Bill aims to extend Medicaid coverage for new mothers

A group of Republicans in the state Legislature is again pushing to extend Medicaid coverage for some of the state's poorest new mothers to a full year.

The bill would allow low-income mothers who make more than the poverty threshold to stay on BadgerCare Plus, the state's largest Medicaid program, for a full year after giving birth — when they may still be at risk of life-threatening, post-pregnancy complications — instead of only two months afterward.

It is a proposal that has gained ground in other, Republican-led states across the country in the wake of the U.S. Supreme Court's decision to overturn the constitutional right to an abortion. Republicans in those other states have called the extended coverage for low-income, new moms a key part of their anti-abortion platform.

It is less clear whether the proposal has enough support among Republican lawmakers in Wisconsin, but nearly half of all lawmakers have signed on to the bill, with a sizeable number of them being Republicans. The legislation was authored by four Republicans: Sen. Joan Ballweg, R-Markesan; Sen. Mary Felzkowski, R-Irma; Rep. Tony Kurtz, R-Wonewoc and Rep. Donna Rozar, R-Marshfield.

"We want to make sure that we are out in front of this and make this a major effort," Ballweg said in an interview.

"With nearly half of the legislature signing onto this bill, it certainly seems like, knock on wood, that this strategy, I hope, will prove positive."

Supporters of the bill say it will help prevent pregnancy-related deaths — many of which happen in the months following the birth and which have been on the rise in recent years — by allowing low-income women to keep their health insurance and continue seeing the doctors they did during pregnancy. The National Center for Health Statistics recently released a report showing 1,205 women died from pregnancy-related causes during pregnancy or within 42 days of giving birth in 2021, a 40% increase in maternal deaths compared with 2020.

But previously, the Republican-controlled Legislature has resisted calls to extend BadgerCare Plus coverage for postpartum women beyond three months after giving birth. Ballweg was among those who introduced the same bill in the last legislative session, but it did not make it to a floor vote.

Two years ago, during budget deliberations, Republicans approved a one-month extension of coverage, to three months, but rejected the proposal by Democratic Gov. Tony Evers for a year-long coverage period. A waiver application is pending now before the federal Centers for Medicare and Medicaid Services to extend coverage to three months, from the current two.

Evers has again included an extension of postpartum coverage in his current budget proposal. The Legislature will ultimately choose whether to keep the extension in the final budget bill.

One year coverage embraced in other GOP-led states

In other parts of the country, Republican-led states that had previously rejected extending postpartum Medicaid coverage are now backing the measure. Mississippi and Wyoming are two of the latest such states to embrace a one-year coverage period.

The increased support comes as anti-abortion groups, including Pro-Life Wisconsin, have voiced their support for extending postpartum Medicaid coverage, to support new mothers especially in states where abortion has been restricted or outlawed. Mississippi Gov. Tate Reeves, a Republican, declared the policy part of the state's "new pro-life agenda" and Wyoming Gov. Mark Gordon, also a Republican, called it a "signature piece of pro-life legislation."

In all, 37 states and Washington, D.C. have implemented a year-long postpartum coverage period or are planning to, according to the Kaiser Family Foundation.

Ballweg hopes that increased support in other states translates to an embrace of the proposal in Wisconsin.

"I think there is some comfort in other states moving toward this," she said. "I think that's very comfortable for many of our legislators. ... They're seeing this isn't out of the norm anymore."

The Wisconsin bill is also being considered at a time when federal protections guaranteeing people stay continuously enrolled in Medicaid during the COVID-19 pandemic are set to expire in the coming weeks.

Once those protections fall away, new mothers who make more than the poverty threshold will again lose Medicaid coverage about two months after giving birth.

Change could affect 5,300 women a month

About four of every 10 births in Wisconsin are covered by BadgerCare Plus. If the postpartum coverage extension passes, it would mean that an average of 5,300 more pregnant women per month would be covered under BadgerCare Plus in fiscal year 2025 than would be covered under current law, according to figures provided by Elizabeth Goodsitt, a spokeswoman for the state Department of Health Services. That figure assumes that the state would not expand its Medicaid program to cover people who make up to 138% of the poverty threshold.

The postpartum Medicaid extension would have particular effect on Black mothers, who are much more likely than white mothers to die from pregnancy-related causes, according to a report on Wisconsin's maternal mortality.

New mothers are particularly vulnerable to depression, untreated mental illness and substance use disorders, said Dr. Jasmine Zapata, a pediatrician and a state epidemiologist at the state Department of Health Services, while speaking at a public hearing in 2021 for the bill introduced in the last legislative session.

"Unfortunately women are losing coverage under current law right when they need it most," she told legislators. "Providing access to high-quality and uninterrupted health coverage is critical during the first year for both mother and child."