Montana moves toward extending postpartum health care coverage

Montana took a step toward funding 12 months of Medicaid coverage for mothers after they give birth, a priority for Gov. Greg Gianforte’s administration and health care advocates concerned about postpartum complications, including maternal mortality. Women on Montana’s public insurance program are currently guaranteed coverage for only 60 days after they deliver.

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.

The 12-month coverage plan requested in Gianforte’s executive budget proposal previously failed to gain enough support from Republicans on the state health department’s budget subcommittee. Instead, Republicans drafted and passed a change to give new mothers coverage for six months postpartum if they have a substance use disorder or a mental health diagnosis. Democrats voted against that plan, instead advocating for a year of continuous coverage. 

Lawmakers in the minority party returned to the topic this week as the larger House Appropriations Committee considered amendments to the health department budget. 

“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. 

Medical groups and social service providers testified before the committee last week about the importance of helping new mothers access health care from primary care providers and specialists for behavioral health and chronic conditions, including diabetes and heart disease.

“[A]lthough the proposed extension may be somewhat helpful, significant gaps are left in the system that will limit ability to prevent maternal deaths,” physicians from the Montana chapter of the American College of Obstetricians and Gynecologists wrote in a Thursday letter submitted to lawmakers. “Improving women’s health for the first year of their child’s also results in increased child wellbeing.” 

After voting to approve the postpartum coverage adjustment, Republicans on the budget appropriations committee shot down a Democrat-sponsored amendment to extend 12 months of continuous Medicaid coverage to all Montanans covered by the Medicaid Expansion program. That effort also failed as a standalone bill in the last 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 did approve two amendments to expand eligibility for the federal TANF program, or Temporary Assistance for Needy Families, and increase the money distributed to qualifying individuals. 

The budget will eventually proceed to the House floor for further debate.