psychiatrists, psychiatric nurse practitioners, psychologists, and licensed clinical social workers or counselors for ongoing care.

However, provider access, not the coverage rule itself, tends to be the real bottleneck — many psychiatrists don't accept Medicaid, which is part of why the ability of OB-GYNs to prescribe matters so much.

Therapy. Individual counseling and psychotherapy, including cognitive behavioral therapy, are standard Medicaid behavioral health benefits in every state, since behavioral health treatment is a required part of Medicaid's benefit package.

Medication. Standard antidepressants (SSRIs and similar) have long been covered Medicaid benefits nationwide. In 2023, the FDA approved two drugs specifically for postpartum depression, and state Medicaid programs widely cover them. Zulresso (brexanolone) is an IV infusion requiring a 60-hour hospital stay. Zurzuvae (zuranolone) is a once-daily pill taken for 14 days, and works far faster than typical antidepressants, which can take six to eight weeks to take effect.

For the most severe cases — postpartum psychosis, the condition Lindsay Clancy's defense pointed to — Medicaid covers inpatient psychiatric hospitalization and emergency stabilization in all states, since it's treated as a psychiatric emergency rather than something managed through outpatient visits alone.

However, the MACPAC report found that both beneficiaries with and without mental health conditions had high rates of delaying or skipping needed care in the year after birth, for different reasons. Some new mothers can't line up childcare, can’t get transportation, or can’t take time off from work or school. In some cases, new mothers could not get an appointment at all, due to a lack of Medicaid providers in their area.

So even those who screen positive for depression at a well-child visit frequently never receive follow-up treatment.

Arkansas: An Outlier

Since the pandemic-era American Rescue Plan Act gave states an easy path to extend postpartum Medicaid coverage from the federal minimum of 60 days to a full 12 months, every state and Washington, D.C. has taken it except one: Arkansas. Arkansas Medicaid still cuts off pregnancy-related coverage at 60 days postpartum, according to KFF's tracker.

The state has tried and failed to change that. A bill to extend coverage to 12 months passed the Arkansas House with bipartisan support in 2025 but died in a Senate committee, with Gov. Sarah Huckabee Sanders (R) opposed to the extension. She instead signed the Healthy Moms Healthy Babies Act, which streamlines the state's maternal care process but doesn't lengthen the coverage window.

The consequences are showing up in the data: recent state figures found that 44 percent of Arkansas mothers on pregnancy Medicaid lost that coverage in the last quarter of 2025, according to Arkansas Advocates for Children and Families. Arkansas also has the nation's highest maternal mortality rate. Advocates reportedly plan to bring another extension bill to the legislature in 2027.

What We Are Watching

President Trump's One Big Beautiful Bill Act (OBBBA) is estimated to make close to $1 trillion in cuts to Medicaid over 10 years.

The cuts do not explicitly impact Medicaid pregnancy services and do not eliminate the 12-month postpartum Medicaid extension that states have implemented. It also does not contain language that singles out postpartum depression screening or treatment for elimination.

However, new work requirements could have future impact:

Pregnant and postpartum beneficiaries are exempt, but that federal exemption runs only through the first 60 days postpartum rather than automatically covering the full 12-month extension. It remains unclear whether beneficiaries in extension states will need to separately document a different exemption (such as caregiver status) to keep coverage past two months without proving work hours.
Maternal-health groups like the Maternal Mental Health Leadership Alliance and the Policy Center for Maternal Mental Health point to indirect factors: reduced federal matching, lower reimbursement to community mental health centers, and coverage churn from more frequent paperwork requirements could shrink the provider network available to screen and treat postpartum mental health issues.
More facility closures are expected, particularly for rural areas where obstetric units are already disappearing (a majority of rural hospitals had no maternity ward as of 2022). Since 2010, 153 rural hospitals have closed or discontinued inpatient services, and more than 400 remain at risk.