Republicans who control the Iowa Legislature and governor’s office are signaling their intent to allow some pregnant women covered by Medicaid to keep coverage for 12 months after the end of pregnancy.

In her Condition of the State address Tuesday evening, Iowa Gov. Kim Reynolds said she is proposing lengthening Medicaid coverage for moms who make less than a certain amount. The governor’s website says the cutoff would be set at 215% of the federal poverty level. That’s about $64,500 for a family of four.

“Let’s do more to help moms, babies and their families get off to a good start,” Reynolds said in her address.

Only three states, including Iowa, have not extended postpartum Medicaid for a full year; currently, Iowa law allows for 60 days of coverage after a pregnancy ends. Similar legislation has advanced in recent years but has never made it to Reynolds’ desk.

The day before Reynolds’ address, House Study Bill 500 was assigned to a subcommittee; that bill would also extend postpartum coverage to 12 months but does not mention unique income restrictions. No legislation to implement the governor’s proposal had been introduced as of late Friday.

State Rep. Beth Wessel-Kroeschell, D-Ames, said in an email message to Fearless that Reynolds’ plans for a stricter income eligibility threshold would keep thousands of pregnant Iowans each year from getting the coverage extension. “This is a great program made bad by this change,” she said. Wessel-Kroeschell is a member of the subcommittee on House Study Bill 500. She frequently speaks about policies that affect women, their families and the economy.

Reynolds’ office did not immediately reply to an emailed request for comment Friday afternoon.

Advocates say that longer coverage would help thousands of Iowa women annually to manage postpartum complications and other issues.

Medicaid is a critical source of health insurance coverage for half of mothers in Iowa, said Brittney Haskins, president of the Iowa chapter of Postpartum Support International, also known as PSI. Haskins said extending postpartum Medicaid coverage for women is Iowa PSI’s top legislative priority this year.

Maternal health emergencies can occur long after a birth
Haskins said that mothers can experience major health problems long after 60 days postpartum, including ongoing cardiac issues, mental health disorders and more.

“Removing Medicaid coverage leaves women unable to pay for medical expenses and less likely to seek treatment, which leads to higher rates of morbidity and mortality,” Haskins said. “This has a ripple effect on the family system, as mothers are often the primary caregivers.”

Mary Nelle Trefz is the advocacy network director of Iowa ACEs 360. Trefz said that some of the most dangerous pregnancy-related complications, such as eclampsia, cardiomyopathy and strokes, may not surface until months after a delivery.

“If a new mom loses health insurance coverage shortly after giving birth, these complications are unlikely to be identified or treated,” Trefz said.

The same is true for perinatal or postpartum mood and anxiety disorder, also known as PMAD, which are some of the most common conditions identified during pregnancy and postpartum, Trefz said.

“Losing coverage just 60 days after giving birth makes it difficult to identify and manage these conditions,” she said.

Consequences of poor postpartum health include generational trauma, health problems for offspring
Left untreated, maternal mental health conditions are costly and have multigenerational consequences, both Trefz and Haskins emphasized to Fearless.

“The costs come not just from health care services for mothers, but also in lost workforce productivity and increases in child developmental and behavioral disorders,” Trefz said.

Moms with Medicaid coverage are 25% more likely to have symptoms of postpartum depression compared with mothers covered by private insurance, Trefz added.

Women who live with untreated postpartum depression have children with a higher ACES [Adverse Childhood Experiences] score later in life, Haskins said.

The higher a person’s ACES score, the more at-risk that person is for major health complications over a lifetime, including cancer, heart disease, diabetes, depression and more, according to the Centers for Disease Control and Prevention. People with high ACES scores are also more likely to be the victims of a crime and more likely to struggle with finances and jobs, according to the CDC.

Extending the length of Medicaid coverage provides access and funding to resources and treatment for doctor’s visits, cancer screenings, postpartum mental health medication and sometimes therapy, Haskins said.

“Healthy mothers are better able to bond with their children, create secure attachments with their babies, are more likely to attend their children’s well-visits, and are less likely to call into work sick or quit their jobs,” Haskins said. “Extending Medicaid coverage beyond the current 60 days postpartum is not only basic health care for women, but will have positive effects for their families, communities and the economy.”