The Missouri legislature sent a nearly 200-page healthcare bill to Gov. Mike Kehoe on Thursday that includes adding doula services to Medicaid coverage and allows 12-month prescriptions for oral contraceptives.
By a 116-21 vote, the House approved legislation to allow patients to start their care through telemedicine, rather than a physical examination, whenever possible.
Missourians on private insurance will also be permitted to obtain 12 months' worth of birth control pills at once to make the process easier.
The legislation "touches every man, woman and child in the state of Missouri," said the bill's sponsor, Rep. Tara Peters, R-Rolla.
"(It) is a culmination of lots of legislators from both sides listening to their constituents and working together to make healthcare affordable, accessible, making it protecting patients, putting people first, with the end result being making Missourians healthier," Peters said.
Doula services before, during and after a pregnancy will be newly covered by Medicaid.
Under the bill, insurance companies will also be required to cover blood pressure monitors for pregnant and postpartum mothers, and doctors will be allowed to issue general recommendations for doula services and prescriptions for prenatal vitamins.
The legislation also permits the state to apply for federal permission to implement a Food is Medicine program that would allow doctors to issue "produce prescriptions" to Medicaid recipients with nutrition-related diseases — through vouchers for fruits, vegetables and other foods with no added fats, sugars and salts.
Earlier versions of the legislation would have required the state to apply for the waiver.
The bill will allow the sale of ivermectin, a drug that has grown in popularity since the COVID-19 pandemic, over the counter, and expand the kinds of vaccines pharmacists may administer.
It will also require the state to track and report cases of Lyme disease and alpha-gal syndrome, a tick-borne disease creating an allergy to mammalian products that has spread across Missouri. Any identifiable information on the blood test could only be shared between a patient and their physician.
"These are not abstract policy issues. They are real-life issues for Missouri families, including my own," said Rep. Matthew Overcast, R-Ava, whose wife and some of his children have alpha-gal. "I believe this bill is going to make a meaningful difference for many across the state."
Another provision prevents insurance companies from capping payment for anesthesia by imposing time limits. Anthem Blue Cross Blue Shield underwent scrutiny for its proposal to do so in 2024.
"You don't want to have a situation where you're under the knife and undergoing surgery, and you don't want the doctor to think that the insurance company is not going to pay for anesthesia services halfway through and have him rush through this," said Rep. David Tyson Smith, D-Columbia.
The legislation also permits schools and daycares to provide epinephrine, via injection or orally, to treat allergic reactions. Daycares will also be required to adopt policies to prevent and treat allergic reactions.
"You don't know your kid has a strawberry allergy until you give them a strawberry. And that can happen for the first time in daycare," said Rep. Bridget Walsh Moore. "I think this is incredibly crucial."
The Senate voted 25-6 in favor of HB 2372 earlier this week, after adding some provisions and removing others.
One amendment, sponsored by Sen. Barbara Washington, D-Kansas City, expands the state's maternal mortality review board from 18 to 22 members to ensure it seats representatives from across Missouri.
The board will be required to work on identifying maternity care deserts and recommend ways to eliminate racial disparities in maternal mortality.
According to the board's report issued last year covering 2018 to 2022, Black women in Missouri are 2.5 times more likely to die of pregnancy-related causes than white women.
"This is not just an urban or suburban issue," said Rep. LaKeySha Bosley, D-St. Louis. "This is something that affects rural communities across the entire state, especially our rural women, where they may not have access to healthcare, hospitals, as quickly as we do in urban and suburban communities."
One provision stripped from the bill would have regulated pharmacy benefit managers, such as St. Louis-based Express Scripts, which has been sued for artificially raising drug prices.
Another that didn't achieve passage would have prevented artificial intelligence developers from advertising that AI chatbots can provide mental health therapy.
"We really desperately need to have a broader discussion about how AI is used by our professionals across the state," said Sen. Mary Elizabeth Coleman, R-Arnold, who sponsored an amendment to remove the language. "But I deeply disagree with the idea that we do it … just for mental health professionals."
Coleman, who voted against the legislation, said it was overbroad and did not receive enough robust debate.
"I'm trying to have no reaction as we're going through this litany of bad ideas," Coleman said. "But it's truly shocking to me what kind of garbage we're trying to pass (that) has never even been vetted."
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