By Robin Opsahl, Iowa Capital Dispatch
The Iowa Senate approved two bills Monday that Republicans said would help improve maternal care in Iowa.
Senate File 2251 was approved on a 34-13 vote and moves next to the House. The legislation, a priority of Iowa Gov. Kim Reynolds’ for the 2024 session, extends postpartum Medicaid coverage for new mothers from 60 days to a year, while limiting eligibility to families with income at or below 215% of the federal poverty line.
The governor praised bill’s passage in a statement Monday.
“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. “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.”
The previous limit for postpartum coverage was at 375% of the poverty line. Sen. Mark Costello, R-Imogene, spoke in opposition to an amendment proposed by Democrats to bring back that higher limit. The bill sets “reasonable income eligibility requirements for public assistance,” he said, as a mother and infant in a family of four making up to $64,500 or less would qualify for Medicaid coverage.
“Iowans do not support Medicaid for all,” Costello said. “And this amendment will allow that same household of four, making $112,500, to be eligible for Medicaid. There are numerous state, federal and private entities providing support to expectant mothers and those who gave birth to their children outside public welfare.”
Democrats argued that the bill would mean the loss of coverage for mothers in need. The Legislative Services Agency’s fiscal note estimated that 1,300 women and 400 infants would lose Medicaid coverage per month under the restrictions. The bill would also move roughly 1,100 infants each month from Medicaid to HAWKI, the state children’s health insurance program, who are between 215% and 302% of the federal poverty level.
Sen. Janet Petersen, D-Des Moines, said this income restriction, alongside the timeline of implementation, could leave some new mothers without health care coverage. She also said the restriction was put in place needlessly. The federal COVID-19 emergency plan signed by President Joe Biden in 2021, used to fund the Medicaid expansion, allows for a less restrictive income limit, Petersen said, meaning that the state is “walking away from 10 million dollars” by tightening income requirements.
“This is a real disappointment, that the governor was the holdout on expanding postpartum coverage — 47 states have already done it,” Petersen said. “We finally get the governor’s bill to expand postpartum coverage, and she does it at the expense of pregnant women and their babies.”
Democrats said Iowa’s high maternal and infant mortality rates show the need for more public support for new mothers and infants. Costello responded that postpartum Medicaid is not the “silver bullet” to reducing these mortality rates, saying the Iowa Department of Health and Human Services reported higher severe maternal morbidity rates among people on public assistance than those on private insurance.
He said Iowa HHS is working with health care providers and researchers to find practices to reduce “specific abnormally high causes of death” related to pregnancies and birth.
“We are trying to work on this problem, and we just don’t know that Medicaid is the best way to go about that,” Costello said.
Costello pointed to the More Options for Maternal Support, or MOMS program, as a way to support new and expecting mothers in Iowa in a way “that is not public welfare.”
The MOMs program, created in 2022, provides state funding for “crisis pregnancy centers,” maternal care nonprofits that encourage alternatives to abortion. Funding through the MOMS program is designated to go to organizations providing “qualified pregnancy support services,” such as counseling and support, material items like cribs and diapers, as well as adoption support services and parenthood classes.
Some centers provide services like ultrasounds, but are not licensed medical facilities, while some former patients have claimed pregnancy centers have misrepresented themselves as licensed medical providers.
The Senate passed Senate File 2252, on a 31-16 vote Monday. It would give Iowa HHS the power to directly oversee the MOMS program and contracts with providers, removing the previous requirement to hire a third-party administrator. HHS Director Kelly Garcia has said the state failed to find a qualified applicant to serve in the position in the past year, and that the department was already provisionally performing these duties.
The legislation would also remove requirements for HHS post online their criteria on both the MOMS program providers and the administrator.
Democrats proposed amendments, including requiring MOMs providers to follow medical privacy standards, use licensed professionals to administer services like mental health counseling and ultrasounds and advertise that they are not licensed health care providers. None of the Democrats’ amendments were adopted.
Costello argued that the purpose of the MOMS program was to provide nonmedical maternal support, and that Iowa law already has provisions addressing problems with people who improperly use occupational titles. But Democrats argued that pregnancy centers have been reported to portray themselves as health care providers to people seeking help with unplanned pregnancies.
“I believe our role as lawmakers is to make sure that pregnant women are receiving safe care and not misled about where they are obtaining their care,” Petersen said. “This just puts safeguards in place to make sure that they the care they are receiving is evidence-based that they are not misled.”
Mazie Stilwell with Planned Parenthood Advocates of Iowa criticized Senate Republicans for voting “against transparency and privacy protections for their constituents” by passing the bill.
“It is shameful that these lawmakers have ignored real solutions to the multiple heath care crises facing this state,” Stilwell said in a statement. “Instead, they are focused on a flailing program that has yet to get off the ground after two years and diverts millions of taxpayer dollars to anti-abortion centers. These centers prey on vulnerable, unknowing Iowans and feed them with misinformation while posing as legitimate health care providers. Despite that, politicians who control state government are selling them as a solution for people facing unplanned pregnancies.”
Costello said the program already has “a lot of safeguards in place” through Iowa HHS, which will monitor compliance and collect data from organizations that get funding through the MOMS program. The measure, he said, will allow HHS to continue oversight while getting funding — and the supportive services provided by pregnancy centers — to parents and infants in Iowa.
“Here’s another opportunity to vote to support expectant mothers and (new) mothers in our state,” Costello said. “This bill ensures the department has the most flexibility to operationally support the goals of this program.”
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