Sam Lee, lobbyist for Campaign Life Missouri, testifies before the House Committee on General Laws about postpartum Medicaid extension, April 4, 2023 (Clara Bates/Missouri Independent).
Missouri legislators heard testimony Tuesday night urging them to remove an anti-abortion provision from a bill that seeks to extend postpartum Medicaid coverage out of concern it could put federal approval at risk.
The House Committee on General Laws heard a bill passed out of the Senate in February that would extend postpartum Medicaid coverage from 60 days to one year in an effort to lower Missouri’s maternal mortality rate.
The Department of Social Services estimates it would cover upwards of 4,000 people who otherwise go uninsured two months after the end of pregnancy. Missouri had the 12th highest maternal mortality in the nation from 2018 to 2020, and three-quarters of pregnancy-related deaths in the state were preventable, the Missouri Pregnancy Associated Mortality Review Board found last year.
But the Senate added language stating that no one who “knowingly receives services that are in violation of state law” can receive the coverage — which supporters said was designed to include anyone who has an abortion. They also added other language with various tweaks to Medicaid.
During testimony on Tuesday, advocates on both sides of the abortion issue expressed concern that the change could jeopardize federal approval for the state to extend coverage.
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Ron Berry, lobbyist for Planned Parenthood Great Plains Votes, testified in opposition to this version of the bill Tuesday, pointing to the Senate’s added language.
“We do understand the essential need for postpartum care,” Berry said, “but some of the language that came out in the Senate, we just cannot simply support this bill.”
Sam Lee, a longtime lobbyist for Campaign Life Missouri which has been a proponent of extending postpartum care, said he hopes the House cleans up the bill so the federal government is more likely to approve it without delay.
Lee said at a January hearing that those seeking abortions would typically not be enrolled in Missouri Medicaid for pregnant women — or the Children’s Health Insurance Program, which is called Show Me Healthy Babies in Missouri — in the first place, and so would not qualify for the extension of coverage.
“Typically a woman who’s seeking an abortion would not have been enrolled in Missouri Medicaid for pregnant women, would not have enrolled in Show Me Healthy Babies, and therefore would not be eligible for postpartum care for any period of time after that abortion,” Lee said.
Missouri law already bans abortion except in the case of a medical emergency.
“I just think there’s just some confusing language…By having that language in there, it’s going to cause head scratching and back and forth and could only delay that approval of that state plan amendment from going into effect,” Lee said.
Rep. Keri Ingle, D-Lee’s Summit, who sits on the committee, asked about the potential broadness of the language of those “knowingly violating” the law.
“The concerns that I’m hearing is that it could be expanded to anything from jaywalking, right, to keep a mom from having access to the care that she needs,” Ingle said.
“I think it’s pretty broad,” Lee agreed.
“The Senate process is different than the House process…sometimes things are done on the fly, so to speak. And things were put in that maybe were thought to be a good idea at the time,” Lee added, “But, you know, on occasion, the House has to fix up the work that the Senate does.”
The added language also requires various changes to the Medicaid program, including that the state remove from its rolls the same number of people as the number expected to receive extended postpartum coverage before the extension could go into effect.
In Texas, a bill extending postpartum coverage was passed with language that went beyond the federal guidelines, including about abortion, in 2021. The state has still not received federal approval to implement the extension.
The federal Medicaid agency provides a template for states to apply for the program. They wrote in guidance to the states in late 2021 that individuals under state extension plans are “entitled to the extended postpartum coverage regardless of the reason the pregnancy ends.”
Mandy Hagseth, director of policy and external affairs for Missouri Family Health Council emphasized the need for federal approval to “ensure that this policy becomes reality and is not simply performative,” she said.
“We believe the need is too great to risk the federal approval for Missourians who need this care and coverage now,” Hagseth added.
When the bill cleared the Senate in February, several senators made it known that they only allowed the bill to come up for a vote because of the inclusion of the additional provisions. If the House removes the anti-abortion and Medicaid reform language, the bill would need to go back to the Senate and could inspire a GOP filibuster.
“The value in the bill that’s before us right now is the reform aspects,” Sen. Bill Eigel, R-Weldon Spring, said during the February debate.
“If it was just a conversation about expansion of benefits,” Eigel added, “then…that is a conversation that would get extensive discussion here on the Senate floor, and may not ultimately lead to a place where we would get any bill at all.”
Democratic Sen. Tracy McCreery of Olivette, who sponsored an earlier version of the bill along with Sen. Elaine Gannon, R-De Soto, said in an interview with The Independent Tuesday night that she is “very hopeful” the House will clean up the language and conservative Republican senators “will do the right thing” and allow the bill to pass.
“I feel like we’re doing a good job of communicating. There’s still plenty of time to get this done,” she said, adding that the committee’s “thoughtful questions” to witnesses Tuesday were an indication they may take action to address the issues.
Other GOP-run states have championed the policy.
Mississippi Gov. Tate Reeves, a Republican, signed postpartum extension into law last month, saying: ”This is one more thing we can do to tip the scales in favor of life.” The proposal had failed in the state legislature several times in previous years.
The Missouri House version of the postpartum bill — without the abortion provisions — was passed by the Standing Committee on Emerging Issues last week. It has not yet come before the full House for a vote.
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