Missouri Gov. Mike Parson signed into law last week a bill that extends Medicaid benefits for new moms from 60 days to a full year postpartum.
That extension would have helped Sharron Prather, who suffered from postpartum depression after she gave birth to her son 14 years ago.
“I was a first-time mom, my mom had recently passed away, so I had no family here in St. Louis,” Prather said. “And so, I didn't know what I was doing, you know, being a first-time mom. And I didn't know what postpartum depression was.”
Prather said she couldn’t figure out why she wasn’t connecting with her son.
“By the time I found out what it was, it was after my Medicaid had ended, so I didn't know I could have gotten services with counseling,” Prather said.
Because Prather had health insurance through Medicaid, she was covered through her pregnancy plus 60 days after giving birth. She says knowing she had limited time with health insurance added to the stress she was already experiencing.
“I tried to think like, I have to try to get my eye exam and I got to try to get my dental in, I have to try to make sure my baby’s got all the immunizations and everything in, within that window. But you're also still healing from having the baby,” Prather said.
Currently, people like Prather, who received health care during their pregnancy through MO Healthnet or the Show-Me Healthy Babies program see the same cutoff of 60 days postpartum. That short time frame of postpartum care means less opportunity to treat health conditions, like hypertension and diabetes, according to Dr. Ebony Carter, a high-risk obstetrician in the St. Louis area.
“During pregnancy, we manage to pull them together and try to tie everything in a nice bow and optimize it really well. And then they have the baby, and then they get kicked off,” Carter said. “And then I don't see them again till their next pregnancy when it's even more out of control than it was for the first one.”
Carter says the extension bill that Parson signed helps the most vulnerable, low-income mothers who often have underlying health issues.
“I think knowing that people don't just fall off of the health care cliff immediately, means that you can continue to engage and support and I hope what this will do is help us to better bridge care back to primary care after pregnancy,” Carter said.
Prather, who received health insurance through Medicaid during her pregnancies and births of all three of her children, said she believes having a year of postpartum care would have helped with her healing.
“Because I didn't have that support, I rushed my body because I had to go back to work, I had to do everything so I can pay these bills, because those bills were coming in. Like, after you have your baby. It's like, ‘Oh, great, yeah, we'll give you this formula, we'll give you all that. And then you're on your own,’” Prather said.
Missouri joins a growing number of states addressing maternal health
Through a provision in the 2021 U.S. American Rescue Plan Act, the federal government offered states the option to extend postpartum Medicaid benefits to a full year.
According to KFF, since April 2022, the Centers for Medicare and Medicaid Services has already approved programs in 35 states across the country, including fellow Republican-led states like Alabama and Tennessee.
A report published in 2022 by the Missouri Department of Health and Senior Services found that an average of 61 Missourians each year died while pregnant or within one year of giving birth. The report studied maternal deaths from 2017-19.
Furthermore, the rate of mothers on Medicaid dying during or within one year of pregnancy was more than eight times higher than those with private health insurance.
Republicans point to interest in family care
Both Democrats and Republicans played their part in getting the bill through both chambers. But opinions on why the legislation passed the extension can differ depending on political party as well as stance on abortion.
Missouri Republicans spoke on their commitment to decrease maternal mortality in the state during the legislative session, including both Parson and Senate President Pro-Temp Caleb Rowden, R-Columbia.
Rowden said Republicans should redefine what it means to be “pro-life,” which includes supporting policies like the coverage extension.
Sen. Elaine Gannon, R-De Soto, who sponsored the bill, said she fielded questions from some of her more conservative colleagues about the cost of more postpartum care.
“We are talking about saving lives here. Therefore, in my opinion, if it increases the cost of spending, then it's for one of the best causes,” Gannon said.
Sam Lee with anti-abortion group Campaign Life Missouri said he was ecstatic to see lawmakers pass the bill this session and believes the bipartisan support shows just how popular that idea was.
“I think everybody wants to help pregnant and new moms,” Lee said. “I think that just sort of a natural inclination, regardless of your politics, whether you're on the left or on the right.”
Lee said he doesn’t believe the passage of the bill had anything to do with the Dobbs decision that overturned abortion rights in June 2022. He said there was a desire to pass a Medicaid postpartum care extension the session before Dobbs even occurred.
“I don't think Dobbs had anything to do with timing. But it is clear that the public does want lawmakers to provide support for pregnant and new moms and their children. And this is one of those components,” Lee said.
