Low-income pregnant women can access timely prenatal care regardless of their Medicaid application status thanks to legislation passed by lawmakers this year.
The change brings Mississippi in line with 29 other states and Washington, D.C. The American College of Obstetricians and Gynecologists has long championed the practice for its ability to improve maternal health outcomes.
“Presumptive eligibility simply removes some of the red tape so that individuals can have immediate access to this coverage, especially women of color who are disproportionately affected by coverage disruptions,” explained Taylor Platt, senior manager of health policy at the American College of Obstetricians and Gynecologists.
The law, which will be effective July 1, allows pregnant women whose household income is at or below 194% of the federal poverty level – about $29,000 annually for an individual – to be presumed eligible for Medicaid and receive 60 days of coverage for outpatient care while their applications for Medicaid coverage are being processed.
Without presumptive eligibility, Medicaid-eligible pregnant women are forced to go without care or pay out of pocket during this interim period.
Pregnancy presumptive eligibility makes the largest difference in states that have not expanded Medicaid, explained Usha Ranji, the associate director of women’s policy at KFF. That’s because in states with expansion, the majority of income-eligible women are already on Medicaid and aren’t subject to this no-coverage interim period.
“There are a lot of people who are uninsured (in Mississippi) and who will only qualify for Medicaid once they become pregnant,” Ranji said. “Not surprisingly, people in expansion states tend to have had coverage for a longer period before the pregnancy.”
Before passing House Bill 539, Mississippi was one of only three states with neither pregnancy presumptive eligibility or Medicaid expansion.
Medicaid eligibility is restrictive in Mississippi. In addition to falling below an income threshold, Mississippians must belong to one of three categories to qualify for Medicaid: parenting, pregnant or disabled. After months of negotiations, a bill that would expand Medicaid in Mississippi died late in the session this year.
First-time mothers only become eligible for Medicaid once they become pregnant, meaning their application processing time can cut well into their first trimester. Applications for pregnancy Medicaid can take up to 45 days to be approved, according to the Division of Medicaid.
Medicaid funds more than two-thirds of births in Mississippi, the state with the second highest rate of births financed by Medicaid in the country.
If everyone eligible for presumptive eligibility took advantage of it, the policy could affect tens of thousands of pregnant women.
“Medicaid is an important player in the state’s maternal health infrastructure,” Ranji said. “… Presumptive eligibility could really help a lot of people in the state.”
Early prenatal care has been proven to mitigate a number of pregnancy-related problems including hypertension – the leading cause of maternal mortality in Mississippi and across the country.
“You may miss infections that could be easily treated early but now have gone untreated, that can lead to increased complications during your pregnancy, or you may have health conditions that need to be addressed early,” explained Dr. Charlene Collier, a member of the Mississippi Maternal Mortality Review Committee and a Jackson-area OB-GYN. “Even more dangerous, there could be an ectopic pregnancy or an abnormal pregnancy that can lead to serious risk to yourself.”
Last year, the Legislature passed a bill to guarantee Mississippi mothers care for 12 months postpartum. Now, along with presumptive eligibility, low-income pregnant women should receive care from the start of their pregnancy through one year postpartum. Experts hope these policies will not only help maternal and infant mortality rates but also health disparities.
People of color are disproportionately subject to discontinuous coverage, according to a 2020 study published in Obstetrics and Gynecology, with nearly half of all Black women experiencing disruptions in insurance coverage from pre-pregnancy to postpartum.
House Medicaid Chair Missy McGee, a Republican from Hattiesburg, authored the bill. She said the policy is a no-brainer in a state boasting some of the highest maternal and infant mortality rates in the country.
The Division of Medicaid estimates that presumptive eligibility will cost the state $567,000 annually, which McGee says is “a minimal investment for a tremendous benefit to women in our state.”
That cost includes medical services and overhead for women initially presumed eligible but later determined ineligible. Doctors will be reimbursed for any prenatal care they provide to pregnant women who they deem eligible for Medicaid according to income.
Not all doctors will choose to participate, explained Matt Westerfield, spokesperson for the Division, but those who do will receive training from the agency to help them make eligibility determinations.
Providing presumptive eligibility for the thousands of pregnant women on Medicaid in the state will cost roughly half as much as it costs the state to pay for just one infant’s prolonged stay in a neonatal intensive care unit – which can easily top $1 million, according to a study published in the American Medical Association Journal of Ethics.
Mississippi has the highest rate of preterm births in the country.
It’s an example of how fronting a small amount of money for preventative care can save the state millions of dollars in the long run, explained Dr. Anita Henderson, a Hattiesburg pediatrician and former president of the state pediatric association.
“The return on investment is going to be great,” Henderson said. “Because if we can prevent even just one premature baby that might cost the state a million dollars, then the program pays for itself. So the healthier we can get that mom, the healthier we can get that baby.”
How to know if you qualify
Anyone who is pregnant and makes at or below 194% of the federal poverty level qualifies for Medicaid and for presumptive eligibility. These individuals can start receiving care as soon as they find out they’re pregnant by showing proof of monthly income to a doctor at a qualifying location. A spokesperson from the Division of Medicaid told Mississippi Today that the agency will communicate to the public which locations are participating in presumptive eligibility, but said that they “are still working on what that outreach will look like.”
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