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Iowa Senate approves 12 months of postpartum Medicaid with a more restrictive income limit

The entrance to the Senate chamber
Madeleine Charis King
IPR file
The Iowa Senate passed Gov. Kim Reynolds' bill to extend postpartum Medicaid and further restrict eligibility.

Iowa Gov. Kim Reynolds’ proposal to extend Medicaid pregnancy coverage from 60 days postpartum to a year after giving birth passed in the Senate Monday.

Her bill would also lower the program’s income limit so fewer pregnant Iowans and infants would qualify for Medicaid, keeping government costs from significantly increasing.

Sen. Mark Costello, R-Imogene, said this expands Medicaid for people who truly need public assistance.

“We’ve found that not all the medical needs associated with pregnancy happen in the first two months, so we want to enable those women to get that coverage for a full year,” he said.

Costello said with the proposed changes, Iowa’s income limit would still be above the national average. Iowa currently has the most generous income threshold for pregnant women to get Medicaid.

Sen. Pam Jochum, D-Dubuque, urged Republican lawmakers to support an amendment to keep the current income limit in place.

“This is your chance to actually show that you care about babies and women after they’re born, to make sure that these babies and these moms are going to be healthy,” Jochum said.

Republicans rejected the amendment.

Sen. Janet Petersen, D-Des Moines, said 47 states have already expanded postpartum Medicaid, and Reynolds’ approach “is a real disappointment.”

“We finally get the governor’s bill to expand postpartum coverage, and she does it at the expense of pregnant women and their babies,” Petersen said.

Pregnant women in Iowa can currently qualify for Medicaid health coverage if their income is below 375% of the federal poverty level. Their new babies can also get covered by Medicaid. The bill would bar pregnant women from Medicaid if their income is more than 215% of the federal poverty level.

Costello said a pregnant mother in a family of four making $112,500 or less qualifies under current law. He said the bill sets a reasonable income limit of $64,500 or less for a family of four.

“Iowans do not support Medicaid for all,” Costello said.

According to a fiscal note, there are currently 10,800 Medicaid members with postpartum coverage.

The Iowa Department of Health and Human Services estimates about 15.8% of them would lose coverage under the bill, which is a monthly average of 1,300 women and 400 infants.

More than one thousand other infants who would lose Medicaid under the bill would qualify for the Children’s Health Insurance Program, which has different eligibility requirements.

A monthly average of about 2,300 pregnant women would be expected to stay on Medicaid beyond the current two months postpartum instead of transferring to a lower level of coverage. And an additional 2,700 women who otherwise would’ve lost health insurance coverage altogether two months postpartum would get to continue being covered by Medicaid for a year after birth.

The bill passed 34 to 13, with three Democrats joining all Republicans in support of the bill.

“Building a culture of life in Iowa means getting families off to the right start, but two months of postpartum care isn’t enough,” Reynolds said in a statement following the vote. “Extending postpartum care to 12 months for women with the greatest need helps them recover from childbirth, access family planning services, manage chronic health issues, and address mental health. For our state to be strong, our families must be strong.”

According to the nonpartisan Legislative Services Agency, the bill would ultimately cost the state $286,000 annually starting in fiscal year 2027. It would save the federal government more than $5 million that same year.

Sen. Sarah Trone Garriott, D-West Des Moines, said Iowa had the highest increase in infant mortality last year compared to all other states. She said babies should not be kicked off of health insurance in their first year of life.

“Now one explanation I heard for cutting eligibility for pregnant Iowans and their babies was that my Republican colleagues wanted this expansion to be cost neutral,” said Trone Garriott, who ultimately voted for the bill. “But there is a cost to kicking pregnant Iowans off of Medicaid. There is a cost to kicking infants off of Medicaid. It is the cost of lives.”

Democrats asked Costello what pregnant women who don’t qualify for Medicaid should do to pay for prenatal care, birth, and health care for themselves and their babies after birth.

Costello suggested some would have to pay out of pocket for these services. He also said Iowans can purchase insurance on the health care marketplace. Birth is a qualifying event to buy health coverage outside of the open enrollment period, but pregnancy is not.

Katarina Sostaric is IPR's State Government Reporter