Postpartum Medicaid extension bill inches forward

A bill to extend postpartum Medicaid coverage cleared its first legislative hurdle of the 2023 general session on Friday — by a single vote. 

After giving birth, eligible mothers are currently covered by Medicaid for two months. House Bill 4 – Medicaid twelve month postpartum coverage would extend that coverage to a year. The House Labor, Health and Social Services Committee voted 5-4 to send the legislation to the floor for further consideration. 

Over the interim, the committee worked the bill with input and broad support from the medical community, who largely said the extension would improve health outcomes for moms experiencing conditions like postpartum depression, substance use disorder and cardiac disease. Medicaid covers 33% of births in Wyoming, according to a Legislative Service Office memo.

The committee has a new makeup, however, following the November 2022 elections and members spent a large part of two meetings this week rehashing the previous discussion and hearing public testimony anew. The panel also spent time reviewing the basics of lawmaking — six out of nine of the committee members are altogether new to the process, serving in their first terms. 

The close vote divided new members while the three senior legislators supported the bill. The vote also split along gender lines: the committee’s three women all opposed the measure. 

Background

A pandemic-era rule barring disenrollment from Medicaid spurred lawmakers to take up the issue. 

Hundreds of Wyoming moms had extended access to care after birth as a result of the policy. That provided the Wyoming Department of Health with a “natural experiment,” to examine enrollment, cost and utilization for such a program, according to the agency’s director, Stefan Johansson. 

But the rule is being phased out and an enhanced federal match is running out this spring, Johansson told lawmakers, so incremental disenrollment will soon begin. 

If the bill becomes law, Johansson said, an estimated 250 new enrollees would come in during any given month. It’s expected to cost the state roughly $2 million a year with the federal government paying for the other half of the program. 

Outcomes associated with such a program are difficult to study since variables cannot be isolated, Johansson said, but his department would do a pre- and post-analysis if implemented. About 36 other states have adopted the extension, according to the WDH. Wyoming is one of several Republican-led states currently considering such a proposal. 

Testimony

Gov. Mark Gordon is among those in favor of the bill. Jen Davis, who serves as his health and human services policy advisor, told the committee his support is due to his pro-life stance. Gordon was joined in his support of the bill by the Diocese of Cheyenne, the Northern Arapaho Business Council, the Wyoming Women’s Foundation and roughly nine medical associations. 

“I’m here to educate,” Erin McKinney, clinical director of women and children’s service at Cheyenne Regional Medical center, told the committee. Without speaking for or against the bill, McKinney drew lawmakers’ attention to the high maternal mortality rate in the United States and how many of those deaths — occurring between pregnancy and the 365 days that follow — are preventable. 

From 2018 to 2020, there were 13 pregnancy-associated deaths in Wyoming, according to the WDH, which plans to publish a study with more details about those deaths next month. 

Although to a lesser degree, the committee also heard testimony against the bill. Opposition focused less on the efficacy of postpartum care and more on the appropriate role of government in providing such care. Reps. John Bear (R-Gillette) and Ken Pendergraft (R-Sheridan) both testified against the bill. Bear expressed concern about the limited number of available providers across the state resulting in a potentially strained system. Pendergraft, meanwhile, called for personal responsibility. 

“Whenever an individual cedes responsibility, they cede liberty,” Pendergraft said. 

Amendments and lawmaker conclusions

Ultimately, newly elected Reps. Ben Hornok (R-Cheyenne), Sarah Penn (R-Lander), Tamara Trujillo (R-Cheyenne) and Jeanette Ward (R-Casper) agreed with Bear and Pendergraft and voted against the bill. 

Ward was especially pointed in her opposition, rebuking Gordon in the process and criticizing an instance in the bill that used the word “person” instead of “woman” (the terms were later changed with an amendment). Ward said the vast majority of people who emailed her about the bill opposed it. 

The bill seeks to do a good thing, Penn said, but to the detriment of women who suffer “if we create situations where there’s always a safety net.” Penn expressed confidence in the free market “stepping up” so long as the government stays out of the way. 

Before the committee passed the bill, it also amended its fiscal note to accurately reflect the WDH’s funding request of $1.9 million.