A piece of Indiana legislation could expand postpartum Medicaid coverage – something one lawmaker said is crucial to residents’ health and safety after pregnancy.
Indiana HB 1140, authored by Republican Rep. Ann Vermilion, District 31, would provide for eligible people to get between 60 days and 12 months of Medicaid care after pregnancy. This would include medical, dental, family planning and treatment for substance use disorder — not just health care related to pregnancy.
It passed the Senate on third reading last week and has been returned to the House.
Dr. Rita Fleming, a Democratic state representative from Jeffersonville and a co-author of the bill, said the extension is much-needed. She said she knows from her decades of practice as an OB-GYN that six weeks is not long enough to help people get the care they need.
“I would often try to cram in whatever care I could in six weeks, knowing that this individual was going to lose her coverage,” Fleming said. “But that’s hard to do and if the patients maybe weren’t able to keep their appointment or they had a sick child at home … beyond six weeks, that was it. It wouldn’t get paid for.”
And there’s evidence to show that when people have died in Indiana in recent years, many times it’s been after that Medicaid coverage window.
Reports from the Indiana Maternal Mortality Review Committee show that in 2018, there were 63 pregnancy-associated deaths either during pregnancy or within a year of it. Just over a third of deaths were outside that six-week window.
In 2019, the most recent state data show more than half the deaths were after that time period.
“The postpartum period is when women are the most vulnerable and it’s not that traditional six weeks period,” Fleming said. “This data show that that’s poor practice and most of the deaths occurred well beyond six weeks.”
The state reports show that Black people had the highest postpartum death rate in 2018, with 103.1 deaths per 100,000 live births. This is compared to 86 for white residents and 25 for Hispanic residents.
Substance use was responsible for around half of the deaths across the board in both 2018 and 2019. Fleming said she hopes the extension outlined in this bill will give them more opportunity for meaningful treatment options.
She said while people are more likely to seek addiction treatment during pregnancy due to concerns of the baby, “We also know there’s a big fall off and a lot of reentry into substance abuse after delivery,” she said.
“You’ve got a screaming baby, you’re sleep deprived. You may not have the support from family that you really need, that anybody needs.”
For a pregnant person to be eligible for Medicaid under the new bill, they cannot make more than 208% of the federal income poverty level for a family of their size. This would mean they couldn’t make over $38,084 for a family of two, and 57,720 for a family of four.
Current law says they can’t earn over 200% of the federal poverty level and still receive Medicaid.