Pressure grows for lawmakers to pass postpartum Medicaid extension

by Kate Royals, Mississippi Today
January 26, 2023

As the first major legislative deadline of 2023 nears, legislative leaders face growing pressure to extend health care coverage for moms on Medicaid from two months to one year.

After Speaker of the House Philip Gunn killed the effort last year, a bipartisan coalition of lawmakers, mothers across the state and health care professionals are ratcheting up the conversation at the Capitol this session about the benefits of the bill for Mississippi mothers and children. Mississippi, as it has for many years in a row, has the highest infant mortality rate and among the highest maternal mortality rates in the nation.

Several lawmakers — Republicans and Democrats in both the House and Senate — filed bills early this year to extend the Medicaid coverage to one year. This would put Mississippi on the same page as 29 other states, including most of the Southeast. Eight additional states are currently considering full extended coverage or a limited extension of coverage.

The Senate last year overwhelmingly passed the legislation and has since held hearings where experts and physicians spoke to its positive impact on women and babies' health. Several senators filed bills early this year to extend postpartum Medicaid coverage, and Lt. Gov. Delbert Hosemann said he would usher it through his chamber.

And in the House, Rep. Missy McGee, R-Hattiesburg, filed a bill this year to extend the coverage. Several of her Republican colleagues, including Rep. Rob Roberson, R-Starkville, co-authored the bill.

“I really think that this is a pro-family position and certainly a pro-life position to take care of these moms who are carrying and delivering and bringing these babies into the world,” McGee said. “Healthy moms equal healthy babies. They go hand in hand, so I really believe it's currently the most impactful thing we can do for women and children.”

Roberson, who authored the main postpartum bill last year that the House never had the opportunity to vote on, also cited being pro-life as a reason he fully supports the extension.

“I feel like if you're pro-life, then this is a pro-life issue,” Robertson said. “You support the baby and the mother for as long as we can, and obviously we have financial constraints that enter into this, but I do think in the long run it would be less expensive and more conducive to the health of that child and that mother.”

But that momentum could halt, as it did last year, at the House dais, where Gunn wields immense power. He could, as he did last year, block the issue from ever coming up for a full vote.

Gunn spoke to Mississippi Today this week about his stance on the proposal. He said he believes the Mississippi Division of Medicaid should act — not the Legislature — to extend the coverage.

“My point is, any time I can call an agency and say, ‘Fix this by regulation, it doesn't take legislation,' that's the best way to do it,” Gunn told Mississippi Today on Monday. “Legislation is the hardest way to get it done. If the Division of Medicaid felt like it was a good idea, they could've submitted a request a year ago and I believe CMS would grant it in a heartbeat.”

The Division of Medicaid has not taken a stance on extending postpartum coverage. But even a committee appointed by Republican leaders, including Gunn, to advise on Medicaid policy recommended that the Legislature extend postpartum coverage.

Dr. David Reeves, a pediatrician from the Gulf Coast whom Gunn appointed to the committee tasked by law to advise and make recommendations to the agency, penned a letter to state leaders, including Gunn, earlier this year urging them to extend postpartum Medicaid coverage to 12 months. 

“I see moms that lost postnatal care after a few months and ended up pregnant again, or have postpartum depression and couldn't get treatment,” Reeves told Mississippi Today. “A lot of women do have complications during pregnancy, and they need follow up (care) that will take more than two months — like for gestational diabetes, hypertension … These things need continued coverage.”

Gunn said he had not seen Dr. Reeves' letter. The Division of Medicaid, which is housed under the governor's office, did not respond to questions Mississippi Today sent over a five-day period. Medicaid Executive Director Drew Snyder did not return text messages to his personal cell phone about the issue.

Staffers for Gov. Tate Reeves, who oversees the Division of Medicaid and appointed Snyder, also ignored questions from Mississippi Today on the topic of extending postpartum coverage.

In the Mississippi Today interview this week, Gunn said he has asked the Division of Medicaid for data on how continuous coverage during the federal public health emergency impacted health outcomes for women and babies, but he has not received it. Trey Dellinger, Gunn's chief of staff, told Mississippi Today he wanted to see data that covers whether there was “any actual change in maternal or infant mortality.”

Experts say Gunn's office hasn't seen that data because it does not exist yet.

“The research awards for … what the full impact of the postpartum coverage extension has been — those were just awarded, and they're five year grants,” said Maggie Clark, senior state health policy analyst for Georgetown University Center for Children and Families. “We're not going to know the impact of this (extended coverage during the Public Health Emergency) nationally and definitely at the state level for many years.”

In Mississippi, for example, the latest maternal mortality data available is for the time period of 2013-2016. The Health Department has said it plans to release a report for 2017 through 2019 soon.

Clark made another point about making decisions around postpartum based solely on mortality numbers.

“The goal of extending postpartum coverage is to support maternal health. There's a lot more to maternal health than, ‘Did you die?'” she said. “That's just the absolute bare minimum.”

A recent Texas study, however, showed postpartum women with continuous coverage used twice as many postpartum services, up to 10 times as many preventive, contraceptive and mental health services, and 37% fewer services related to what's called “short interval pregnancies” within the first year postpartum compared to before continuous coverage was in place.

Short interval pregnancies are defined as becoming pregnant within six months after giving birth – and they are associated with a higher risk for preterm birth. For mothers over 35 with short interval pregnancies, there's an increased risk of death and serious illness. 

Dellinger, Gunn's chief of staff, said they had reviewed that study but concluded it was not the data they needed to see.

“The Texas study you sent us, it showed there was increased utilization of health care services,” Dellinger said. “But what it didn't cover was whether there was any improvement in outcomes.”

But according to Clark, the Texas study is “one of the only, if not the only” such study. She also pointed out the time frame researchers looked at was early in the pandemic (March to December 2020) — when health care utilization as a whole was down.

A reduction in short interval pregnancies, Clark said, is a positive health outcome.

The Texas study also showed an increase in the use of mental health and substance use services. Data shows mental health conditions (including substance use disorder) are the leading underlying cause in maternal mortality.

“The Texas study showing increases in services for mental health and substance use disorder is significant, because these conditions are drivers of maternal mortality,” said Clark.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.