DNP870 Module 3 Sample Paper

Extending Medicaid Postpartum Coverage to 12 Months in a Rural State: A Financing and Advocacy Analysis

[Author Name]

Doctor of Nursing Practice Program, Aspen University

DNP870 Health Policy, Advocacy, and Partnerships

Module 3 Assignment

[Faculty Name]

August 11, 2026

Original model document. The state, the agency figures and the coalition described are composites built for teaching; no real jurisdiction, official or organization is described.

What this page is doingThe title states the change, the jurisdiction type and the two things the paper adds to a position: financing and advocacy. A reader who only sees the title already knows this is not an opinion piece. The course and module lines carry the classroom's own vocabulary rather than an invented deliverable name, and the composite line does real work in a policy paper, where a named state would imply data the writer does not hold. Policy graders reward specificity that can be checked and penalize specificity that cannot.

The Problem and the Policy Gap

The state of Northfield is a composite rural jurisdiction of 2.1 million residents with 24,000 live births a year, 54 percent of them financed by Medicaid. Over the five calendar years 2020 through 2024 the state maternal mortality review committee identified 71 pregnancy-associated deaths, a rate of 59.2 per 100,000 live births against 120,000 births in the period. Fifty-two of the 71 deaths, or 73 percent, occurred between 43 and 365 days after delivery, and the committee judged 62 percent of all 71 to have been preventable. The leading contributors in that late window were cardiovascular conditions, overdose and suicide, and untreated hypertension. Twenty-eight of the state's 41 counties have no obstetric provider, so the average driving distance to delivery care is 47 miles.

The gap between that pattern and the coverage rule is exact. Medicaid postpartum eligibility in Northfield ends 60 days after delivery, and 43 percent of the roughly 13,000 women whose births Medicaid finances each year lose coverage at that point because their income sits above the parent eligibility threshold of 27 percent of the federal poverty level. The deaths cluster in a period the coverage does not reach. State claims data for 2024 show that 61 percent of postpartum women with a hypertensive disorder of pregnancy had no blood pressure check billed between day 60 and day 180, and pharmacy records show a 38 percent drop in filled antihypertensive prescriptions in the month after eligibility ends.

Two consequences follow that a policy reader should see stated separately. The first is clinical: chronic conditions unmasked by pregnancy lose their monitoring exactly when the risk of a fatal event stays high, and behavioral health treatment started during pregnancy stops mid-course. The second is fiscal: uncovered emergency care is not free care, and Northfield hospitals reported 41.2 million dollars in uncompensated care attributable to adults aged 19 to 44 in fiscal 2024, of which the state hospital association attributes an estimated 6.8 million dollars to postpartum presentations. A coverage cliff moves cost rather than removing it, which is the argument that reaches a finance committee when a clinical argument alone does not.

What this page is doingThe rate arrives complete: 71 deaths over 120,000 births across five named calendar years, expressed per 100,000. The paragraph then does the move a policy argument depends on, splitting the deaths by timing so the gap and the coverage rule line up on the same calendar. The claims and pharmacy figures convert a moral claim into a measured one. Ending on the fiscal consequence is deliberate, because the committee that decides this question reads cost first, and a clinical case that ignores cost arrives at that table already answered.

Current Authority and the Proposed Change

The 60-day limit is not a state invention. It sits in federal Medicaid law, and the American Rescue Plan Act of 2021 opened a state option to extend postpartum eligibility to a full 12 months, made permanent by the Consolidated Appropriations Act of 2023. A state adopts the option through a state plan amendment filed with the Centers for Medicare and Medicaid Services, which is an administrative filing rather than a waiver negotiation, and the federal share follows the state's regular medical assistance percentage. Northfield has not filed. The proposal in this paper is therefore narrow and concrete: direct the state Medicaid agency to file a state plan amendment adopting 12-month continuous postpartum eligibility for all pregnancy-related enrollees, effective the first day of the following state fiscal year.

Naming the instrument settles what would otherwise stay vague. Because the option is already federal law, no congressional action is needed and no federal waiver is required, so the decision sits with the state legislature and the Medicaid agency alone. Continuous eligibility is written into the proposal deliberately, meaning coverage holds for the full 12 months without a mid-period income redetermination, since a redetermination at month six would reintroduce the same cliff three months later and would cost administrative staff time to produce. The proposal also directs the agency to report, at 12 and 24 months, the postpartum visit rate and the share of enrollees with a blood pressure check between day 60 and day 180.

The fiscal note is where a policy paper stops being an essay. Extending coverage for the roughly 5,600 women who currently lose eligibility, at an average per-member per-month cost of 412 dollars for 10 additional months, produces a gross annual cost of about 23.1 million dollars. With a federal medical assistance percentage of 72 percent, the state share is roughly 6.5 million dollars a year. Against that sits avoided spending: the state hospital association's 6.8 million dollar estimate for uncompensated postpartum care, a share of which returns to the state through the disproportionate share hospital pool, and emergency presentations that would be billed at coverage rates rather than absorbed.

