Postpartum Medicaid coverage expanded despite concerns

A proposal by Iowa Gov. Kim Reynolds to expand post-birth coverage for Medicaid patients drew mixed reactions Monday from Iowa providers and organizations supporting pregnant women.

Senate Study Bill 3140 calls for increasing the coverage of postpartum care for new moms under Medicaid from two months to 12 months.

Iowa is one of only three states that has not implemented the extension, which was made available to states in the American Rescue Plan Act.

Groups lauded the governor's support of the expansion, but raised concerns with her proposal to change the eligibility for Medicaid coverage of birth and postpartum care to 215% the federal poverty line, from 375% under current law, in order to keep Medicaid costs for pregnancy and postpartum care budget neutral.

While the benefits would be extended, fewer Iowa women would qualify.

Under the governor's proposal, a single pregnant woman making less than $42,000 a year would have her pregnancy and 12 months of postpartum care covered under Medicaid. For a family of four, that equates to more than $64,000 a year.

"The governor's proposal offers coverage for those who truly need it," Molly Severn, legislative liaison for Gov. Reynolds, told a panel of lawmakers during a Monday subcommittee hearing on the bill.

The panel voted 3-0 to advance the bill for consideration by the full Senate Health and Human Services Committee.

Iowa has the highest Mediciad postpartum eligibility coverage in the nation, and the governor's proposal would bring the state in line with other states and make Iowa the 13th-highest in the nation, Severn said.

The governor's proposal also includes coverage for newborns at 302% of the federal poverty level through Hawki, which provides free or low-cost health and dental insurance for children and teenagers of eligible Iowa families.

Many groups were registered undecided on the bill, citing concerns about "unintended consequences" of scaling back income eligibility, noting it would also apply to prenatal care.

Chaney Yeast, director of government relations at UnityPoint Health Blank Children's Hospital in Des Moines, applauded the governor for including postpartum care in her legislative priorities for the session, but warned working mothers in Iowa could lose Medicaid coverage under the proposal.

"Those are moms typically working for small businesses that don't provide an employer-based insurance program," she said.

Severn said those with incomes above 215% of the federal poverty level may qualify for subsidized coverage through the federal health insurance marketplace.

Yeast, however, said pregnancy is not a qualifying condition to enter the marketplace.

"So if you don't happen to become pregnancy during open enrollment, you're out of luck," she said.

However, denial and disenrollment from Medicaid coverage are, said Iowa Health and Human Services Director Kelly Garcia.

Yeast encouraged lawmakers to leverage Children's Health Insurance Program funding, which has a higher federal match rate, to increase eligibility from the proposed 215%, "and actually make investments in moms and babies."

"One of the things I think needs to be the backdrop as we talk about this is we have a maternal mortality crisis," Yeast said. "We have an infant mortality crisis. This is a single policy lever that you can pull to improve the health of moms and babies, but also support or workforce in Iowa."

Iowa's maternal death rate and infant mortality rate have climbed as birthing units have closed in recent years.

Mary Nelle Trefz is with Iowa ACEs 360, which is part of a maternal health coalition of more than 60 faith-based groups, family advocates and health and mental health care providers.

Trefz said providing 12-months postpartum coverage will increase access, improve outcomes, reduce costs "and save moms' and babies' lives here in Iowa." But in doing so will disproportionately leave rural families in the lurch.

"The state is leaving money on the table right now," she said. "There is an option to cover some of our pregnant women under Hawki, which has a higher federal match. The federal government pays for more of the program implementation for Hawki than for Medicaid. So I would ask you to cover pregnant women between 200 and 300% (of the federal poverty level) on Hawki versus Mediciad, providing that critical access to care and saving the state money."

The Senate last year passed a bill that would have extended postpartum Medicaid coverage while maintaining eligibility requirements, but it did not pass in the House.

Sen. Janet Petersen, D-Des Moines, said the bill presents "a pretty significant step backward for pregnant moms" to receive postpartum coverage at a time when Iowa saw the largest increase in infant mortality in the country.

"You're taking money away from pregnant moms to put those dollars into the postpartum care, correct?" Petersen said.

Severn responded "yes," and reiterated the proposal is intended to be budget neutral.

Iowa Health and Human Services Director Kelly Garcia said the governor's office intends to bring Iowa's income eligibility requirements in line with other states "and to use those investment dollars to extend coverage."

Petersen, who served on the subcommittee, voted to advance the governor's bill, "because I truly believe that we need 12 months postpartum coverage."

"I think the ultimate question is, is this the best that Gov. Reynolds can do for pregnant moms in Iowa?" Petersen said. " … I think the governor can do better. I know Republicans in the Senate have done better. We should not be taking a step backward to be taking a step forward for pregnant women and babies in this state."

Sen. Mark Costello, R-Imogene, who chaired the subcommittee, noted of the 47 states who have extended postpartum Medicaid coverage, the average income-eligibility cutoff is 210% of the federal poverty level.

"Thirteenth is still pretty high up there," Costello said.