Is Mississippi Medicaid intentionally stalling on timely health care for mothers?

After the head of Mississippi Medicaid said his agency needed more time to research a policy that would make it easier for poor moms to receive timely health care, a medical advisory board said it would meet in January to decide whether to recommend that the Legislature establish it.

However, with just a few days left this month, the committee has not met. And documents show the board and agency have been aware of the policy, presumptive eligibility for pregnant women, for months if not years.

The state Medicaid director, Drew Snyder, and CEO of Memorial Health System, Kent Nicaud, thwarted efforts at the Mississippi Medical Care Advisory Committee’s December meeting to make a decision on recommending pregnancy presumptive eligibility.

Pregnancy presumptive eligibility allows people to receive health care when they’re pregnant, even if they’re not on Medicaid because it’s presumed that they qualify. It makes receiving timely health care easier, which is an important part of safe pregnancies and deliveries. In Mississippi, most births are covered by Medicaid.

According to Mississippi Medicaid, a person can qualify by attesting they are pregnant, but many doctors and expecting people are under the impression a pregnancy test from a health care provider is required to be covered. Some doctors won’t see patients without health insurance, and for those people who can get appointments with Medicaid coverage, they have to pay out-of-pocket until their Medicaid application is approved.

The Mississippi Medical Care Advisory Committee, composed of 11 people appointed by the governor, lieutenant governor and speaker of the House, advises the Division of Medicaid.

Though lawmakers say they will move forward on pregnancy presumptive eligibility regardless of any bureaucratic impasse, the committee is influential. Last year, its recommendation to the Legislature to extend postpartum Medicaid coverage was instrumental in its passage.

At the December meeting, two doctors presented research showing that presumptive eligibility for pregnant women would positively impact perinatal health in Mississippi.

The latest maternal mortality report shows Mississippi is still one of the most dangerous places in the country to give birth, and one of just three states that has neither expanded Medicaid nor established presumptive eligibility for pregnant women. Research shows that preterm births are less likely for low-income people when they live in a state with presumptive eligibility and expanded Medicaid.

However, Snyder, a lawyer reappointed to his position by Gov. Tate Reeves, suggested at the meeting that his agency needed more time to research the policy. Nicaud, one of Reeves’ top donors, then pushed for a January meeting to discuss presumptive eligibility.

“Twenty minutes of discussion from two presenters is not enough on this complex issue,” Snyder said at the meeting.

But documents show that the Division of Medicaid has had ample time to research presumptive eligibility for pregnant women.

Rep. Missy McGee, R-Hattiesburg, emailed officials from the board and Medicaid on August 31, 2023, a records request revealed.

“I have come to believe presumptive eligibility would be very beneficial for health outcomes for both expectant mothers and babies in our State,” she wrote. “I am contacting you today to request the Medical Advisory Board for Medicaid offer an opinion on this issue and to ask you to add this to your agenda in a coming meeting. Your opinion would be very helpful as we begin preparations for the 2024 legislative session.”

The board has been hearing about this measure long before McGee’s August email.

Dr. Anita Henderson, a pediatrician from Hattiesburg and one of the presenting doctors at the December meeting, told committee members about pregnancy presumptive eligibility’s benefits at a meeting in 2022, and again in 2023.

And the approval of presumptive eligibility for pregnant women is recommended in a report released by the Mississippi State Department of Health in January 2023.

“State leaders can facilitate early initiation in prenatal care by implementing presumed eligibility for Medicaid or expanding Medicaid such that people enter pregnancy with necessary insurance and primary care,” the 2017-2019 Maternity Mortality Report reads.

It’s not clear whether Medicaid has the power to establish presumptive eligibility on its own or the policy needs legislative action. Snyder has said previously that the Division of Medicaid wouldn’t utilize pregnancy presumptive eligibility unless directed to by the Legislature.

The board’s next meeting has not been scheduled — the current board members’ terms expired at the beginning of the year.

“Once new appointments are made, the Division of Medicaid will facilitate the scheduling of the next meeting,” said Matt Westerfield, spokesperson for the Division. It’s not clear when new committee members will be selected.

Regardless of the committee’s actions, McGee, who was recently named chair of the House Medicaid committee, has once again introduced legislation this session to establish pregnancy presumptive eligibility.

“I believe we have strong support for this measure in the Mississippi House and look forward to taking it up in the weeks to come,” she said.