Postpartum Medicaid extensions advance in red states

Proposals to extend Medicaid coverage for new mothers are advancing in Mississippi and Wyoming, red states where lawmakers blocked previous attempts to expand government-paid health care for low-income people.

Bills that would take advantage of new federal incentives to provide postpartum Medicaid coverage for 12 months, rather than 60 days, appear to be on track for final floor votes in both states this week.

“Having Mississippi and Wyoming considering this is huge,” said Avenel Joseph, vice president for policy at the Robert Wood Johnson foundation, which supports Medicaid expansion efforts.

The option to extend postpartum coverage for a full year was among the incentives the federal government offered to states to expand their Medicaid rolls after the Covid-19 pandemic began. It was first extended as a temporary provision of the 2021 American Rescue Plan and made permanent by the consolidated Appropriations Act of 2023, which President Biden signed in December.

The program has attracted broad support in both red and blue states, a stark contrast from the response that greeted the Obama administration more than a decade ago when it offered federal matches to states that expanded their Medicaid populations as part of the Affordable Care Act of 2010.

For years, Republican politicians have organized around their resistance to the program, calling it “socialist medicine” and a handout to the poor. Those arguments to the broader program have not gone away.

Eleven states, including Mississippi and Wyoming, have declined to expand Medicaid despite public opinion polls that show it is popular among Republicans and Democrats. Republican leaders at the state and federal levels have pushed for work requirements and Medicaid budget cuts in recent weeks.

But in the postpartum extension debate, opposing voices are increasingly overpowered by advocates who say it is the best way to combat alarmingly high maternal mortality rates, especially among minorities, and to care for expected surges of babies in states that limited abortion access after the Supreme Court overturned Roe v. Wade. Many of these states also have high uninsured populations.

“I’m very pro-life,” Wyoming Sen. Ed Cooper (R) said during a floor reading of the bill there this week. “If you claim to be pro-life, you have no other option but to support this bill.”

States are facing pressure this year as millions of people are expected to lose Medicaid coverage after the expiration of a provision of the federal Covid Public Health Emergency that prohibited states from disenrolling beneficiaries throughout the pandemic. That provision, which ensured new mothers stayed on Medicaid rolls after their babies were born, expires in April.

Twenty-eight states and Washington, D.C., have so far extended postpartum Medicaid coverage, with seven additional states planning to do so, according to KFF, a nonprofit organization focused on health policy issues.

That list includes almost every state that has not adopted broader Medicaid expansion, except for Wyoming and Mississippi. Texas and Wisconsin, the other two non-expansion states that have not adopted 12-month postpartum extensions, have requested federal waivers for more limited coverage periods — for 6 months in Texas and 90 days in Wisconsin.

Other red states are considering postpartum extension bills this year. That includes Missouri, where a proposal passed the Senate last week and unanimously passed the House Emerging Issues Committee on Tuesday. But the state’s two chambers clashed over a provision in the Senate-passed version that would bar women who have abortions from receiving the extended benefits.

The Wyoming bill passed the House 34-28 in February and survived a series of preliminary votes in the Senate. It was scheduled for a third reading in the Senate on Wednesday. Wyoming Gov. Mark Gordon (R) has announced his support.

In Mississippi, obstacles to the postpartum extension measure steadily fell away throughout the week, starting with Gov. Tate Reeves (R) announcing Sunday that he would support a bill that passed the Senate in February.

Reeves, who is facing a competitive re-election challenge, tweeted that his support for extending postpartum coverage would be part of a “new pro-life agenda” after the Supreme Court decision reversing the constitutional right to an abortion in a case that originated in Mississippi.

“I believe that to be a beautiful thing,” Reeves wrote. “I also believe that added stress will be felt by more Mississippi moms. We have to love them. We have to support them.”

House Speaker Philip Gunn (R), who spiked a similar bill last year after it had passed the Senate, then said he would allow the bill to advance. It passed the House House Medicaid Committee on a voice vote, with some opposition, on Tuesday. Now, Gunn and Medicaid Committee Chairman Joey Hood (R) must decide whether to bring the bill up for debate in the full House before the March 8 deadline.

Roy Mitchell, executive director of the Mississippi Health Advocacy Program, which supports Medicaid expansion, said Reeves’s about-face came after a number of influential groups — including the state medical association, the state Economic Council and a coalition of religious leaders — announced support for it.

“It bodes well for Medicaid expansion in general in Mississippi,” he said. “There’s a political awakening by the powers that be in this state that the majority of Mississippians support postpartum coverage for one year for moms.”

So far, though, broader Medicaid expansion remains a non-starter there: More than 15 bills that aimed to expand the program died in the state House and Senate without a debate or a vote in February.

An earlier version of this story inaccurately described Gov. Reeves’ position on the legislation. This piece has been updated.