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Medicaid would cover post-birth care longer, but for fewer Iowans, under Reynolds’ bill approved by Senate
Republicans say the proposal expands postpartum care for low-income Iowans who need it most, while Democrats say it expands care for some low-income Iowans at the expense of coverage for others
Feb. 19, 2024 6:32 pm, Updated: Feb. 20, 2024 7:44 am
DES MOINES — Roughly 1,700 Iowa mothers and infants would lose their Medicaid coverage for post-birth care under legislation that also would expand the period of time that care is covered for the Iowans who would remain eligible.
The proposal, which came from Iowa Gov. Kim Reynolds, was approved Monday in the Iowa Senate.
The legislation — Senate File 2251 — would extend postpartum care for Medicaid patients in Iowa from two months to 12 months; but it also would reduce eligibility for Medicaid postpartum care from 375 percent of the federal poverty line to 215 percent.
Reynolds said she crafted the proposal to make it cost-neutral.
In 2024, 375 percent of the federal poverty level is $76,650 for a family of two or $117,000 for a family of four.
At 215 percent of the federal poverty level, eligibility for Medicaid postpartum coverage would be capped at roughly $44,000 for a family of two or $67,000 for a family of four.
The changes prescribed in the bill would result in 1,300 women and 400 infants in Iowa losing insurance coverage, according to analysis by the state’s nonpartisan Legislative Services Agency.
“Senate Democrats believe that we should not be taking care away from pregnant moms and their babies,” Sen. Janet Petersen, a Democrat from Des Moines, said during debate. “The governor does not put one dime of new money in her bill to extend postpartum coverage. She pays for extending postpartum coverage to a few members that still remain eligible for pregnancy care by dropping thousands of pregnant moms and their babies off of Medicaid.”
Petersen proposed an amendment that would have expanded Medicaid postpartum care from two months to 12 months and kept the eligibility level at the current 375 percent of the federal poverty level; that was defeated on a party-line vote, with majority-party Republicans voting against.
“(The bill) expands Medicaid coverage for Iowans who need public assistance,” Sen. Mark Costello, a Republican from Imogene who managed the bill, said during debate. “Iowans do not support Medicaid for all.”
The federal American Rescue Plan, passed in 2021 as part of the Biden administration’s pandemic response efforts, allowed states to provide postpartum Medicaid coverage up to 12 months. As of this month, Iowa was one of only three states to not yet submit such a plan, according to LSA.
“Building a culture of life in Iowa means getting families off to the right start, but two months of postpartum care isn’t enough,” Reynolds said in a statement issued after her proposal was approved by the Senate. “Extending postpartum care to 12 months for women with the greatest need helps them recover from childbirth, access family planning services, manage chronic health issues, and address mental health. For our state to be strong, our families must be strong.”
Currently, Iowa pregnant women and infants in households up to 375 percent of the federal poverty level have postpartum care covered by Medicaid for two months. There are 10,800 Medicaid members in Iowa with postpartum coverage, according to LSA.
Under the bill, according to LSA:
- Postpartum Medicaid coverage would remain uninterrupted for Medicaid members at or below 215 percent of the federal poverty level.
- 2,300 pregnant women per month would maintain their Medicaid coverage beyond the initial two months.
- 1,100 infants would shift from Medicaid to the Hawk-i plan for children in low-income families.
- 1,300 women and 400 infants in Iowa would lose postpartum Medicaid coverage.
Pregnant women who lose coverage would be eligible to seek insurance under the Iowa Health and Wellness Plan, which is Iowa’s version of Medicaid coverage for adults up to 133 percent of the federal poverty level.
According to LSA’s fiscal analysis, the proposal would save the state $1.7 million in the first two years and then cost the state an additional $286,000 in the third year and each year after.
Three Democrats — Sens. Eric Giddens of Cedar Falls, Sarah Trone Garriott of Waukee and Zach Wahls of Coralville joined all Senate Republicans in voting for the bill, which now is eligible for consideration in the Iowa House.
Anti-abortion program could be run by the state under GOP proposal
A state-funded anti-abortion program to provide support to pregnant women and new mothers would be permitted to be run by the state, under legislation approved by Iowa Senate Republicans.
The Iowa Department of Health and Human Services would be allowed to operate the program known as More Options for Maternal Support, or MOMS, under the bill.
The state has twice failed to find a third-party nonprofit administrator to oversee the MOMS program, which was created in 2022. Previous requirements stated the administrator must have at least three years of experience managing a statewide network of providers of pregnancy support services.
Sen. Sarah Trone Garriott, a Democrat from Waukee, called the program “intentionally deceiving” and “dangerous” because it is portrayed as a prenatal and postpartum health care program, but operates from an anti-abortion viewpoint. Sen. Mark Costello, a Republican from Imogene, said the program creates “another opportunity to support expectant mothers in our state.”
The bill, Senate File 2252, passed with only Republican support.
Comments: (515) 355-1300, erin.murphy@thegazette.com
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