Montana is making progress in securing funding for a full year of Medicaid coverage for mothers following childbirth, which is a top priority for Governor Greg Gianforte’s administration and health care advocates who are concerned about postpartum complications, specifically maternal mortality. Presently, women enrolled in Montana’s public insurance program are only assured coverage for a period of 60 days after giving birth.
A bipartisan group of lawmakers on the Republican-controlled House Appropriations Committee voted on Tuesday to insert the change into House Bill 2, the state’s primary budget bill, with six Republicans in opposition. The provision could be struck or amended in the coming weeks as legislators continue to hammer out state funding priorities for the upcoming biennium.
Gianforte’s executive budget proposal initially failed to secure sufficient support from Republicans on the state health department’s budget subcommittee for the 12-month coverage plan. As an alternative, Republicans introduced and successfully passed a modification offering six months of postpartum coverage for new mothers with substance use disorders or mental health diagnoses. Democrats opposed this plan and instead advocated for a full year of uninterrupted coverage.
As the House Appropriations Committee reviewed amendments to the health department budget, lawmakers from the minority party revisited the topic during the week.
“The first year is critical in maternal health. I can speak to that from experience. I’m still not done with a full year after having my own child and it has been a wild year,” said Rep. Emma Kerr-Carpenter, D-Billings, in remarks to other lawmakers on the committee.
The United States registered 17.3 pregnancy related deaths per 100,000 births in 2018, a rate higher than in previous decades. One in three of those deaths happen in the time between one week and one year after giving birth, when cardiovascular issues, infection, hemorrhage and other complications put women at increased risk. Black, Hispanic and Native American women face higher rates of maternal mortality compared to their white counterparts.
Women with opioid use disorders are also a higher risk of overdose in the seven to 12 months after giving birth. The state chapter of the American Academy of Pediatrics also estimates that nearly 15% of Montana mothers experience depressive symptoms postpartum, with that phenomenon more likely for women on Medicaid.
Last week, the committee received testimonies from medical groups and social service providers stressing the significance of facilitating new mothers’ access to healthcare services such as primary care providers and specialists. These services are particularly crucial for addressing behavioral health issues and chronic conditions like diabetes and heart disease.
In a letter submitted to lawmakers, physicians from the Montana chapter of the American College of Obstetricians and Gynecologists expressed their concerns about the proposed extension. They acknowledged that while it may offer some assistance, it still leaves notable shortcomings in the system, ultimately hampering efforts to prevent maternal deaths. The physicians also emphasized that enhancing women’s health during the initial year of their child’s life has a direct positive impact on the wellbeing of the child.
Republicans on the budget appropriations committee rejected a Democrat-sponsored amendment to expand Medicaid coverage for all Montanans covered by the Medicaid Expansion program, despite previously approving the postpartum coverage adjustment. This attempt to extend 12 months of continuous Medicaid coverage also faced failure as a standalone bill in the final week before the March transmittal deadline.
Lawmakers also rejected a proposal by Rep. John Fitzpatrick, R-Anaconda, to increase Medicaid provider rates beyond what the health department subcommittee had already allocated. That amendment, which would have also accounted for annual inflationary increases, received blowback from other Republicans who touted the already agreed upon rate increases as “historic” and a significant boost for providers who take care of some of Montana’s most vulnerable and low-income residents.
The committee granted approval for two amendments aimed at broadening the eligibility criteria for the federal TANF program, also known as Temporary Assistance for Needy Families, as well as enhancing the financial support provided to eligible individuals.
The budget will ultimately move forward to the House floor for additional discussion.
