Health and Fitness : Postpartum Medicaid extension, with cut in eligibility, heads to governor’s desk

BY: ROBIN OPSAHL

The Iowa House approved a bill extending postpartum Medicaid coverage from 60 days to a year Wednesday, despite criticism from Democrats about increased income restrictions on eligible families.

Senate File 2251, passed 70-25, extends postpartum Medicaid coverage for new mothers and infants through provisions made by a federal coronavirus pandemic emergency plan signed by President Joe Biden in 2021. While the federal plan funding would allow for a less restrictive income limit, the Iowa bill would limit eligibility for coverage to families with income at or below 215% of the federal poverty line.

This limitation is a drop from the previous 375% FPL limit for postpartum coverage, a measure lawmakers estimated would cost the state roughly $6.2 million. House Democrats introduced an amendment Wednesday to reinstate the existing limit for coverage.

Average FPL coverage among 47 states participating in the postpartum Medicaid expansion is at 210%, Sen. Mark Costello, R-Imogene, said in a February subcommittee meeting.

Rep. Heather Matson, D-Ankeny, said Democrats and maternal health advocates were excited to see Iowa participating in the postpartum Medicaid expansion, as has been called for, but were shocked that it came with the "major caveat" of reducing eligibility.

"I am not asking anyone in this chamber to increase the number of Iowans who are eligible for postpartum care," Matson said. "I'm asking you to ensure all the moms who are currently eligible for prenatal care and two months of postpartum will receive a full 12 months of postpartum care."

With the new limit, 1,300 mothers and 400 babies each month who are currently eligible for coverage would no longer qualify for the program, according to the bill's fiscal note from the nonpartisan Legislative Services Agency. These families should remain eligible for program, Matson argued, and Iowa could use its sizable budget surplus to fund the coverage.

With the proposed restriction, postpartum Medicaid coverage would be limited to mothers and infants in a family of four with a household income of $67,100 or less, and $43,900 for a single mother and infant, Rep. Megan Srinivas, D-Des Moines said. Srinivas, a physician, said prenatal health care and delivery can often cost uninsured patients up to $25,000 - costs that could prevent a single mother making $44,000 annually from receiving needed health care during pregnancy.

The bill's floor manager, Rep. Devon Wood, R-New Market, said it is important to note that families currently receiving postpartum Medicaid coverage who exceed the new income limit would be grandfathered in to the extended program, and would not lose care. She also said that while she looked forward to continuing the conversation on maternal health care coverage, that it is time for the Legislature to take "make a movement on this" and extend coverage.

"I want to note that this bill, as is, is imperative for those moms that need it most," Wood said. "It would still put us at 13th most generous in the nation, including … our neighboring states. It would put us higher than South Dakota, it would put us higher than Nebraska, it would put us comparable with Illinois and it would put us at just under Missouri and Minnesota."

The amendment failed. House Minority Leader Jennifer Konfrst said that she wanted to be clear that House Democrats support expanding postpartum coverage, but that Democrats also believe Iowa is in a "budget situation where we can afford to fund those moms."

"Frankly, I resent the fact that we have to make this choice," Konfrst said. "This is a policy choice that many other states have made. It's a policy choice that is clearly the right thing to do. But it's not enough just to expand it, we have to have something in there to make it budget neutral. And that's frustrating. Because this isn't an expensive endeavor, and the cost is so high for not doing it."

The House also passed Senate File 2252 in a 61-34 vote Wednesday, making changes to Iowa's More Options for Maternal Support, or MOMS program. The legislation would give the Iowa Department of Health and Human Services direct oversight of the MOMS program and contracts with providers, following problems the department faced with finding a qualified applicant to serve as a third-party administrator as required by the original law.

Matson said the bill's changes to the program's oversight and difficulties in finding an administrator "should reflect on the viability of the program that will send taxpayer dollars to crisis pregnancy centers."

Democrats brought up their concerns with the overall MOMS program, which provides government funding to "crisis pregnancy centers" that encourage alternatives to abortion, for support services such as counseling, adoption services, parenthood classes and material items like diapers or baby formula. Some former patients of pregnancy centers have said such programs misrepresent themselves as licensed medical providers.

"Fundamentally I do not believe we should be spending taxpayer dollars on unaccountable organizations with varying levels of ethical practices," Matson said. "Government funding should go to legitimate health care clinics. Misinformation endangers women."

Rep. Michael Bergan, R-Decorah, said concerns about the practices of pregnancy center staff funded through the MOMS program are covered by existing licensure systems, and HHS will monitor and enforce standards of care.

"We look at this being one more opportunity to provide supports and benefits to expectant mothers in Iowa," Bergan said.

Both bills head to Gov. Kim Reynolds for final approval.