Iowa House passes postpartum Medicaid extension, with stricter eligibility limits

DES MOINES — A bill headed to Iowa Gov. Kim Reynolds' desk would extend Medicaid postpartum coverage to a year for new mothers who qualify, but remove prenatal and postpartum care for hundreds of other Iowans.

House lawmakers passed the bill on Wednesday, along with a bill altering the rules for an anti-abortion pregnancy support program.

The Medicaid bill takes advantage of a federal program giving states the option to extend Medicaid coverage from the 60 days currently required by law to 12 months. The option was made available in the 2021 American Rescue Plan Act, and Iowa is one of the last states to enact the extension.

The maximum income to qualify for coverage would be lowered, though, making some families who are currently eligible for prenatal care under Medicaid no longer eligible.

The income limit for Medicaid eligibility is higher for pregnant women and infants, and the number varies by state. Iowa currently provides birth and postpartum Medicaid coverage for families making up to 375% of the federal poverty line, the highest eligibility limit of any state.

The bill, Senate File 2251, would lower that limit to 215% of the federal poverty line, extending coverage for eligible mothers to 12 months after birth. The change would make Iowa's eligibility limit for prenatal and postpartum care around 13th in the nation. The new level would cover single mothers making up to $43,900 a year and a family of four making up to $67,100.

That change would lead to around 1,300 women and 400 infants a month being no longer eligible for prenatal or postpartum care under Iowa's Medicaid program, according to an analysis from the nonpartisan Legislative Services Agency. Those mothers would need to pay out of pocket for checkups and birth if they do not have private insurance.

Around 2,700 women who would have otherwise lost postpartum coverage after two months would instead remain eligible for the full 12 months, the agency said.

The changes would take effect Jan. 1, and anyone who is pregnant and covered under Medicaid before that date would not lose their coverage.

House lawmakers approved the proposal on Wednesday, moving the bill on to Reynolds, a Republican, for a signature. The bill passed the House 70-25. Ten Democrats joined nearly all Republicans in voting for the measure, while one Republican and 24 Democrats voted no.

Maternal health care experts have lobbied for years to extend the coverage, saying it will improve health outcomes for women during a vulnerable period and address inequities in health care. Problems like postpartum depression, substance abuse and some heart conditions can show up months after giving birth, proponents have said.

Groups like the American College of Obstetricians and Gynecologists and the Iowa Hospital Association registered in favor of the bill.

Reynolds proposed the bill at the beginning of the session, saying it would help new mothers who are struggling to make ends meet. A spokesperson for the governor did not immediately respond to a request for comment.

Democrats want to keep current income eligibility

Lowering the income eligibility was an attempt to keep the program cost-neutral while providing more coverage for low-income Iowans, Republicans said.

Though the cost increase will be minimal by 2028, the changes are expected to cost the state around $6 million over the next three years, including one-time IT costs and an increase in infants moving from Medicaid to the Healthy and Well Kids of Iowa program, which has a higher eligibility limit.

Democrats said they wanted to keep the current eligibility limit for pregnancy care under Medicaid while extending coverage to 12 months, arguing the state has the funds to cover everyone. An amendment offered by Democrats to keep the eligibility limit at 375% was voted down by Republicans.

Extending the coverage at the current eligibility level would cost about $14 million over four years, according to bills proposed during the last legislative session.

Democrats said the high cost of medical care to carry a pregnancy to term and give birth would be a burden on the thousands of women who will no longer qualify for Medicaid coverage under Iowa's program. They argued that Iowa should retain its distinction of having the most generous eligibility limit in the country.

Rep. Sharon Sue Steckman, a Democrat from Mason City, argued the bill changes would lower the income of OB-GYNs in the state and worsen the state's maternal health care crisis.

"Bills like this do not make Iowa a welcoming state," Steckman said. "I guess it's not any good to be a shining example for all the other states on how to treat moms and children. We're going to go to the bottom of the pile again."

Republican Rep. Devon Wood of New Market, who managed the bill, said it would give vital help to low-income Iowans who need it the most, giving them 10 more months of coverage than they currently receive.

She said new mothers who have mental health problems and substance use issues after two months are "falling through the cracks" and would be helped under the change.

"With the money that we have in our Medicaid program, we're only able to cover 60 days, and I absolutely want to see the most of this money go to the moms and babies who need it the absolute most for a longer period of time," Wood said.

MOMS program changes

House lawmakers also passed a bill Wednesday to allow the state Department of Health and Human Services to independently administer a program set up to fund anti-abortion pregnancy support centers.

The More Options for Maternal Support (MOMS) program was created by state lawmakers in 2022 to direct state funds to crisis pregnancy centers, which are non-medically licensed centers that provide education, support and services for pregnant women. They are often run by religious organizations and discourage abortion.

Opponents of the program argue the centers provide misleading information, are not bound by medical privacy laws and use fear tactics to dissuade patients from receiving abortions.

The HHS department has failed to find an administrator for the program after multiple bid opportunities, and lawmakers hope the legislation will get the program up and running.

The bill, Senate File 2252, would allow the HHS department to directly administer the program and change some of the requirements for a contractor to administer the program, if the department chooses one.

The bill passed the House along party lines on Wednesday. It is now eligible to be signed into law by Reynolds.

Democrats said the centers misrepresent their medical expertise and give inaccurate information about abortion.

"Why would we send taxpayer dollars to an organization that promotes medically dangerous misinformation as part of their pregnancy support services? That is a bad idea," said Rep. Heather Matson, D-Ankeny.

Republicans argued that the medical services provided by the centers would be overseen by the state's medical boards and that the staff performing the procedures, like ultrasounds, have adequate training.

Rep. Michael Bergan, a Republican from Dorchester, said the bill keeps the requirements for contractors strong and gives the HHS department the oversight authority to ensure the centers are following the law.

"We look at this being one more opportunity to provide support and benefits to expecting mothers in Iowa," he said. "They'll be there to provide counseling service and enhance that with other services that are available through referral processes to the communities."