Iowa Senate votes to extend Medicaid for low-income mothers; others would lose coverage

Low-income Iowa mothers would be eligible for a full year of Medicaid coverage after giving birth, under a bill that passed the Iowa Senate Monday.

But the bill would also lower the income threshold to qualify for postpartum coverage under Medicaid, cutting off coverage for about 1,700 women and babies each month who are currently eligible for Medicaid coverage during and after a pregnancy.

The Senate voted 34-13 Monday afternoon to pass Senate File 2251, which Gov. Kim Reynolds proposed during her Condition of the State address in January.

"Building a culture of life in Iowa means getting families off to the right start, but two months of postpartum care isn’t enough," Reynolds said in a statement. "Extending postpartum care to 12 months for women with the greatest need helps them recover from childbirth, access family planning services, manage chronic health issues and address mental health. For our state to be strong, our families must be strong."

Three Democrats, Sens. Eric Giddens, D-Cedar Falls, Sarah Trone Garriott, D-West Des Moines, and Zach Wahls, D-Coralville, voted with every Republican present in favor of the bill, while every other Democrat was opposed.

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Iowa law currently provides women with Medicaid coverage during pregnancy and for 60 days after giving birth, the minimum required by federal law.

Iowa is one of only three states, along with Arkansas and Idaho, that has not implemented or is actively planning to implement a 12-month extension of coverage for new mothers.

Reynolds' bill would provide a year of postpartum Medicaid coverage to those whose family income is up to 215% of the federal poverty level ($64,500 annually for a family of four).

Current Medicaid eligibility in Iowa for women postpartum allows for a maximum family income of 375% of the federal poverty level (about $117,000 for a family of four).

Sen. Janet Petersen, D-Des Moines, tried unsuccessfully to amend the bill to offer one year of postpartum Medicaid coverage at the current income threshold, saying, "Iowa is better than this."

"The governor does not put one dime of new money in her bill to extend postpartum coverage," Petersen said. "She pays for extending postpartum coverage to a few members that still remain eligible for pregnancy care by dropping thousands of pregnant moms and their babies off of Medicaid."

About 1,700 people each month would lose Medicaid coverage if the new requirements take effect, according to an analysis of the bill by the nonpartisan Legislative Services Agency. That includes 1,300 women and 400 babies who would no longer be covered under the less generous income restrictions.

Another 1,100 babies would be moved from Medicaid coverage to the Hawki children's health insurance program each month, which applies to families up to 302% of the federal poverty level.

Democrats said Iowa's rising maternal mortality rate shows the need for extending Medicaid coverage at the higher income level.

"Iowa had the highest increase in infant mortality last year of any state," Trone Garriott said. "Iowa babies are dying. We should not be kicking even one baby off health care coverage during their first year of life."

The bill would also mean 2,700 women who would have otherwise lost coverage after 60 days will be able to remain on Medicaid for a full year. Another 2,300 women would remain on Medicaid after the first two months, rather than qualifying for insurance through the Iowa Health and Wellness Program.

Sen. Mark Costello, R-Imogene, said "Iowans do not support Medicaid for all" and that the bill extends coverage for those with the most need.

"Not all the difficulties or medical needs associated with pregnancy happen in the first two months so we want to enable those women to get that coverage for the full year," he said.

Once the new income requirements are implemented, it would result in the state spending $286,000 less annually on Medicaid coverage for new mothers and infants, according to the analysis.

The House must still pass the bill before it can go to Reynolds for her signature.

Senate votes along party lines to pass bill changing anti-abortion MOMS program

The Senate also voted 31-16 Monday to pass a bill with changes to the More Options for Maternal Support, or MOMS, program.

Every Republican present voted to pass Senate File 2252, while every Democrat was opposed. The bill is now eligible for consideration in the House.

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The MOMS program provides state dollars to pregnancy resource centers that counsel women against abortion. The centers typically offer donated items for new mothers like cribs and baby clothes, as well as family planning classes and other programs. Some centers also offer ultrasounds, though these centers are not licensed medical clinics.

The bill removes the requirement that the state hire a third-party administrator to oversee the program. Instead, it would let the Iowa Department of Health and Human Services take on that role, which it has already been doing on an interim basis.

The state failed twice last year to identify a qualified entity to serve as an administrator for the program. The first search only garnered one applicant who failed to meet the state's requirements. The second search yielded "no responsive bidders."

The bill also removes the requirement that an administrator have three years of experience in Iowa before they could be hired by the state to oversee the program.

Democrats unsuccessfully offered amendments to require any ultrasounds to be performed by licensed medical providers, to require pregnancy resource centers to prominently display if they are not licensed health care providers and to require centers to comply with state and federal patient privacy laws.

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"Iowans need to know what they can expect from these programs," Trone Garriott said. "If these are not medical services, then they need to be told that up front."

Iowa lawmakers have allocated $2 million to the program, and the state announced last month that it would award grants to four providers, with exact amounts to be negotiated.

Republicans expressed confidence in the program.

"We have a lot of safeguards in place," Costello said. "Here’s another opportunity to vote to support expectant mothers and mothers in our state. This bill ensures the department has the most flexibility to operationally support the goals of this program."

Des Moines Register Reporter Michaela Ramm contributed to this article.

Stephen Gruber-Miller covers the Iowa Statehouse and politics for the Register. He can be reached by email at sgrubermil@registermedia.com or by phone at 515-284-8169. Follow him on Twitter at @sgrubermiller.

This article originally appeared on Des Moines Register: Iowa Senate votes to extend Medicaid coverage for low-income mothers