Iowa would become one of the last states to extend Medicaid coverage for pregnant women 12 months after giving birth, under a bill advanced by a Senate subcommittee Monday.
Maternal health advocates praised Gov. Kim Reynolds’ proposal to provide a year of postpartum Medicaid coverage instead of the current 60 days, saying it would improve health outcomes for moms and their babies. But they expressed concerns about the part of the bill that would tighten income limits for pregnant people to qualify for Medicaid.
Pregnant Iowans can be eligible for Medicaid if their income is below 375% of the federal poverty level (FPL), or $93,225 for a family of three. The governor’s bill would cap eligibility at 215% of the FPL, or $53,449 for a family of three.
Blank Children’s Hospital lobbyist Chaney Yeast said she applauds Reynolds for making postpartum Medicaid expansion a priority. But she said lawmakers should reconsider cutting eligibility.
“We have a maternal mortality crisis. We have an infant mortality crisis,” Yeast said. “This is a single policy lever that you can pull to improve the health of moms and babies but also support our workforce in Iowa.”
Yeast said moms who work for small businesses that don’t provide health insurance could lose out on coverage if the state lowers the income limit. She said buying insurance through the federal marketplace is not an option outside of the open enrollment period.
Mary Nelle Trefz, lobbyist for Iowa ACEs 360, thanked state leaders for proposing 12 months of coverage.
“It increases access, improves outcomes, reduces costs to our state, and most importantly, it saves moms’ and babies’ lives here in Iowa,” she said.
But Trefz said the lower income eligibility could hurt working and rural families, and she urged lawmakers to consider options for getting more federal funding to provide health coverage to more pregnant women.
The bill got unanimous support from the Senate subcommittee.
Sen. Janet Petersen, D-Des Moines, said she would vote for the bill in subcommittee because she supports extending postpartum Medicaid coverage. But she said Iowa currently has the most generous income limit for pregnancy coverage in the country, and the bill would put Iowa in 13th place.
“So why would we take a pretty significant step backward for pregnant moms in order to get postpartum coverage?” Petersen asked.
“I think the concept is to bring our FPL in line with other states…and to use those investment dollars to extend coverage,” said Kelly Garcia, director of the Iowa Department of Health and Human Services.
The bill would not cost the state any additional money, according to the governor’s office.
Sen. Mark Costello, R-Imogene, said 375% FPL is “pretty good money.”
“And you probably should be able to have insurance or take care of yourself at that rate,” he said. “So I think there’s room for us to move that down to be in line with other states.”
Speaking on Iowa PBS last month, Reynolds called her proposal a “drastic improvement.”
“I want to make sure that we could not only extend it to 12 months, but to make sure that we were providing these services for the people that really need it,” Reynolds said.
The Senate passed a bill in 2022 that would have extended postpartum Medicaid without changing eligibility requirements. That bill was not brought up for a vote in the House.
