Thousands of Mississippians stand to lose health insurance later this year because of Speaker of the House Philip Gunn’s refusal to extend postpartum Medicaid coverage from 60 days to a year.
When the COVID-19 public health emergency ends, possibly as early as July, the 40,000 Mississippians currently covered under pregnancy Medicaid rules will lose coverage. People who give birth after that point will have 60 days to recover and make follow-up appointments with doctors.
After that, they’ll be on their own.
That harsh, quick disintegration of a safety net is one that many Mississippi mothers already know well: About 60% of births in the state are covered by Medicaid, one of the highest percentages in the United States.
Dr. Nina Ragunanthan, an OB-GYN at Delta Health Center, a federally qualified health clinic in Mound Bayou, said the “vast majority” of her patients are on Medicaid. Complications after birth are a major contributor to the state’s high maternal mortality rate, she said, and depression and anxiety in particular can arise and worsen well after 60 days postpartum.
Black women in Mississippi die of pregnancy-related complications at a rate three times higher than white women.
“I just think that this is a no-brainer,” she said. “It would be so good for the health of women, the health of babies, and even makes economic sense.”
There are still paths to extending postpartum coverage that don’t depend on the state legislature, according to Joan Alker, executive director and co-founder of the Center for Children and Families (CCF) at Georgetown University. The U.S. Congress is considering legislation to require states to provide 12 months of Medicaid coverage postpartum.
Theoretically, Gov. Tate Reeves could direct the state Medicaid agency to ask the federal government to grant approval for the extension. But the legislature would still need to approve appropriations.
Sen. Kevin Blackwell, R-Southaven, who authored the bill extending postpartum Medicaid coverage, said he plans to reintroduce the legislation next year and hold a hearing on the issue sometime this summer.
Mississippi Today spoke with six moms from around the state about their experiences with Medicaid coverage during and after their pregnancies. Several of them gave birth during the pandemic and found that extended coverage let them access care for postpartum depression that would otherwise have gone untreated. Others had babies before the pandemic and lost their coverage after 60 days. One mom sustained an injury during childbirth that she couldn’t get treated because she lost health coverage too soon. Thirteen years later, she’s still dealing with the consequences.
27 years old, graduate student, Florence
I was 28 weeks pregnant when I lost my insurance. And I applied for Medicaid. It was pretty easy to apply for. I ended up having to go a lot because I had high blood pressure while I was pregnant. Like probably two weeks before I was supposed to give birth, I started having some contractions. I went to the hospital. They paid for my ER visit. I gave birth early. They paid for that, my C-section, and I had to have emergency gallbladder surgery two weeks after I gave birth. It paid for that.
I am still on my Medicaid, from my understanding, due to the COVID pandemic. I had to have a postpartum depression follow up with my primary physician. I went in for my six-week appointment, I was fine. I didn’t ask for anything. I had to go in again after my six-week appointment and basically I told my doctor like, “Hey, I’m not coping well. I’m fine. My son is safe. But I just feel like I’m not coping well. I’m crying, I’m tearful, any little thing is setting me off.” He was like, “Yeah, after you give birth sometimes you have those hormones.” I was breastfeeding as well. I was up, down, up, down, not getting sleep. He put me on something. He was like, “Follow up with your primary doctor within a week.” I did, and Medicaid paid for that.
[Not having health insurance] would have affected me bad. I wouldn’t have been able to go in and just be like, “Oh, I got a doctor’s appointment.” They’re gonna ask you for money…. Medicaid really gave me the opportunity to get the help that I needed. I could actually be not crying while helping my child. I could be a full-time parent and just be able to take care of him without feeling down or depressed and not miss his moments, not be unhappy with him, you know.
Personally, I feel like men shouldn’t make decisions regarding women’s health. … But if they cared about females and mental health and postpartum depression and anything like that, they would pass [the postpartum Medicaid extension]. Because the bigger issue is if women don’t have Medicaid or it’s not extended, do you not know how much could go wrong? Postpartum depression can lead to suicide, it can lead to infant death, it can lead to anything. It’s like they’re not seeing the bigger picture.
