Photo by Raúl Hernández González/Flickr.

A bill that would extend health care coverage for new West Virginian mothers is inching closer to becoming law. 

House Bill 2266 seeks to extend postpartum Medicaid coverage for qualifying West Virginians from 60 days to one year after giving birth. The bill has bipartisan support; affordable health care groups and child welfare workers have advocated for it as a way to improve the health of mothers, and thus indirectly their babies, during the first year of life. 

Last week, the bill passed the House of Delegates with a vote of 98 to 2. It was referred to the Senate Health and Human Resources Committee, where it passed last Friday, and now has until Saturday at midnight to move through the Senate Finance committee and pass a full vote on the Senate floor.

“We’ve found little to no resistance to this from either party,” said Kat Stoll, policy director for the consumer advocacy group West Virginians for Affordable Health Care. “This bill is about keeping mothers healthy, so the family can have a healthy start, and we thank our lawmakers for supporting it.”

Here’s what the bill would do

Currently, West Virginia’s Medicaid program covers people who earn  up to 138% of the federal poverty line. For a family of three, that’s a household income of just over $30,000 a year. 

But that qualifying income threshold is extended for pregnant West Virginians, who become eligible for Medicaid if they live at up to 185% of the federal poverty line. 

Right now, those West Virginians are eligible to be insured by Medicaid from the day they conceive, until 60 days after giving birth.

But on day 61, they lose coverage and are forced to either buy into market insurance plans or be uninsured. 

“The postpartum period does not end at 60 days and neither do health care needs,” said Usha Ranji, associate director of women’s health policy for the Kaiser Family Foundation.

According to Ranji, having access to health care during the postpartum period — or the time after a person gives birth — is important for the health of both the mother and the baby. 

HB 2266 would grant new mothers greater access to health care services that could be needed to address serious health complications a person might face after pregnancy, but could also help a mother maintain access to care that could improve general health — like diabetes treatment, mental health counseling, or access to recovery services for substance use disorders.   

Little research on potential outcomes

Right now, multiple states are considering forms of legislation that would extend benefits for new mothers, many prompted by the $1.9 trillion American Rescue Plan, which passed Congress last month and included provisions that encouraged states to expand postpartum coverage. The legislation is being pushed as a way to help reduce maternal mortality rates, improve family health and address racial disparities in maternal health outcomes. Black women die from complications linked to pregnancy nearly three times as often as white women.

Experts say extending health coverage is almost always a good thing. But there isn’t actually any research on how much the proposed changes will impact health outcomes. That’s because we haven’t seen these changes like these enacted before.

When the extended Medicaid program for pregnant women was designed, the focus was on improving health for babies rather than mothers, according to Sarah Gordon, a professor of health law, policy and management at Boston University.

“We don’t have data yet on what it looks like to actually do this extension,” Gordon said. “But what we do know is that this is a vulnerable time for women and 60 days [as the coverage cut-off] is completely arbitrary.”

But Gordon said we can look at the impact of Medicaid expansion — which allowed states to opt-in to providing more residents with Medicaid under the Affordable Care Act — as somewhat of a predictor.

In a study published in January 2020, Gordon and fellow researchers looked at how Medicaid expansion affected postpartum coverage and health care utilization for women in Colorado and Utah. 

They found that in Colorado, which had expanded Medicaid, women at high risk of pregnancy complications were more likely to use outpatient services that help to manage chronic conditions or tend to delivery-related health conditions.

“So if our goal with this policy is to reduce adverse events, we do have some evidence from Medicaid expansion,” Gordon said. “It’s sort of a mini version of what this newer policy extension would do.”

She said the only downside of this legislation is that the need for health care doesn’t ever end. The extension of coverage to a year — although much better than 60 days — is still an arbitrary amount of time, Gordon said.  

But in West Virginia, the state with the highest rate of children enrolled in foster care in the nation, as well as the highest rate of neonatal abstinence syndrome, advocates for child welfare see this new extension of benefits as a key step toward protecting the state’s children, who are most susceptible to maltreatment during the first year of life.

“Coordinating health care services — primary and substance abuse care — for a woman who may be struggling with a substance use disorder after giving birth is absolutely key,” said Kelli Caseman, executive director for Think Kids WV, a new nonprofit dedicated to advocating for West Virginia’s children.

If HB 2266 passes, Caseman said the bill would be “one of the biggest wins of the session.”

The bill is on the agenda of the Senate Finance Committee, which is set to meet Tuesday at 3 p.m.

Lauren Peace is a Report for America Corps Member who covers public health.