Alabama is poised to become the latest domino in a line of Southern states choosing to extend Medicaid coverage to birthing people for a full year after birth – pulling the region more in line with the rest of the country.
First came Georgia, which expanded its Medicaid coverage for pregnant people from 60 days to 6 months in 2021. Then Florida legislators voted in favor of extending their Medicaid coverage to one year postpartum later that year. Tennessee legislators did the same.
This year, Georgia’s Republican Gov. Brian Kemp included in his recommended state budget funding to extend coverage from six months to a full year, “to help address the problem of maternal mortality in our state,” he said in his letter outlining the budget.
Alabama appears likely to be next, with Mississippi right on its heels.
Alabama’s proposed general fund budget, expected to be released this week, will include a $4 million allocation to Alabama Medicaid to extend its coverage to birthing people for 12 months postpartum, Alabama state Rep. Steve Clouse, a Republican from Ozark, told Reckon this week. Clouse is chair of the Alabama House’s General Fund budget committee.
That $4 million will be added to the approximately $4 million that Alabama Medicaid had already set aside in its current budget to extend coverage to six months postpartum, Clouse said. The additional money in the general fund will bump the coverage to a full year.
“We’ll see how the numbers stack up from Oct. 1 of this year to Sept. 30 of 2023, and we’ll go from there,” Clouse said.
“It’s what all of our surrounding states seem to also be doing.”
It’s a course-correction with a potentially significant impact. Nationally, Medicaid covers about 40% of births. But in the South that percentage is far higher: Medicaid covers about 60% of births in Louisiana and Mississippi, 50% in Alabama and 47% in Georgia and Florida.
In states that haven’t expanded Medicaid – there are 12 of them, nearly all in the South – pregnancy Medicaid coverage is only required to last for 60 days after a birth. That means new moms and other birthing people can be left without insurance to cover care for physical or mental health issues that arise more than two months after a birth.
In states that did expand Medicaid, coverage for low-income birthing people is a given.
Postpartum Medicaid expansion is low-hanging fruit, said Jane Adams, campaign director for Cover Alabama, a statewide alliance that advocates for Medicaid expansion. While many state leaders across the conservative South continue to balk at full-scale Medicaid expansion, they’re increasingly more open to extending year-long coverage to low-income moms, she said.
That’s likely because in recent years, maternal mortality rates have risen steadily in the U.S., drawing more attention to the need for improved healthcare for birthing people. Disparities in the rates are stark: Black mothers are three times more likely to die than white mothers. And Southern states have seen higher mortality rates than most other parts of the country. In 2020, after Alabama fully funded its Maternal Mortality Review Committee to investigate maternal deaths in the state, one of the committee’s first recommendations was that Alabama expand Medicaid to cover more low-income birthing people.
It’s an issue that shouldn’t be political, said Dr. Nadia Richardson, executive director of No More Martyrs, a mental health awareness campaign focused on supporting Black women. Richardson and her organization have advocated for postpartum Medicaid expansion.
“When we’re talking about the health and wellness of residents of our state, that’s not a Democratic or Republican issue,” she said. “We have the opportunity to save lives and we should be able to do that together.”
One-third of pregnancy-related deaths occur between one week and one year postpartum. Coverage that ends two months after a birth interrupts healthcare access during a potentially critical time.
“What’s complicated and scary is that a mother might be experiencing, for example, a high level of fatigue or dizziness, but not recognize that it’s related to a cardiovascular problem,” Richardson said. “It takes ongoing checkups with a health care professional to catch complications that can arise.
“That additional six or eight months of Medicaid coverage has the potential to save a lot of lives.”
In Mississippi, the state Senate overwhelmingly passed a bill in February to extend Medicaid benefits to a year postpartum. It’s now in the House and its chance of passing looks favorable, Adams said. The Mississippi Legislature almost approved the one-year postpartum provision last year, before a fight between the House and Senate in the session’s final days left it off a final Medicaid bill.
The federal government also made expansion more attractive this year. A provision in the American Rescue Plan Act, passed in 2021, removed much of the red tape for states wanting to extend postpartum coverage to a year. Beginning April 1, those states can opt for the one-year expansion with a simple letter to the U.S. Centers for Medicare & Medicaid Services.
It’s one more reason for states like Alabama and Mississippi to jump on board, particularly when state leaders look around and see their Southern neighbors doing the same thing.
“I think when we naturally look on any type of legislation, whether it be taxes or any type of bill, our legislators want to know what our neighbors are doing,” said Clouse, “versus what somebody’s doing in California or New York.”
This week, advocates will gather at the Alabama State House for a Save Alabama Moms rally in support of postpartum Medicaid expansion. The group includes Alabama Arise, the American Heart Association, the March of Dimes, Women’s Foundation of Alabama, the Alabama Medical Association and others. The event will feature guest speakers, including some state lawmakers.
It’s the culmination of years of advocacy work, said Adams. For advocates, postpartum Medicaid expansion is just one piece of the puzzle when it comes to improving healthcare for all Southerners. But it will extend healthcare access for tens of thousands of moms and birthing people across the South, she said.
“It takes all of us to solve these complex problems,” Adams said. “It’s the pride of my life as an advocate to see the process work to benefit vulnerable populations. It’s beautiful.”