What this page is doingA doctoral policy paper names the instrument. Here the reader learns which federal law created the option, which filing adopts it, who holds the decision, and what would change on which date. Writing continuous eligibility into the proposal, then explaining why a mid-period redetermination would rebuild the cliff, shows design judgment rather than endorsement. The fiscal note is the paragraph that separates this genre from an essay: enrollees, per-member cost, months, federal match and state share, each figure carried through the arithmetic rather than asserted.

Financing Mechanism and Advocacy Pathway

The 6.5 million dollar state share needs a named source, and three were compared. A general fund appropriation is the simplest and the most fragile, because it competes annually with every other line and can be reversed in one budget cycle. An increase in the existing hospital provider fee is the second, and it is the mechanism recommended here: a 0.4 percentage point increase on net inpatient revenue raises an estimated 7.1 million dollars, is paid by the sector that currently absorbs the uncompensated care, and draws federal match on the resulting state expenditure. The third option, a tobacco tax increment, raises comparable revenue but on a declining base, which makes it a poor match for a permanent entitlement. The provider fee is recommended with the reservation that it must be structured to stay within federal limits on health care related taxes.

The advocacy pathway is a sequence with names attached, not a call for awareness. The bill would originate with the chair of the senate health and human services committee, since revenue-adjacent health bills in Northfield are heard there before finance. The maternal mortality review committee is the strongest messenger because it is a statutory body reporting its own data, so its annual report becomes the evidence document rather than an advocacy paper. A coalition of the state nurses association, the hospital association, the state chapter of the American College of Obstetricians and Gynecologists, and two rural health clinic networks is assembled around the hospital association's fiscal interest rather than around sentiment. Testimony is scheduled for the committee hearing, and the doctoral-prepared nurse appears as the clinical witness who can connect the claims data to what happens at day 61.

Opposition is anticipated in writing because a policy paper that does not name it has not been tested. Two objections are likely. The first holds that a provider fee is a tax on hospitals that will be passed to commercial payers, which is answered with the sector's own uncompensated care figure and with the observation that the fee draws federal match the general fund cannot. The second holds that a state should not expand an entitlement that federal policy could later restrict, which is answered by the option's permanence in the 2023 federal law and by the reporting requirement written into the proposal, which gives the legislature a scheduled review rather than an open-ended commitment. Neither objection is dismissed; both are answered on their own ground.

What this page is doingFinancing is compared, not assumed. Three sources are weighed on durability and match, one is recommended, and its regulatory risk is stated rather than hidden. The advocacy pathway then names a committee, a statutory messenger, a coalition assembled around interest rather than sentiment, and the writer's own role at the hearing. Anticipating the two strongest objections and answering each on its own ground is the move that earns the top band, because it shows the proposal has been tested against the people who would have to vote for it.

References

American College of Obstetricians and Gynecologists. (2018). ACOG committee opinion no. 736: Optimizing postpartum care. Obstetrics & Gynecology, 131(5), e140-e150.

Centers for Disease Control and Prevention. (2024). Pregnancy Mortality Surveillance System. U.S. Department of Health and Human Services. https://www.cdc.gov/maternal-mortality/

Centers for Medicare & Medicaid Services. (2024). Medicaid postpartum coverage extension tracker. U.S. Department of Health and Human Services. https://www.medicaid.gov

Kaiser Family Foundation. (2024). Medicaid postpartum coverage extension: State adoption and enrollment. KFF. https://www.kff.org

Mason, D. J., Dickson, E., Perez, A., & McLemore, M. R. (Eds.). (2021). Policy and politics in nursing and health care (8th ed.). Elsevier.

Medicaid and CHIP Payment and Access Commission. (2023). Report to Congress on Medicaid and CHIP. MACPAC. https://www.macpac.gov

How this DNP 870 Module 3 example is structured

In many sections this module asks for a policy analysis that argues a position and then shows how the change would actually be paid for and enacted; your classroom's instructions and rubric decide the exact form, so read the module's assignment page before treating this DNP870 Module 3 example as a template. The order is the order a policy reader tests an argument in. The problem comes first as a rate with its denominator, because a policy claim with no measured gap is an opinion. The current authority comes second, since a proposal has to name the law it changes. The financing mechanism comes third, where most graduate policy papers stop short. The advocacy pathway comes last, naming who decides, who else is at the table, and what the opposition will say.

DNP870 Module 3 questions, answered

What does DNP870 Module 3 usually ask for?

In many sections this module asks for a policy analysis on a current issue, taking a position and supporting it with data, law and stakeholder analysis. The exact form belongs to your classroom: read the module's assignment page and rubric, since some sections want a formal analysis paper, others a policy brief, and the required elements differ between them.

What separates a doctoral policy paper from a strong opinion piece?

Two things. A named instrument, meaning the specific bill, rule, waiver or state plan amendment that would carry the change and the body with authority to enact it. And a financing mechanism with arithmetic behind it, including who pays and what is displaced. A position without those is a preference, and graders at this level read it that way.

Do I need real state data, or can the scenario be composite?

Follow your classroom's instructions. Where a course asks you to analyze your own state, use published state and federal sources and cite them. Where the scenario is illustrative, as it is here, say so plainly on the title page and keep the internal arithmetic consistent, since a policy reader checks whether your numbers still hold three paragraphs later.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

DNP870 Module 3: sample paper, in real form