Iowa governor signs bill extending postpartum Medicaid

DES MOINES — New moms in Iowa who qualify for Medicaid will receive 12 months of postpartum care, but fewer women will qualify for the assistance under a law Iowa Gov. Kim Reynolds signed on Wednesday.

The law extends coverage under Medicaid from the 60 days required under federal law to 12 months after a woman gives birth. Iowa is one of the last states to enact the extension, which was made available to states under the 2021 American Rescue Plan Act.

The law also tightens the income threshold for a pregnant woman to qualify for Medicaid, meaning around 1,700 fewer women and infants will be covered each month.

The law will lower the income eligibility to qualify for Medicaid from 375 percent of the federal poverty line, the most generous in the U.S., to 215 percent of the poverty line. The new requirement is equivalent to around $43,900 for a single mother and $67,100 for a family of four.

“Being pro-life means supporting mothers and strong families,” Reynolds, a Republican, said in a statement. “By extending postpartum Medicaid coverage for thousands of new moms, we will set new families on a path to prosperity and opportunity. Thank you to the Legislature for passing this pro-family bill with bipartisan support.”

The legislation, which Reynolds proposed at the beginning of the legislative session, was backed by maternal health care groups and advocates, who say providing maternal care for longer will improve outcomes and detection of heart conditions, mental illness and other problems that can arise months after a person gives birth.

Around 2,700 women who would otherwise have lost their postpartum coverage after two months will be covered for the full 12 months, according to an analysis from the nonpartisan Legislative Services Agency.

The law, Senate File 2251, is set to take effect Jan. 1, and anyone who is pregnant and covered under Medicaid before that date will not lose their coverage.

Some Democrats supported the bill, but many argued the lower income eligibility was unnecessary and would be a financial burden on new parents who will no longer be covered for birth and postpartum expenses.

Republicans, though, said the proposal would keep the cost to the state neutral while extending critical care to the people who need it most.

The changes are expected to cost the state around $6 million over the next three years, including one-time IT costs and an increase in infants moving from Medicaid to the Healthy and Well Kids of Iowa program, which has a higher eligibility limit, according to the Legislative Services Agency. The cost increases are expected to be minimal by 2028.

Planned Parenthood Advocates of Iowa said the “long overdue step is worth celebrating,” but the organization said further limiting eligibility for the coverage was unnecessary.

“If Gov. Reynolds and legislative Republicans actually cared about the health of Iowa moms and babies, they would have used our enormous budget surplus to continue coverage without changing income requirements,” said Mazie Stilwell, a lobbyist for Planned Parenthood Advocates of Iowa.

Among the seven other bills Reynolds signed into law Wednesday was Senate File 2405, changing the distribution formula for general state financial aid to community colleges.

Under the new law, presidents and chancellors from each of Iowa's community colleges would create a formula that would determine how state aid is distributed across the campuses, commencing with the fiscal year beginning July 1, 2025.

Community college presidents and chancellors would convene annually in the fall to draft a formula by the end of October for the coming budget year.

In doing so, they will consider enrollment and combined support for each community college — including how much it receives property taxes and other revenues in addition to state aid — “along with any other factors deemed relevant,” according to the bill.

At least 10 of the 15 community college heads must agree on the formula and then submit it to the Iowa Department of Education. If they can’t agree, the department will establish the formula.

No formula can lower funding to a community college below what it received in general state aid the previous year, unless lawmakers cut the total base funding appropriation.

Emily Shields, executive director for the nonprofit advocacy association Community Colleges for Iowa, has said the aim is to distribute funding more equitably among colleges, taking into account enrollment and other factors.

Given enrollment growth, some smaller colleges are getting more than the average per-student aid while others are getting below the average, Shields told lawmakers in March. That’s created funding gaps with some colleges receiving anywhere from 70 percent to 170 percent of what they should receive, she said.

Shields said community college leaders would use a three-year rolling average of full-time equivalent enrollment in deciding the formula to avoid “big swings” in funding should enrollment jump or drop in a particular year.

Each community college will be required to complete and submit an annual student enrollment audit to the Iowa Department of Education.

Comments: cmccullough@qctimes.com