Expansion of Medicaid benefits for new moms gaining support in some Republican states

After years of refusing to expand Medicaid benefits for new moms, Republican officials in more than a half-dozen states are now reversing course and trumpeting that coverage as central to their conservative, anti-abortion agenda.

The shift in GOP support for postpartum Medicaid coverage is occurring in some states that have severely limited or outlawed abortion access since the Supreme Court overturned the constitutional right to an abortion last June. The effort also comes as federal protections guaranteeing people stay continuously enrolled in Medicaid during the COVID-19 pandemic is set to expire in a few weeks.

Deep-red Mississippi on Tuesday became the latest state to require Medicaid to provide a full year of coverage for low-income mothers after giving birth. Days earlier, Republican Gov. Tate Reeves declared the policy was part of the state’s "new pro-life agenda."

Extended postpartum coverage had been rejected three times by the state’s lawmakers since 2021 but a push for the measure succeeded after most abortions became illegal in Mississippi, following the U.S. Supreme Court’s ruling.

In Wyoming, where an abortion ban remains in legal limbo, Republican Gov. Mark Gordon echoed a similar refrain when he signed a bill extending postpartum Medicaid coverage into law on Friday, calling it a "signature piece of pro-life legislation."

The Biden administration is encouraging all states to extend postpartum Medicaid coverage to a full year, Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure said in a statement.

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"Postpartum care is crucial for the health and wellbeing of women, and can have benefits for their babies and their growing families," she said. "In addition to comprehensive pregnancy and postpartum care, reproductive health care is essential to support the health of women and families."

Republicans, however, have long criticized efforts to expand Medicaid, a taxpayer funded program that provides health care coverage to roughly 84 million of the country’s poorest people.

Roughly 40% of births are covered by Medicaid, and states are required to keep women enrolled for up to two months after giving birth. Most states have already extended Medicaid coverage, guaranteeing access to the program for up to a year after a woman gives birth.

That coverage can be crucial in a country where maternal deaths — many of which occur in the days or months following a delivery — are rising. Research has found that women are less likely to be hospitalized during the postpartum period if they live in a state that has broaden Medicaid coverage to those with slightly higher incomes.

Mothers who are cut off from Medicaid after 60 days might not only lose access to their insurance, but the doctors they developed relationships with throughout their pregnancy as well, noted Laura Wherry, a New York University economics professor who researches Medicaid expansion.

"A lot of those maternal deaths occur after this period when pregnancy Medicaid coverage ends," Wherry said. "There are a number of different ways that expanding coverage could effect women and their health outcomes and their mortality outcomes."

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But 13 states have held out on expanding postpartum coverage for up to a year, a decision that has been met with intensified criticism when some of those states restricted or banned abortions last year.

Texas, Wisconsin, Missouri, Iowa, Idaho and South Dakota are among the states that have mostly banned abortion and only offer women 60 days of postpartum Medicaid coverage.

Wisconsin's Democratic Gov. Tony Evers' proposed a budget last month that would extend the postpartum coverage period to a year, but the Republican-controlled Legislature has expressed little interest in supporting the plan.

Republicans in other states, however, are now quickly pushing to expand the coverage.

South Dakota Gov. Kristi Noem, a Republican who has long opposed expanding the income eligibility threshold for Medicaid to those who make up to $18,800 annually, announced in February that she'd seek to extend the postpartum Medicaid coverage period to 12 months.

In Alaska, where abortion is still legal, Republican Gov. Mike Dunleavy introduced legislation earlier this year that would do the same. Meanwhile, Idaho state representative Megan Blanksma, a Republican, proposed a similar law for her state in February.

Last week, Missouri's Senate signed off on a plan to expand the postpartum coverage for a year. The bill will now be considered by the House.

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The proposal would have had little support from Republican Senate Majority Leader Cindy O’Laughlin in years past, the lawmaker told reporters just last week.

"Prior to now I would have probably said, `I don’t want to expand welfare,’" O’Laughlin said. But she's since changed her to tune saying that without Medicaid coverage, the "person that might suffer the most would be the child or the children."