32 years old, teacher, Heidelberg
With [Deysha, now 13] being my first pregnancy, I didn’t know what to expect, what was going on, what was gonna happen. After I had her, my body didn’t go back to normal. My back just started bothering me with other types of just– little odds and ends. I just felt like, ‘hey, I didn’t get a chance to figure out a lot of issues that I was experiencing.’ Also [within] six weeks, you’re supposed to be at home, trying to recover, being at home with the baby, not out in public.
[After R’Jay was born in December 2021] I actually received the letter in the mail saying that it would be reinstated on March the first . I was actually shocked, but I was also excited about that at the same time. With me not going back to work right now, dealing with other issues, that’s kind of a savior to me…
I’m kind of dealing with anxiety and depression. If you’ve never experienced it, it’s hard to explain. It’s hard for people to understand what it is that you’re going through and why. It’s like, in my community, it’s like, people don’t try to understand it. It’s like they think you snap out of it overnight. So any time that I need to reach out to the doctor, or mental health clinics, like I have to try to get myself better, [and Medicaid] has definitely been a major role. I don’t want to keep it covered to the point that I’m so down and out that I can’t dig myself out of that hole. I want to be the best parent that I can be for not only R’Jay, but also my other kids as well.
30 years old, stay-at-home mom, Brandon
If your Medicaid is canceled within 60 days [postpartum], you only have that 60 days. To me that’s like, OK, if you have any immediate needs, they need to be addressed now, while you’re still adjusting, trying to get back to normal life. Your body is still going under major changes, especially during those first six to eight weeks. It’s such a short time to expect mothers to not need postpartum care. So I’ve been thankful that I have had the extended care [since the birth of Sadie, my fifth child, in October 2021] and that it has been covered. My husband owns a small business, so we don’t have insurance otherwise. And I stay at home with the kids.
The Medicaid went out after 60 days [with my fourth baby]. The postpartum depression, it was actually a good bit later. Truly I think I was dealing with it before I actually got help. But that’s a big thing– new moms, you’ll blow things off as, well, we’re adjusting or things are just hard because there’s a new baby and you’re not getting enough sleep. You just fall underneath all the laundry and the dishes and nursing the baby. You don’t really think about yourself. She was closer to nine months before I ever got on anything, and saw somebody for my postpartum depression.
When I finally decided that I needed to go, a huge hesitancy was not having any medical coverage at that time. I was in a gap of where it was gonna cost out of pocket for me to go. So I was already kind of in a bad place, I didn’t want to get out of bed. I didn’t want to do anything. I just wanted to lay around and sleep. If I did get out of bed it was major anxiety. I would panic over small things.
Elliott paid out of pocket for treatment for postpartum depression following the birth of her fourth child.
I can tell such a huge difference [following the birth of Sadie], because one, I was already on prior medication for my anxiety and depression, things like that. But the adjustments that I’ve needed after having her, you know, it’s so much of an ease to just go and not have to stress over the finances and things like that. I don’t have to let it build up to where I’m at my breaking point. I felt like I’ve connected with my baby more, I feel like I’ve bonded with her more. I’ve felt more like myself, bringing her home, getting settled in. We had a NICU stay and we were in and out of the PICU, for the first eight weeks of her life, and even through all of that, if I hadn’t had that care, I think things would have looked a lot different for me.
31 years old, finance, Copiah County
We had a rough road from the very beginning, with a high-risk pregnancy from five weeks. He was delivered at 28 weeks [on Jan. 8, 2020]. We spent 84 days at the University of Mississippi Medical Center in the NICU.
Medicaid covered me through my six-week postpartum visit to get birth control, to make sure my pap smear was gonna be fine, I was healing well from my incision and all of this. I got a letter stating that I would be dropped March 31st , ‘cause that was gonna be my 60 days. And I was like ‘well, I don’t know what I’m about to do because I’m not gonna go back to work right now. I’m not gonna spend my maternity leave in the NICU then send him to daycare. That’s not an option.’
Then COVID hit in the middle of him being at UMMC. I got a letter from Medicaid stating that it was going to be reactivated until the end of 2021. … That made me feel better. I’m not gonna lie, I did have some depression issues. My child was born at 28 weeks, he weighed two pounds, I couldn’t hold him or touch him. Of course there’s some issues there.
