Iowa lags in postpartum Medicaid coverage for new moms

DES MOINES — Iowa is in a shrinking minority of states that do not offer coverage under Medicaid to new mothers for 12 months after they give birth, and lawmakers are not likely to extend the coverage this year.

New mothers in Iowa have 60 days of postpartum care if the birth is covered by Medicaid, the current federal minimum. A provision in the 2021 American Rescue Plan allowed states to extend their Medicaid postpartum care to 12 months.

Nearly 40 states have implemented the extension or are in the process. But, though bills have been filed to implement the extension in Iowa, those aren’t likely to advance in his year’s legislative session, lawmakers said.

Pregnant women have a higher income eligibility to be covered under Medicaid, which covers 4 in 10 births in the state. If they no longer qualify for Medicaid 60 days after giving birth, they lose that coverage.

Even as fellow Republican-led states such as Mississippi and Montana moved to extend their coverage this year, there are no plans to enact that same extension in Iowa, said House Health and Human Services Committee Chair Rep. Ann Meyer, R-Fort Dodge.

“It’s something that we may look at in years forward,” she said.

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Meyer said she supported extending the coverage but wanted to make sure there was enough support to make it law — including from Gov. Kim Reynolds. Some Republicans, too, are hesitant to spend the money — about $14.5 million over two years — to expand the program.

“I think it’s a good thing,” Meyer said, but “there’s always the question of extending or expanding an entitlement program that we’re concerned about.”

A spokesperson for Reynolds did not respond to a request for comment about the measure.

Meyer said one reason the extension had not happened yet was that Medicaid coverage had been continuous since the beginning of the COVID-19 pandemic under the federal health emergency, so no one had been disenrolled. But that coverage ended this month, and tens of thousands of Iowans who are no longer eligible will lose coverage over the next year.

Addressing health needs

OB-GYN organizations and women’s health advocates have lobbied for the measure as a way to save lives and help Iowans in one of the most vulnerable times in their lives. Postpartum deaths from overdose and suicide often happen after the 60-day coverage ends, and heart complications can appear as much as six months after giving birth.

Iowa’s maternal mortality rate in 2020 was 8.3 per 100,000 live births — that’s lower than some of the preceding years but higher than 1990 and 2010. Racial disparities exist in maternal health as well, with Black Iowans about six times more likely to die of maternal causes compared with white Iowans in 2019.

Mazie Stilwell, a lobbyist for Planned Parenthood Advocates of Iowa, said extending coverage to 12 months would expand health equity in the state and ensure more people had lifesaving care.

“Access to care is dwindling all the time,” she said. “We just saw (MercyOne Des Moines) close down more services with midwives earlier this week. Services are disappearing left and right, and ultimately this comes down to a matter of access and equity.”

Many of the health impacts related to giving birth persist beyond 60 days, Stilwell said, making coverage in the first year important for a new mother's long-term health.

“When we’re looking at ways to support mothers and young families, and especially their ability to care for their babies, cutting off that source of support at two months is just simply inadequate,” she said.

In an Iowa Senate budget committee hearing last Tuesday, Sen. Mark Costello, R-Imogene, said he was not sure whether the chamber was going to include a postpartum care extension in its budget.

“We definitely are looking at that, and we’re trying to maybe think about different ways we can make that happen, but I can’t say for sure whether we’re going to get there or not,” he said.

The Senate passed a bill to fund the extension in 2022, but it stalled in the Iowa House. Instead, House lawmakers directed $500,000 to fund crisis pregnancy centers — non-medical facilities that offer pregnancy support and counseling and discourage abortions.

Bills filed by both parties

Multiple bills from both parties have been filed this year to enact the extension, but they have not advanced.

House Democrats announced a bill that would fund the extension in March, part of a package of abortion-rights legislation they submitted, and Senate File 57, proposed by Senate Democrats, would do the same. Those bills have not received any support from Republican leadership.

House Ways and Means Committee Chair Bobby Kaufmann, R-Wilton, also filed a bill to extend the coverage, but it has not received an initial subcommittee hearing.

Rep. Beth Wessel-Kroeschell, D-Ames, said extending the coverage would help address maternal death rates without a high cost to the state.

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Extending the coverage would also bolster health care options in rural Iowa, Wessel-Kroeschell said, because women covered by Medicaid would be able to see their doctor more easily.

“We’re throwing a lot of money into these other programs. … What would really help is to have women covered in rural Iowa so they could go to the doctor, then the provider gets paid for providing the service, instead of just trying to beg people to come to rural Iowa," she said.

Wessel-Kroeschell blamed the priorities of Republican leadership as the reason lawmakers have not passed the extension yet.

“We’re in the darkest hole of just not really helping people who need our help,” she said.