Rep. Lands: A First Step Toward Improving Maternal Health Care

By Rep. Marilyn Lands

ADDRESSING DISPARITIES: Alabama State Rep. Marilyn Lands advocates for Alabama’s Maternal Healthcare Access Act (HB494) to provide presumptive Medicaid eligibility, aiming to reduce barriers to early prenatal care and improve outcomes for mothers and babies across the state.

Alabama has a massive problem when it comes to accessing early prenatal care. According to the March of Dimes, 27% of Alabamians are unable to see a doctor within the first trimester, a number that increases to 33% if a patient is Black and 53% if that patient is Hispanic. For these patients, this delayed care makes it far more likely for them to have serious complications both for themselves and the child, possibly ending in tragedy for both. These consequences are unacceptable.

Fortunately, there is an extremely easy fix to this serious health crisis: better access to health insurance for those who are newly pregnant. While Alabama has a process in place to help those who are pregnant apply for Medicaid if they are uninsured, the system is onerous, antiquated, and causes unnecessary delays that force patients into unnecessarily long waits before that first appointment. That’s why we have introduced a bill to provide presumptive Medicaid eligibility, which would eliminate much of the lag time be- tween a positive pregnancy test and that first appointment with a doctor.

For those who become eligible for Medicaid due to a new pregnancy, the system for obtaining insurance is a “catch-22”, meaning it’s an impossible situation where you are prevented from doing one thing until you have done another. In this case, no person can apply for the program without a pregnancy verification letter from a doctor, but many people cannot get in to see a doctor to get that letter because they do not have insurance. Many find themselves trying to schedule an appointment at a county health department or other free venue for this initial step, which further delays their application submission, often as much as 45 days. It is only then that the patient can book their first prenatal care appointment, sometimes as long as eight weeks after first realizing they are pregnant, which could be well into their second trimester.

Delaying that initial appointment can have devastating effects on both mother and child. Early prenatal visits offer a baseline health check that can address any pre-existing health conditions or preventative care that had been delayed due to being uninsured Patients can receive STI testing and treatment, blood pressure monitoring and medication, equipment for testing blood sugars to monitor for diabetes. Each of these health conditions don’t just hurt the pregnant patients but can cause miscarriage, stillbirth, and preterm labor that cause much of our poor maternal and child morbidity and mortality numbers.

With presumptive eligibility, a newly pregnant person who is uninsured will be financially screened to see if she is eligible for Medicaid. If she is screened as likely eligible for Medicaid, she can go ahead and start receiving prenatal care while her application is being processed.

First trimester prenatal care is considered a standard part of pregnancy care. Yet for far too many Alabamians even that basic care is being denied to them simply because of a slow-moving bureaucracy, a medical system concerned about lost costs, and a model that is failing thousands of pregnant patients a year (and even killing some in the process).

Two weeks ago, HB494 (The Maternal Healthcare Access Act) was introduced and will provide presumptive eligibility for all pregnant women in Alabama, the bill has received strong bipartisan support and the support of women in leadership. This is a first but vital step in providing improved maternal healthcare policies and making Alabama more family friendly.