To Prioritize the Health of Missouri Families, We Must Extend Postpartum Medicaid

A bipartisan group of Missouri lawmakers have proposed evidence-based policy that will help close to half of Missouri’s growing families. They seek to extend postpartum Medicaid coverage from 60 days to a full year – to give one year of uninterrupted access to healthcare after a person’s pregnancy ends.  

Despite the fact that the bills are aiming to secure healthy outcomes for thousands, some Missouri lawmakers are willing to endanger new moms to ensure that their stance on abortion is codified anywhere and everywhere. Please don’t let them. 

What has been proposed and why?

Medicaid covers mothers and babies in families with low incomes and who are impacted by the other social determinants of health that go along with lower incomes – meaning that they are already at higher risk of poor health outcomes than families with higher incomes and better access to healthcare. According to birth data provided by the CDC’s National Center for Health Statistics, Medicaid is the primary source of payment for 41% of all births. So, tens of thousands of Missouri women and babies are impacted by pregnancy-related Medicaid policies. Any policy changes in this area will play a critical role in the health and well-being of nearly half of all growing families in the state.

HB 965, HB 354, HB 957, HB 254, and SB 45 (SB 90 merged with SB 45) are proposing that Missouri extend postpartum coverage for women from 60 days to one full year. The bill sponsors recognize the need for and the benefits of providing healthcare beyond the first two months post-pregnancy, and are seeking to do the right thing and provide that coverage. It is that plain and simple. 

What is being added to the bills and why?

For additional context and as a reminder, Missouri voters understand how important access to healthcare is for our collective well-being. We passed Medicaid expansion in 2020 through the initiative petition process, giving Medicaid access to roughly 275,000 people who make less than 138% of the federal poverty line. Even with the people in Missouri making their priorities clear, the majority in the General Assembly refused to fund the extended program until the Missouri Supreme Court ordered the state to honor what voters passed in August 2021. 

The bills currently under consideration are offered in the same vein and have proven to be effective for healthy moms to not just give birth to healthy babies, but to stay healthy and raise those healthy babies. Using the proposed legislation to serve as a soapbox for an unrelated issue – seeking to make sure that no one who has an abortion has access to healthcare – it also appears in that same spirit that some policymakers are seeking to create barriers to what has been proposed, to what the people of Missouri have generally made clear is important to them, and to what health professionals tell us is in the best interests of our communities. 

Abortion access is illegal in almost all cases in Missouri. The intended outcome of this legislation – providing postpartum healthcare to thousands of women who need it – is unaffected by what your or my position is on abortion, and trying to make it so will very surely impede the implementation of the extension. 

What is at stake and why?

Other states have attempted, similarly, to add in exclusionary language. And so far, the federal agency that administers Medicaid (Centers for Medicare & Medicaid Services) will not accept it. Published guidelines clearly state: “The 12-month postpartum period begins on the last day of a beneficiary’s pregnancy and extends through the end of the month in which the 12-month period ends. … individuals are entitled to the extended postpartum coverage regardless of the reason the pregnancy ends.” Adding in any language that creates a conflict with that language renders the full proposal ineffective and unable to be implemented. 

Make no mistake, people’s lives are at risk. According to Missouri’s Department of Health and Senior Services (DHSS), 80% of pregnancy related deaths during the period studied (2017-2019) occurred postpartum. For Black women, that risk is four times that of their white counterparts. 

Adding in extraneous language that we know will jeopardize the ability to implement the proposed extension to a full year of coverage is self-serving political theatrics that, this evidence shows, will cost people their life. Maternal deaths can be mitigated with access to quality healthcare. These bills seek to do just that. 

In January’s State of the State address, we heard Governor Parson say: 

Now…frankly, an area in which we are heartbroken to be failing is maternal mortality. Currently, Missouri ranks 44th in the United States for our abnormally high maternal mortality rate. This is embarrassing and absolutely unacceptable….We refuse to accept this tragic Missouri statistic. We must do better. If we can’t get it right for the mothers and children across our state, we might as well pack our bags and let somebody else occupy our seats.

I couldn’t agree more. Please show your support of SB 45 (combined with SB 90) as it was originally filed, not as it has been amended. Support House bills 965, 354, 957, and 254 that do not include the problematic additions. Don’t let a few fringe policymakers get in the way of what, otherwise, has strong bipartisan support – extending our literal and figurative care to the thousands of Missourians who need it.

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