Governor signs bill extending postpartum coverage under Missouri Medicaid

Postpartum Medicaid coverage will expand from 60 days to one year under legislation signed into law Thursday evening by Missouri Gov. Mike Parson. 

Missouri had the 12th-highest maternal mortality in the nation from 2018 to 2020, and three-quarters of pregnancy-related deaths in the state — or roughly 138 people — were preventable, the Missouri Pregnancy Associated Mortality Review Board found last year. 

“Missouri’s maternal mortality rate is frighteningly high, in particular for moms of color,” said Sen. Lauren Arthur, D-Kansas City. “This new law will save lives and make Missouri a safer, healthier place for new moms and their babies.”

The state Department of Social Services estimates the extension signed Thursday will cover more than 4,000 people who otherwise go uninsured two months after the end of pregnancy. 

Thirty-two states and Washington, D.C., have already implemented the extension.

Parson’s signature came as no surprise. 

In his annual State of the State address in January, the governor committed to tackling the state’s high maternal mortality rate, calling it “embarrassing and absolutely unacceptable.” He said the fact that three-quarters of maternal deaths in the state are preventable was a “tragic Missouri statistic.”

The proposal earned support from an ideologically diverse coalition, including both Pro-Choice Missouri and Campaign Life Missouri. But opposition from conservative members of the Senate, which blocked the bill last year, nearly upended its chances in the legislative session’s final weeks. 

Opponents wanted to include language designed to prevent anyone who receives an abortion from receiving the benefit. 

Study shows sharp increases in maternal deaths over two decades

Advocates said including the language would jeopardize federal approval, and though it was added when the bill initially passed the Senate, it was excluded from the version Parson signed Thursday. 

A multi-year report analyzing maternal mortality in Missouri and published last year found that women on Medicaid are eight times more likely to die within one year of pregnancy than their counterparts with private health insurance.

It also found Black women in Missouri were three times more likely to die within a year of pregnancy than white women.

The annual report published by the Missouri Department of Health and Senior Services and compiled by the state’s Pregnancy-Associated Mortality Review board assessed maternal deaths from 2017 to 2019.

It found that each year an average of 61 Missouri women died while pregnant or within one year of pregnancy, putting the state’s pregnancy-related mortality ratio at 25.2 deaths per 100,000 births. Overall, 74.5% of deaths were determined to be preventable — with a little over half of those deaths occurring between 43 days and one year postpartum.

The report found disparities continued to persist in which women are at a higher risk of dying during or after childbirth.

The bill signed Thursday also contained a provision eliminating mandatory blood lead testing for young children, which advocates believe would, counterintuitively, lead to increased rates of testing.

Lead is a dangerous neurotoxin that can be fatal in high doses. But low doses of lead from paint dust and corroded water pipes can also cause lasting damages, including reduced IQ, behavior problems and increased risk of mortality from cardiovascular disease.

Previously, all Missouri children younger than six who lived in — or spent more than 10 hours per week in — areas deemed high risk by state health officials were required to be tested for elevated blood lead every year. Those children who were not at high risk were to be screened for potential lead exposure with a questionnaire and tested if necessary.

Under the bill Parson signed, mandatory testing would be eliminated. Instead, all children under six are to be assessed with the questionnaire and tested if their guardian consents.

Supporters said the change would streamline testing requirements for doctors.

The legislation also eliminated a goal that Missouri test 75% of all children who receive Medicaid and replaced it with a goal to increase the number of children tested for lead poisoning under Medicaid.

The Independent’s Allison Kite contributed to this story.