Missouri finally passes postpartum Medicaid extension

The Missouri Senate voted Friday to extend postpartum Medicaid coverage from 60 days to one year, sending the bill to Gov. Mike Parson.

The Department of Social Services estimates the extension would cover more than 4,000 people who otherwise go uninsured two months after the end of pregnancy.

Missouri had the 12th highest maternal mortality in the nation from 2018 to 2020, and three-quarters of pregnancy-related deaths in the state were preventable, the Missouri Pregnancy Associated Mortality Review Board found last year.

Thirty-two states and Washington, D.C., have already implemented the extension.

"If we want healthy babies, we have to have healthy mamas," Sen. Elaine Gannon, R-De Soto, who sponsored a version of the legislation, said in an interview Friday. "There are several postpartum illnesses that can creep up," she said, citing postpartum depression and heart issues, which may not be obvious within 60 days of birth.

Gov. Mike Parson, in his annual State of the State address in January afternoon, committed to tackling the state's high maternal mortality rate, calling the state's low ranking nationally "embarrassing and absolutely unacceptable" and the fact that three-quarters of maternal deaths in the state are preventable a "tragic Missouri statistic."

An area in which we are heartbroken to be failing is maternal mortality," Parson said.

Aaliyah Bailey, founder of The BlackRoads Project, which works to create investment in Black, rural communities in Missouri and other Midwestern regions, told Anna Spidel of Side Effects of Public Media, "We know that many pregnancy-related health conditions do not manifest until months into the postpartum period, including mental health disorders and cardiac conditions."

The proposal earned support from an ideologically-diverse coalition, including both Pro-Choice Missouri and Campaign Life Missouri. But opposition from conservative members of the Senate, which blocked the bill last year, seemed it could jeopardize its passage again this time around.

Last year, the bill came close to winning legislative support but conservative senators blocked it in the waning days of the session.

Conservative senators wanted to include language designed to prevent anyone who receives an abortion from receiving the benefit. Advocates said including the language would jeopardize federal approval, and though it was added when the bill initially passed the Senate, it was excluded from the version on its way to the governor.

As late as Friday morning, Sen. Bill Eigel, R-Weldon Spring, said in an interview he wasn't sure if he would try to block it again.

"There's a lot of moving parts right now that we're trying to move to the legislature, so I don't think we've made a final decision yet," Eigel said, regarding a potential filibuster.

But while Eigel voted against the bill, he made no effort to stop its passage. It was approved on a 26-6 vote.

The bill that passed Friday also encompassed several other proposals, including one which would create a "transitional" benefits program for the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families.

Sponsored by Sen. Mary Elizabeth Coleman and Rep. Alex Riley, the program would allow a "step-down" of those benefits until the participant reaches 200% of the federal poverty line. Benefits would decrease proportionate to income increases, with those at the highest end — making between 190% and 200% of the federal poverty line — receiving just 20% of the monthly benefit.

Supporters framed the proposal as a way to encourage work and self-sufficiency, arguing that some families have to make the difficult calculation of whether to accept small raises or promotions and risk losing benefits entirely.

The Department of Social Services, which oversees eligibility for both programs, would need to seek a waiver from the federal government to fund the program, according to the fiscal note.

"There are currently no state plan options for SNAP or TANF that would allow the state to implement the provisions of this legislation…[Family Support Division] assumes that if the waiver requests are not approved by the federal partners, the provisions of this legislation will not be implemented," the fiscal note states.

The bill also makes permanent and expands a transitional child care subsidy program. Recipients can receive the transitional benefits without first needing to be eligible for full child care benefits — so someone at an income between 170% and 190% of the federal poverty line, for instance, would qualify for 40% of the base benefit.

Previously, a participant needed to first qualify at the baseline income threshold of 150% to then be eligible for transitional benefits.

Other provisions of the bill include a prohibition on health care providers performing pelvic, prostate or anal exams on patients under anesthesia without first receiving explicit, informed consent. It also would direct medical providers serving children to provide education to parents and guardians of kids under age 4 regarding lead hazards and testing, as well as change lead testing requirements.

The article was originally published in Missouri Independent.