Democrats say Republican support for bill is tied to abortion
Some Democrats and abortion-rights activists say it’s not a coincidence that the legislature was able to pass this bill the first session after almost all abortion became illegal in Missouri.
House Minority Leader Crystal Quade, D-Springfield, who announced Monday her campaign for governor, is one of those Democrats. She thinks the Republicans are trying to protect their public image after pushing for the abortion ban.
“I believe Republican lawmakers decided to start filing these bills that are pro-life bills that are pro-family and passing them and I'm grateful that these bills are moving, but I definitely think it is because of that backlash,” Quade said.
Maggie Olivia with the abortion-rights group Abortion Action Missouri agrees. She said she believes this was a media opportunity for those who are anti-abortion.
“The anti-abortion folks who set themselves up as supporters of this policy were really only doing so in order to save political face and falsely signal compassion, while they are continuing to further attack access to care for pregnant folks across the state,” Olivia said.
The national reframing trend
Anita Manion, a political science professor at the University of Missouri-St. Louis, said this has long been an issue that Democrats have expressed concerns over, and that Republicans in Missouri are following a national trend on reframing what it means to support families.
That includes supporting an extension of postpartum Medicaid services, even in Missouri where Medicaid expansion only occurred after citizens voted to add it to the state constitution. Manion also believes the overturning of Roe v. Wade played a role.
“We've also seen a pivot among a lot of conservative legislators here and nationally to try to find ways to say, ‘We support women and children after birth,’ and not just sort of as some people are seeing it, forcing women to carry pregnancies or forcing pregnant people to have children,” Manion said.
Manion also said states passing these policies could be motivated by political parties wanting to capture the vote of suburban women.
“We've seen them go after those women, whether it's school issues, with vaccines, with staying in school, with masking in school, and we've seen it with the Dobbs decision,” Manion said. “And so I think in some ways, this is a continuation of trying to get those voters and motivate them.”
In June, U.S. Secretary of Health and Human Services Xavier Becerra visited Missouri to mark the one-year anniversary of the overturning of Roe v. Wade. He said while abortion access should be restored, he did not believe it is connected to the extension of Medicaid coverage for new moms popping up across the country.
“We've needed to provide better health care services for women and their babies for a long time. And making sure that a woman can access maternal health care under Medicaid for more than 60 days, which was previous law, but now get it for full 365 days is absolutely indispensable and we are appreciative of all the states that are joining in the effort to expand maternal health care for all women,” Becerra said.
A good start
Dr. Ebony Carter sees this extension as a game changer for her high-risk patients.
“I actually think that it's now going to challenge us as physicians and as a larger medical system to do better to do better by our patients,” Carter said.
For St. Louis mom Sharron Prather, her own experiences led her to help others who are going through what she went through. Prather currently works as a social worker for Nurses for Newborns.
She said the clients she works with are excited about the new law.
“I have repeat moms and so they're just like, ‘Finally, like, this is what I'm talking about.’ I was like, ‘Hey, I'm like, I'm out there. I'm trying to advocate for it.’ So I was very excited to share that with them,” Prather said.
Prather said having health insurance for a year postpartum is going to give new moms more time to learn what their health care options are.
“They have time to actually look into it and they actually explore some of those benefits. I think a year at least, to start, it's not like my goal, but I think it's at least a start,” Prather said.
As to what also could be done, both Carter and Prather have ideas on improving health outcomes for moms.
“You also have to think about the social determinants of health like what are the resources that we have, to be educated and have good housing and have access to healthy foods. So, there's so much more and beyond the social determinants of health, those are not distributed fairly or equally among our society, and why is that? Discrimination and racism and oppression. So, it goes so much deeper,” Carter said.
Carter believes stronger funding for mental health support services and providing paid parental leave are important.
“I think that we don't do a great job of supporting new families with the economic hardship that comes with it, especially if you were already poor, and now you're losing time at work with parental leave,” Carter said.
One of Prather’s goals is to extend postpartum Medicaid coverage to at least three years. She said that could improve the continuity of care between the patients and their doctor.
“I feel like some of the doctors in some of the clinics will take their patients more seriously. Sometimes when they see Medicaid, their treatment is different than if they have a private insurance.” Prather said. “I feel like the stigma will be, I don’t want to say erased, but better, it'll be better.”
