Texas is thinking about doing something very smart. They want to expand the current mandatory categorical eligibility for Medicaid for pregnant women that currently expires at sixty days after birth to a full year of eligibility after birth.
To combat maternal mortality and morbidity, several Democrats and at least one Republican have proposed extending Medicaid coverage to one year after a woman gives birth or has an involuntary miscarriage.
“This is a really important bill because there is a gap in treatment, and this will ensure Texas women will continue to receive Medicaid coverage for 12 months,” said Rep. Shawn Thierry, D-Houston, who filed a bill to extend coverage. “I believe that this will reduce the maternal deaths.”
In 2016, Texas gained national attention for having the “highest maternal mortality rate in the developed world,” based on data from 2012 that was published in a study. Last year, the state found that inaccurate reporting inflated the data, but officials have continued efforts to lower the numbers.
Medicaid requires states to cover income qualified pregnant women for the pre-natal period and for sixty days after birth. The theory is that work is difficult in this time period, the baby needs intensive parental attention and good healthcare for the mom will lead to better health and development outcomes for the baby. Income restrictions are much higher for this adult population than many other adult eligible populations. In Texas, a woman can earn roughly $32,000/year to qualify as a pregnant woman with a single child. After sixty days, the current income cut-off for the same family to get the mom Medicaid qualified is $2,400 per year. Texas transitions women to a limited benefit plan if they don’t qualify for low income Medicaid sixty days after birth.
That is a huge cliff. And many women will fall off that cliff. If they are earning over 100% FPL, they are eligible for a subsidized exchange plan. If they earn under 100% FPL (~$16,480 for a family of two) they get no exchange subsidies and most likely earn too much to qualify for low income Medicaid. A lot of people fall off the cliff.
New Jersey is considering a similar change to their Medicaid program. They are a Medicaid expansion state but Medicaid expansion cuts off at 138% FPL while low income pregnant woman eligibility cuts off significantly higher. It would promote continuity of care.
Why does this matter in a Medicaid expansion state? There is a still a gap in income thresholds for Medicaid for pregnant women and Medicaid for low-income adults. In NJ, households between 138% and 205% FPL fall in this gap ($20,420 to $41,861 for a family of 3).
— Jamie Daw (@jamie_daw) February 12, 2019
This is interesting and potentially good news from Texas and New Jersey.