Sen. Jesse James is the coauthor on the postpartum Medicaid expansion bill. Screenshot via WisEye.
Members of the Wisconsin Senate Health Committee expressed support on Wednesday for a bill that would extend Medicaid coverage for postpartum mothers to a year after the birth of a child.
Typically, people in Wisconsin are only eligible for Medicaid coverage if they make up to 100% of the federal poverty level, but pregnant women can receive Medicaid coverage in Wisconsin if they have an annual income of up to 306% of the federal poverty level. While a newborn whose mother is a Medicaid recipient receives a year of coverage, mothers risk losing their coverage after 60 days if they don’t otherwise qualify for Medicaid.
The bill — SB 23 — seeks to change this by extending Medicaid coverage for postpartum mothers from 60 days to a full year after childbirth.
“This bill does not change that income threshold so no new women would qualify for Medicaid,” bill coauthor Sen. Jesse James (R-Thorp) said at the hearing. “It would just allow for those women, who are already being covered, to be covered for longer to help address potential health issues that arise during the postpartum period.”
“My goal as a legislator… is to make sure we keep moving Wisconsin forward and fight for the future of our youth. We, as a state, are unfortunately behind on this issue,” James said. “We have a chance to do better for our moms, our kiddos and our families as a whole.”
The federal government gave states the permanent option to extend coverage to a year postpartum in 2022 in the American Rescue Plan Act.
Gov. Tony Evers has been proposing covering mothers for a year in each of his budget proposals since 2019, but the Republican-led Legislature has rejected it each time. A Republican bill passed the Senate last session with only one opposing vote and also gained the support of a majority of Assembly lawmakers, but it never came to a vote. Assembly Speaker Robin Vos (R-Rochester) has been a staunch opponent of the policy, saying that he doesn’t support expanding “welfare,” and has so far blocked its passage.
There are currently 23 Senate cosponsors and 67 Assembly cosponsors on the bill.
DHS Legislative Director Arielle Exner told lawmakers that from 2020 to 2022, there were 63 pregnancy-related deaths in the state of Wisconsin with one-third of pregnancy-related deaths occurring after that 60-day postpartum period; 76% of those who died had Medicaid at the time of their delivery. In 2023, Medicaid covered 35% of births in Wisconsin and 41% of births nationwide.
“Wisconsin moms are losing health care coverage when they need it the most,” Exner said.
Exner said the agency projects that an additional 5,020 women would have coverage per month under the bill, and that according to a fiscal estimate by the Department of Health Services, the policy would cost $18.5 million in all funds with $7.3 million in general purpose revenue.
If Wisconsin accepted full Medicaid expansion, which would expand Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, the cost for the postpartum coverage would be reduced to $15.1 million in all funds with $5.2 million in general purpose revenue — a total lower cost to Wisconsin.
DHS chief medical officer Jasmine Zapata, who is also co-chair of the Wisconsin Maternal Mortality Review Team and a newborn nursery hospitalist, called attention to the fact that the numbers and statistics are representative of people’s lives. She noted that the team reviews medical records, police records, hospital records, family interviews and more when looking at the deaths.
“The way they were found deceased in their homes after a suicide or overdose… striking stories and heartbreaking stories… their children were there when they were found, brain matter splattered on the floor after a gunshot wound to the head, these are serious situations that are happening,” Zapata said. “For every statistic that we see, we have to remember that there are real lives and real stories behind them.”
Zapata said that providing access to health care is one of the biggest recommendations that the review committee has.
Arkansas is the only other state besides Wisconsin that has not implemented the extension, a fact that was brought up repeatedly during the hearing. That state has also recently been working on maternal health legislation, though a recent bill still excludes the 12-month Medicaid coverage.
“Are they going to beat us and we [will] become the last in the union that does not have this coverage?” bill coauthor Rep. Patrick Snyder (R-Weston) asked. “It is my sincere hope that Wisconsin does not become the last… If we can’t get something like this done, then I don’t know what I’m doing in the Legislature.”
“Can you believe it?” Snyder commented after a question. “Arkansas.”
Jackie Powell, an OB-GYN who is completing her training in maternal fetal medicine, represented the American College of Obstetricians and Gynecologists at the hearing. She said she often cares for the highest risk patients, who may have chronic medical conditions.
“During pregnancy, we have the opportunity to gain control of these conditions, but for these people who lose their insurance and lose their health care postpartum, we are essentially erasing all progress that we have made throughout their pregnancy,” Powell said.
Powell said that through her work she sometimes diagnoses a major medical condition, including heart failure, cancer and kidney failure, during pregnancy that “alters someone’s life course.”
“Many of these patients need life-saving surgery and intervention postpartum to save their lives. Oftentimes, we need to deliver patients very preterm so that they can receive this care that they need,” Powell said.
“Imagine being told that you need to have major surgery for a life-threatening medical condition within the first few weeks after delivering your baby, and possibly preterm baby, and then losing your insurance. Imagine the complications that you could still experience without the appropriate follow-up care when in the last year, you underwent all of this. Imagine walking into the neonatal intensive care unit to see your baby that you delivered prematurely in a hospital where you can no longer be treated,” Powell said. “This is a failure of our medical system.”
Former Rep. Donna Rozar, who was the lead author on the bill last session and is a nurse, also testified on the bill.
“I could not get, even, a public hearing in the state Assembly, which made me really mad, and so I’m hoping that this year, some things will be different,” Rozar told lawmakers.
Rozar said that she has heard objections to the bill that people could seek coverage through the Affordable Care Act rather than Medicaid once the coverage is lost after 60 days.
“If you have a two-month-old, the last thing you want to do is change insurance programs. At 60 [days], you’re caring for a two-month-old and shouldn’t have to worry about health care coverage,” Rozar said.
There are 37 groups — including American Civil Liberties Union of Wisconsin Inc, Medical College of Wisconsin, American Heart Association, Pro-Life Wisconsin — registered in support of the bill, according to the Wisconsin Lobbying website. No one is registered in opposition.
“I think we’re all on board with this bill,” Sen. Rachael Cabral-Guevara (R-Appleton) commented to the room at one point.
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