I’m [still] on [Medicaid] now, which is a huge blessing. But I really just wish that we could get this going for all the moms– just because they delivered in 2020, it’s not an exception.
Back at the end of November, December 2021, I was looking at going back to work. That gave me severe anxiety. … Who’s gonna have him, where’s he gonna go back to school? It was overwhelming. I called my OB-GYN. I discussed with her the sheer fear and terror that I was having, and she’s like ‘well, I think that maybe we should set you up with the wellness visit at a therapy center.’ So I was able to go and have that one-on-one time with the physician, who prescribed me some medication. Then I got a referral to go and talk to a therapist. I wouldn’t have been able to get that taken care of and handled had it not been for this COVID pandemic extending the coverage. I mean, I understand that I would have had to put your big girl panties on and deal with it. I understand that. But it’s just easier when you have support all the way around and then you have help from the physician.
McCardle has now returned to part-time work. She plans to get health insurance from her employer when she is working full-time.
32 years old, Nurse anesthetist, Madison County
I was an RN for maybe three years, and then I went back to school for nurse anesthesia, which is advanced level practitioner. When you go back to school, you cannot work. The program’s so hard, if they do find out that you work and you’re failing, then you absolutely have no excuse.
I had went travel nursing before, saved up a bunch of money, I thought I was preparing myself. Then I found out I was pregnant. Surprise! I was married for eight years and never got pregnant. Then I was like crap, how are we going to do this, because I can’t work now. I went and got on Medicaid.
Whenever I delivered the baby [in 2015] they gave me 60 days… I think five days postpartum I had an allergic reaction to one of my medications. I had postpartum depression, I had postpartum anxiety, I had to call an ambulance when I had the allergic reaction, and Medicaid covered all of that. Luckily we have a friend of the family that was an insurance agent. He hooked me up with [a plan through] the Affordable Care Act [after I got kicked off Medicaid].
Medicaid is viewed as for poor people. But here I am, college-educated, I had a four-year Bachelor’s degree, and [I was] an RN. [I was] going back to school to get my doctorate. There’s a stigma in getting Medicaid. I hate that people look at it for just low socioeconomics. It’s not. It’s for help.
I paid taxes all those years. I worked since I was 16 years old. I was limited whenever I actually needed it, because I was trying to better myself– it was cut off for a certain amount of time. Now I’m a CRNA. I make over six figures a year. I don’t mind helping others out there who need it. This is how it’s supposed to work.
30s, state employee, Columbia
A.M. works for the state of Mississippi and requested her name not be used by Mississippi Today.
I was 19 when I found out I was pregnant. Here I am waiting tables, not married, and pregnant. So [delays with getting onto Medicaid] was definitely a little bit of added stress. I didn’t really have any trouble with them covering stuff after my pregnancy. But those 60 days after, I mean like to the day, they cut me off. And that was not the greatest. My son just turned 13 and I still actually am having residual SI [sacroiliac] joint pain from delivering him. The first five weeks I could barely walk after delivering him.
During the delivery the doctor did something– I still think he may have fractured my tailbone or actually broken it. I couldn’t walk. So I couldn’t get out to be seen for what was going on with my tail bone.
I go– What is today? Monday. I go in two days to the chiropractor again and probably will be getting referred to a specialist. Even if I had just been able to have [Medicaid] until my child was six months, I probably would have gotten everything handled then. God only knows how much this is going to cost me now, because I couldn’t afford it then.
Really and truly, unless you have been in a low income parent’s footsteps– I’m not trying to toot my own horn by any means. But you’ve got someone who’s going to college, working one to three jobs, and you’re being told, ‘well, you need to work harder.’ I can’t. I can go back and pull a picture of our calendar one month and show you everything I had going on at that time. There was no room for anything else. I can’t tell you how much money I have spent on Monster and Red Bull and Bang and coffee. There’s not always a way to work harder, and telling me to get another job– well, day care’s not open anymore than what I’m already working.
After losing her Medicaid coverage, A.M. had no health insurance for about six years.
And I still, even through all of this, consider myself a relatively lucky person. I didn’t have anything traumatic happen during those times when I didn’t have insurance. I did break a pinky toe. But that was nothing. I didn’t have to go to the doctor. I didn’t almost lose an arm or become deathly ill. I made it through kind of OK.