Lawmakers debated on Wednesday a bipartisan push to expand postpartum Medicaid coverage for low-income Missourians from 60 days to one year — among the first public hearings of the 2023 legislative session.
The Missouri Senate’s Health and Welfare committee heard testimony on a pair of bills sponsored by Republican Sen. Elaine Gannon of De Soto and Democratic Sen. Tracy McCreery of St. Louis.
The proposal was close to gaining approval from the legislature last year, but narrowly failed as collateral damage in the Republican Party’s infighting in the Senate.
“This hearing today sends a message that people are tired of differences on some issues being the excuse for inaction on every issue,” McCreery said, later adding: “It’s our hope that our partnership sends a signal about the bipartisan nature of this legislation.”
Pregnant women qualify for Medicaid during pregnancy and for 60 days thereafter, but a provision of the federal American Rescue Plan Act Act in 2021 allowed states to expand Medicaid coverage to 12 months.
The bill discussed Wednesday would cover the around 4,600 women per year who would otherwise lose Medicaid after 60 days postpartum, McCreery estimated.
Twenty-six states and Washington, D.C., have implemented the 12-month extension. The United States’ rate of maternal mortality exceeds those of other developed countries, and Missouri is generally in the bottom quarter — the state had the 12th highest maternal mortality rate in the country from 2018 to 2020.
There are several essentially identical bills filed so far in the House and Senate seeking to extend postpartum coverage.
Gannon said the bills have particular urgency because the continuous coverage provision of Medicaid, which has prevented the state from removing anyone from its rolls during the COVID health emergency, will end in April. That could include women who were added when pregnant but may no longer qualify, Gannon said, and could lose coverage.
The Missouri Pregnancy Associated Mortality Review Board last year found 75% of pregnancy-related deaths were preventable, and the greatest proportion occurred between 43 days and one year after pregnancy.
“Extending coverage to these women is so important because some of the conditions do not always present themselves in the first 60 days postpartum,” Gannon said, “They may take several months to appear.”
Women on Medicaid in Missouri are eight times more likely to die within one year of pregnancy than their counterparts with private health insurance, a multi-year report analyzing maternal mortality in Missouri published in August found.
The report also found Black women in Missouri were three times more likely to die within a year of pregnancy than white women.
Sen. Mike Moon, R-Ash Grove, in the hearing Wednesday, pressed the bills’ sponsors on the potential cost and medical details of the bill.
“I understand the desire to help people. I think that’s the right thing to do,” Moon began his questions, but went on to ask whether “deliberate termination of pregnancy by abortion” would fall under the bill’s language, allowing those who have abortions to also receive one year of postpartum coverage.
McCreery responded by saying: “I would just say this is a great example of legislators not getting involved in very highly high level medical decisions.”
Only one person testified in opposition to the bill, echoing Moon’s concerns. Timothy Faber, legislative liaison from Missouri Baptist Association, suggested changing the language from the “end of pregnancy” to the day the child is born, but while allowing for “legitimate miscarriages.”
The more than 20 witnesses who supported the legislation in testimony Wednesday ranged from pro-life groups, state health nonprofits, medical associations, a pro-choice group and nonprofits advocating for the low-income and children.
Sam Lee, a longtime lobbyist for Campaign Life Missouri, framed the bill as pro-life, and added that women seeking abortions would not be enrolled in Missouri Medicaid for pregnant women in the first place, but that those who miscarry should be eligible for the program.
“That woman should be supported, not just for 60 days afterward, but certainly for a year after that baby is born, for that courageous pro-life decision she made,” Lee said.
Todd Richardson, director of MO HealthNet, testified that the bills align with the agency’s own goals in addressing maternal mortality.
“While we don’t have an official position on either piece of legislation,” Richardson said, “I will say both are consistent with the policy direction that we try to set at MO HealthNet.”
Gov. Mike Parson, in his annual State of the State address Wednesday afternoon, also committed to tackling the state’s high maternal mortality rate.
“An area in which we are heartbroken to be failing is maternal mortality,” Parson said.
In his speech, Parson called the state’s low ranking nationally “embarrassing and absolutely unacceptable” and called the fact that three-quarters of maternal deaths in the state are preventable, a “tragic Missouri statistic.”
Parson said his budget includes a $4.3 million request for the Department of Health and Senior Services to implement a maternal mortality plan.
“We are determined to change this,” Parson said.
This story was initially publishedin the Missouri Independent.
