Starting this month, pregnant Iowans on Medicaid have 12 months of coverage after giving birth, a significant increase from the previous cutoff of 60 days.
Iowa lawmakers approved the change in the last legislative session, making the state one of the last to approve the extension after the federal government started offering permanent matching funds in 2021 to states that extended coverage to 12 months.
A family of four now needs to make less than $67,080 a year to qualify under the 2025 guidelines.
Doctors like Christian Pettker, the chair of the Department of Obstetrics and Gynecology at the University of Iowa, said the extended coverage period is needed, as many serious issues can come up beyond the first two months postpartum.
"That includes hypertension, diabetes, mental health disorders, so extending it out another 12 months gives the person and the care team time to develop a longitudinal care plan," he said.
That care plan includes exploring and adjusting contraception options, he said.
"We could start somebody off on a plan, but oftentimes that plan has to change as they recover from their childbirth, as they adapt to their new life with a child and with their family," he said.
Pettker said Medicaid patients are also at a higher risk for complications in general, like postpartum depression.
However, the change also means fewer pregnant Iowans now qualify for Medicaid. As part of the legislation, Iowa lawmakers lowered the income cutoff to 215% of the federal poverty level. Previously, it was 375% of the federal poverty level, the highest in the country.
This means a family of four now needs to make less than $67,080 a year to qualify under the 2025 guidelines. Under the state's previous rule, that cutoff would have been at $117,000 a year.
The Iowa Department of Health and Human Services estimated about 15.8% of Medicaid members with postpartum coverage will lose coverage.
The income limit to qualify for Medicaid coverage during pregnancy is significantly higher than the general limit for Iowa adults ages 18 to 64 to qualify for the program, which is capped at 133% of the federal poverty level, or $41,496 for a family of four.
During the legislative session, Republican lawmakers — who hold a majority — argued the lowered limit set a more "reasonable" income limit to qualify and is more in line with other states' limits.
Democrats pushed to keep the cutoff the same, calling the change "a real disappointment."
The Iowa Department of Health and Human Services estimated about 15.8% of Medicaid members with postpartum coverage will lose coverage with the new rule going into effect, amounting to a monthly average of 1,300 fewer women and 400 fewer infants now receiving coverage.
