Alabama’s new budget to extend Medicaid coverage for mothers after childbirth

By Mike Cason 

Women in Alabama who qualify for Medicaid during pregnancy will have coverage for a year after giving birth under the state’s new budget, an extension of the coverage that has ended after 60 days.

The General Fund budget Gov. Kay Ivey signed into law two weeks ago includes $4 million to extend the postpartum coverage for Medicaid. A total of $8.5 million will be applied to the extension, including funds the Alabama Medicaid Agency previously designated.

The extension is a one-year pilot program. Lawmakers want the Medicaid Agency to review the costs, use of the services, and health outcomes to determine if it will be continued.

Advocates who supported the extension expect it to save lives in Alabama, where Medicaid pays for about about 30,000 births per year, about one-half of births in the state.

Mothers die from complications from pregnancy and childbirth in Alabama at more than twice the national rate, according to the National Center for Health Statistics at the Centers for Disease Control and Prevention.

In 2018, Alabama’s rate was 36.4 maternal deaths per 100,000 live births. The national rate was 17.4. Arkansas and Kentucky were the only states with higher rates than Alabama.

Alabama follows neighboring states Georgia, Florida, and Tennessee in extending postpartum coverage. Congress streamlined the extension process as part of the American Rescue Plan Act, the COVID-19 relief package approved last

Robyn Hyden, executive director of Alabama Arise, said the extension will save lives.

“It will help reduce long-standing racial disparities in health care that have plagued our state for generations,” Hyden said in a press release. “It also will promote more stable families, vibrant communities and a healthier future. This is an important step closer to the day when all Alabamians can get the health care they need to survive and thrive.”

Alabama Arise is a nonprofit organization that advocates for state policies that help low-income families. Alabama Arise is a member of the Cover Alabama Coalition, which supports expanding Medicaid coverage to more people in Alabama, which has some of the nation’s strictest eligibility requirements overall, although not as strict for pregnant women.

Medicaid eligibility for pregnant women in Alabama is based on 146% of the federal poverty level. The income limit is $1,654 for a family of one, $2,228 for a family of two, $2,802 for a family of three, and so on.

Jane Adams, director of the Cover Alabama campaign for Alabama Arise, said members of the steering committee, which include the Medical Association of the State of Alabama, the Alabama Chapter of the American Academy of Pediatrics, the Women’s Foundation of Alabama, and other groups, plan to meet with Alabama Medicaid Commissioner Stephanie Azar soon about the startup of the postpartum coverage extension. Adams said she is hopeful the extension is in effect before October.

Adams said it will be important to get the word out about the coverage extension, including through the offices of OBGYNs and pediatricians.

“We want women to utilize the care. That’s the only way this works,” Adams said.

Adams said the 60-day limit on coverage is inadequate for several reasons. For example, it generally does not allow time for women to see specialists, such as a heart doctor, if there is a need. Also, some of the problems that women encounter after childbirth often surface later than 60 days, such as postpartum depression, Adams said.

Alabama launched a Maternal Mortality Review Committee in 2019 to investigate maternal deaths. In November 2020, the committee reported that almost 70 percent of the deaths were preventable.

Dr. Julia Boothe, president of the Medical Association of the State of Alabama, said the committee’s findings underscore the importance of medical care during the 12 months after childbirth. In a statement about the coverage extension, Boothe said the committee identified cardiovascular risk factors and mental health and substance abuse disorders as the leading underlying causes of pregnancy-related deaths in Alabama.

“Moreover, women of color are disproportionately affected,” Boothe said. “As we strive to expand access to care in Alabama and in its most rural areas, this extension will provide women on Medicaid needed treatment and resources before, during and after pregnancies. For the 30,000 Alabamians whose deliveries are covered by Medicaid each year, extending coverage can be life-saving for not only the mother, but also the child. Physicians statewide believe that this is a positive step in the right direction for Alabama in reversing the dangerous trend in maternal deaths and continuing access to care for mothers after pregnancy.”

Alabama is one of 12 states that have declined to expand Medicaid with the federal government paying most of the cost as allowed under the Affordable Care Act.

Medicaid covers about 1 million people in Alabama in one or more of its programs. Children in low-income families make up about half that number. The other main categories are people with disabilities, pregnant women who meet income guidelines, and people in nursing homes.

Adams said advocates for expansion are appreciative of the decisions by Ivey and state lawmakers to extend postpartum coverage. But Adams said Medicaid expansion would do more to protect the health of women.

“If Alabama really wants to tackle maternal mortality and change outcomes for new parents and new moms, then the logical next step would be to make sure that new mothers or women have coverage before, during and after pregnancy,” Adams said. “Because a lot of the health conditions that women have — like diabetes, or hypertension, or let’s say a woman is obese — those are chronic health conditions that they have before they get pregnant. And a lot of times, if you’re able to treat those before you get pregnant, your pregnancy is so much easier, and your health outcomes of you and your baby are so much better after you deliver.

“So, while we’re incredibly grateful for this extension of postpartum Medicaid and it is going to save lives, the reality is the best outcomes will happen when women are covered before, during, and after pregnancy. And that means Medicaid expansion.”