Lawmakers mull extending Medicaid coverage after childbirth

During the pandemic, Medicaid postponed the unenrollment of hundreds of Wyo mothers, expanding their access to care after birth. Lawmakers are considering passing an extension until 2027.

By Sofia Jeremias, WyoFile

Wyoming lawmakers aim to improve pregnancy outcomes for mothers and their babies. The issue is the interim top priority of the Joint Health, Labor and Human Services Committee, which addressed it at a meeting last week in Riverton.

One potential solution is to extend postpartum Medicaid coverage, which covers 33% of births in Wyoming, until one year after the baby is born. No new group of people would be eligible for the program, but thousands of pregnant Wyoming women enrolled in Medicaid could benefit from the proposal.

The LSO report noted that more than half of pregnancy-related deaths occur within a year of giving birth, and extending coverage could potentially reduce these deaths while improving care for a host of chronic conditions. such as diabetes, hypertension, heart disease, substance use disorders and depression. .

Conditions such as postpartum depression can last for years, and proponents of the extension say the current 60-day postpartum coverage period does not always allow enough time to access treatment for mental health and other ailments.

How it would work

Under the American Rescue Plan Act, states can choose to extend postpartum coverage for Medicaid recipients from the usual 60 days for up to one year through a simple state plan amendment process.

Thirty-six states have approved these extensions, according to the Kaiser Family Foundation. The policy change would last through 2027 and cost the state about $2 million a year, according to an estimate from the Wyoming Department of Health. The federal government pays for the other half of the program.

Maternal health issues

The United States faces rising maternal mortality rates, from 20.1 deaths per 100,000 live births in 2019 to 23.8 deaths in 2020, according to the CDC.

From distance to cost, pregnant women in Wyoming face unique challenges accessing medical care. Just finding a facility to give birth can be difficult: Last year, two hospitals – one in Kemmerer and one in Rawlins – announced the closure of their labor and delivery units.

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Mothers struggling with mental health issues after childbirth also face barriers to treatment.

Mental health issues were the underlying cause in four of the six pregnancy-related death cases reviewed by the Wyoming Maternal Committee, and substance abuse withdrawal contributed in all six cases. The National Institutes of Health note that “longer screening periods after birth may be needed to help more women with postpartum depression get treatment.”

In Wyoming, lack of access to health care and lack of financial resources were the most commonly cited contributing factors for pregnancy-related deaths reviewed between 2018 and 2020, said Dr. Alexia Harrist, head of WDH Public Health, during the meeting.

“I just see a lot of our moms struggling with mental health issues,” said Rep. Andi LeBeau (D-Riverton), who supports the extension. She spoke of her own struggles with postpartum depression and the long healing period after giving birth.

“I’ll take whatever we can get,” LeBeau said.

Pandemic change

Normally, pregnant women at or below approximately 150% of the federal poverty level are eligible for Medicaid and this coverage extends for 60 days after delivery. Once postpartum coverage expires, new mothers could potentially re-enroll in Medicaid through Wyoming’s Family Care Adult program, which has lower income standards.

Before the pandemic, about 70% of pregnant Medicaid recipients lost eligibility and were de-enrolled after 60 days, according to an LSO study.

The federal government has provided states with additional Medicaid funding during the pandemic
with the understanding that states could not unsubscribe recipients for the duration of the public health emergency, an official designation that has yet to be completed.

Thanks to this, pregnant women on Medicaid have been able to maintain their health insurance long after giving birth.

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“What we have with this particular group is sort of a natural experiment,” said Wyoming Department of Health Director Stefan Johansson. “In many cases, our postpartum coverage has exceeded 12 months and even longer since the start of the pandemic.”

Defenders

The American College of Obstetricians and Gynecologists supports outreach efforts, noting on its website: “Our country’s maternal mortality rate is rising, and a growing body of evidence shows that many of these deaths, especially from preventable causes such as overdose and suicide, occur after pregnancy-related Medicaid coverage ends.

Medical groups in Wyoming have expressed similar support for extending postpartum coverage for up to a year.

“It makes sense to extend that coverage and give them a few extra months to make sure they’re recovering from childbirth,” said Eric Boley, president of the Wyoming Hospital Association.

“Anything that helps women maintain access to mental health and addiction services wins,” said Andi Summerville, executive director of the Wyoming Association of Mental Health and Addiction Centers. “What we don’t want to see are women losing access to services before they are ready. This can decrease their chances, especially with substance use disorder treatment services, of being successful. »

Wait and see the approach

Some committee members are skeptical of the extension.

“I think we just have to see what happens with that,” committee member Sen. Troy McKeown (R-Gillette) told WyoFile. “And I’m not sure we still understand what that really means.”

Sen. Troy McKeown (R-Gillette) during the 2022 Wyoming legislative session. (Mike Vanata/WyoFile)

WDH presented costs associated with the extension, but did not provide information on how outcomes for mothers who remained enrolled in Medicaid one year postpartum differed from those who did not. coverage only for the usual 60-day period.

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Representative Chair Sue Wilson (R-Cheyenne) asked WDH to gather more information about the results before the committee’s next meeting in August, and asked LSO to draft a sample bill authorizing the plan.

WyoFile is an independent non-profitws organization focused on the people, places and politics of Wyoming.

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