Wyoming lawmakers aim to improve pregnancy outcomes for moms and their babies. The item is the top interim priority for the Joint Health, Labor and Social Services Committee, which took it up during a meeting last week in Riverton.
One potential solution involves extending postpartum Medicaid coverage, which covers 33% of births in Wyoming, up to a year after the baby is born. No new groups of people would be eligible for the program, but thousands of pregnant Wyoming women enrolled in Medicaid could benefit from the proposal.
LSO’s report noted that over half of pregnancy-related deaths happen within a year of giving birth, and extending coverage could potentially reduce these deaths while improving care for a host of chronic conditions such as diabetes, hypertension, cardiac conditions, substance use disorder and depression.
Conditions like postpartum depression can last for years and advocates of the extension say the current 60-day postpartum coverage period doesn’t always allow enough time to access treatment for mental health and other ailments.
How it would work
Under the American Rescue Plan Act, states can elect to extend postpartum coverage for Medicaid recipients from the usual 60 days up to a year through a simple State Plan Amendment process.
Thirty-six states approved these extensions, according to the Kaiser Family Foundation. The change in policy would last until 2027 and would cost the state roughly $2 million a year, according to an estimate from the Wyoming Health Department. The federal government pays for the other half of the program.
Maternal health issues
The United States is contending with increasing maternal mortality rates, experiencing a rise from 20.1 deaths per 100,000 live births in 2019 to 23.8 deaths in 2020, according to the CDC.
From distance to cost, pregnant women in Wyoming face unique problems accessing medical care. Simply finding a facility to deliver can be a struggle: in the last year two hospitals — one in Kemmerer and one in Rawlins — announced closures of their labor and delivery units.
Mothers experiencing mental health issues postpartum also face treatment hurdles.
Mental health conditions were the underlying cause in four of the six cases of pregnancy-related deaths the Wyoming Maternal Committee reviewed, and substance use withdrawal contributed in all six. The National Institutes of Health notes “longer screening periods after birth may be needed to help more women with postpartum depression get treatment.”
In Wyoming, lack of access to healthcare and lack of financial resources were contributing factors that came up the most for pregnancy-related deaths reviewed between 2018-2020, Dr. Alexia Harrist, WDH state health officer, said during the meeting.
“I just see a lot of our mothers struggling with mental health,” said Rep. Andi LeBeau (D-Riverton), who supports the extension. She spoke about her own difficulties with postpartum depression, and the long period it can take to heal after giving birth.
“I’ll take any little bit that we can get,” LeBeau said.
Normally, pregnant women at or below roughly 150% of the federal poverty level qualify for Medicaid and that coverage extends 60 days after childbirth. Once postpartum coverage lapses, new mothers could potentially re-enroll in Medicaid through Wyoming’s Family Care Adult program, which has lower income standards.
Prior to the pandemic, about 70% of pregnant Medicaid recipients lost eligibility and were disenrolled after 60 days, according to research from LSO.
The federal government gave states additional Medicaid funding during the pandemic
with the understanding that states couldn’t disenroll recipients for the duration of the public health emergency, an official designation which hasn’t yet ended.
Because of that, pregnant women on Medicaid have been able to keep their health insurance long after giving birth.
“What we have with this particular group is somewhat of a natural experiment,” Director of the Wyoming Department of Health Stefan Johansson said. “In many cases, our postpartum coverage has exceeded beyond 12 months and even longer since the pandemic began.”
The American College of Obstetricians and Gynecologists supports extension efforts, noting on its website: “Our nation’s rate of maternal mortality is rising, and a growing body of evidence shows that many of these deaths, particularly from preventable causes such as overdose and suicide, occur after pregnancy-related Medicaid coverage ends.”
Medical groups in Wyoming voiced similar support for extending postpartum coverage up to a year.
“It makes sense to extend that coverage and give them that extra few months to make sure that they recover from childbirth,” said Eric Boley, Wyoming Hospital Association president.
“Anything that helps women maintain access to mental health and substance use disorder services is a winner,” said Andi Summerville, Wyoming Association of Mental Health and Substance Abuse Centers executive director. “What we don’t want to see is women that lose access to services before they’re ready. That can diminish their chance, especially with substance use disorder services, of being successful.”
Wait and see approach
Some on the committee are skeptical of the extension.
“I think we just got to see what happens with it,” committee member Sen. Troy McKeown (R-Gillette) told WyoFile. “And I’m not sure we even understand what it really means yet.”
WDH presented on costs associated with the extension but did not provide information on how outcomes for mothers who remained enrolled in Medicaid a year after giving birth were different from those who only had coverage for the usual 60-day period.
Chairman Rep. Sue Wilson (R-Cheyenne) asked WDH to gather more information about outcomes prior to the next committee meeting in August, and requested LSO draft a sample bill authorizing the plan.