Postpartum Medicaid extension is the talk of Mississippi politics this week, with lawmakers, statewide officials and candidates debating the merits of passing the policy designed to help mothers after they give birth.
Lawmakers face a key deadline this week to keep the proposed policy alive, and there is much disagreement about whether it’s right for Mississippi. There have been several rallies and press conferences at the state Capitol this session focused on the issue, and it will continue to emerge as a key theme of the 2023 election cycle.
We’ve compiled answers to some frequently asked questions to help you understand what it is, what it isn’t, and how its potential passage could impact Mississippians.
Click to jump to a specific question.
What is postpartum Medicaid extension, exactly?
Postpartum Medicaid extension is proposed legislation to extend the length of health care coverage for Mississippians on Medicaid who give birth. Postpartum visits can include care of chronic health conditions, such as diabetes and hypertension, as well as mental health issues that might arise after giving birth, such as postpartum depression.
Federal law mandates that states provide postpartum Medicaid coverage for at least 60 days, which is the current limit in Mississippi. After 60 days, most Medicaid patients lose postpartum health care coverage, and this period of time is often most deadly for mothers. Most states, however, have passed measures to extend postpartum Medicaid coverage to one full year post-birth — which is what the currently proposed Mississippi legislation would do.
Would postpartum Medicaid extension provide cash directly to mothers?
No. Mississippi opting into the program would simply send additional federal funds to the state’s Division of Medicaid, which would then reimburse health care providers directly for any care they provide to qualified mothers. Many politicians, however, have tried to equate Medicaid programs — including the postpartum Medicaid extension — with direct cash assistance in efforts to sow discontent among those opposed to more government spending.
Is postpartum care extension the same thing as Medicaid expansion?
No, postpartum Medicaid extension is not the same thing as Medicaid expansion, despite what prominent elected officials and candidates have said. The proposed postpartum extension would simply extend the length of time Mississippians who already qualify can access postpartum services. Medicaid expansion, which has never been seriously considered by Mississippi’s legislative leaders, would broadly cover health care services for hundreds of thousands of additional Mississippians. “Medicaid expansion,” as it’s commonly referred to by politicians, is a completely separate issue from “postpartum Medicaid extension.”
What’s the background of this debate, and why does it matter right now?
Mississippi has one of the highest maternal mortality rates in the country, and it’s getting worse. The state also has the highest infant mortality rate, preterm birth rate and low birthweight rate in the country. Despite these problems, neonatal ICUs and labor and delivery units continue to close in the state — and the state is expecting thousands more births following the U.S. Supreme Court’s decision to overturn abortion rights last summer.
Because two-thirds of babies born in Mississippi are born to people on Medicaid, extending postpartum coverage would boost the access to care and health outcomes of thousands of Mississippians, health care officials and researchers say. Doctors, nurses and major medical associations in the state have joined a growing chorus of everyday Mississippi this legislative session calling for postpartum Medicaid extension.
Who qualifies for postpartum Medicaid coverage?
In Mississippi, pregnant people under 19 years old automatically qualify for pregnancy Medicaid, as well as pregnant people with income under 194% of the federal poverty level, or $2,255 of monthly income for a family of one.
How long are Mississippians who are expecting covered now?
Mississippians on Medicaid have postpartum coverage for two months after giving birth. However, regardless of what postpartum needs they might have beyond 60 days, they lose coverage after that. Research shows that drastic health problems for mothers exist and continue to develop well after two months postpartum.
Have other states extended postpartum Medicaid?
Yes, 29 other states have extended postpartum Medicaid coverage to one year, and seven additional states are planning to offer the extension imminently. States that have also extended postpartum care include contiguous neighbors Alabama, Louisiana and Tennessee. Mississippi and Wyoming are the only two states that have neither extended postpartum coverage nor expanded Medicaid more broadly.
Why hasn’t it passed yet in Mississippi?
Though the Mississippi Senate has passed postpartum Medicaid extension four times in two years (and most recently on Feb. 7 of this year), the legislation has been killed by the House of Representatives — and specifically, by Speaker of the House Philip Gunn. The House Medicaid Committee appears to not have met at all this session, an important note considering the postpartum Medicaid extension legislation must pass through that committee to go into effect.
Gov. Tate Reeves, who has for months voiced his opposition to the legislation, reversed course and urged lawmakers to pass it on Feb. 26. On Feb. 27, Gunn followed the governor’s lead and said he would not block the legislation from coming to the House floor, a stark departure from his previous opposition to postpartum extension. Gunn said he was waiting on guidance from the state Medicaid Division, which has previously declined taking a position on the issue. However, Medicaid Director Drew Snyder sent Gunn a letter on Feb. 27, voicing his support for the measure.
Who supports it and why?
Statewide organizations and health professionals have advocated for the policy change, including State Health Officer Dr. Dan Edney, the Mississippi State Medical Association, the Mississippi Medical Care Advisory Committee and the Mississippi Economic Council. Additionally, a Mississippi Today survey conducted this session showed that a majority of lawmakers — including members of the House — support the policy measure. Recent polling of Mississippi voters shows that more than two-thirds of the state supports the measure. Advocates say it will widely improve health outcomes in Mississippi.
What would the economic impact of passing it be?
Officials and advocates have said that postpartum Medicaid extension would result in net savings for the state by preventing costly medical conditions from lack of treatment. Premature babies can cost the state more than half a million dollars more than babies born at term. It’s estimated that extending postpartum Medicaid coverage in Mississippi would cost about $6 million to $7 million per year, which is a marginal total considering the state’s current $3.9 billion surplus.
Who can extend postpartum Medicaid?
It’s still not clear if Gov. Reeves could pass the policy on his own as head of the state’s Division of Medicaid, though legislative leaders have long said that Reeves has the power to extend postpartum Medicaid coverage without their approval. Reeves recently said if the Legislature passed the bill, he would sign it into law, but he did not address the stated fact that he could pass it himself.
According to House Medicaid Committee chair, Rep. Joey Hood, the committee will meet Feb. 28, the deadline to keep postpartum extension legislation alive by committee passage, to take up the legislation. The measure is expected to pass.
Editor’s note 2/27/2023: This story has been updated to reflect that Speaker Philip Gunn and Medicaid Director Drew Snyder now say they support the extension of postpartum Medicaid coverage, and news that the House Medicaid Committee will meet to discuss the legislation.