Missouri has a problem with maternal mortality, a Missouri representative told his colleagues Tuesday evening.
Rep. Jonathan Patterson, R-Lee's Summit, told members of the Missouri House Emerging Issues Committee, which he chairs, the state is floundering -- and ranks between 42nd and 44th in maternal mortality.
"One of the things that you will hear oftentimes in this building is we have a problem with maternal mortality here in the state," he said, while presenting a bill aimed at easing the rate in Missouri. "We indeed do. Unfortunately here in Missouri, we have a very high rate of maternal mortality."
In Missouri, pregnant women may receive Medicaid services through MO HealthNet or the Show-Me Healthy Babies program for a brief period of time. Both programs limit coverage to 60 days following the end of the pregnancy.
Patterson's bill, House Bill 2604, extends MO HealthNet coverage (Missouri's Medicaid system) for a year following the end of the pregnancy.
If passed, the law would go into effect April 1, or the effective date of the bill, whichever is later, according to its summary. A reason for the quick turnaround would be to take advantage of American Rescue Plan funds, part of which the federal government offered to offset the costs for states to extend coverage of pregnant women to a year past the end of their pregnancies.
Samuel Lee, director of Campaign Life Missouri, said federal funds would remain available for five years afterward.
Show-Me Healthy Babies is also available for women who did not receive approval for coverage through the MO HealthNet for Pregnant Women program.
It requires women be pregnant, apply for MO HealthNet before their delivery date, live in Missouri (Social Security numbers are not required for non-citizens), have a household income up to 300 percent of the Federal Poverty Level, have no access to employer or private insurance pregnancy coverage, and not be eligible for any other MO HealthNet programs.
The national poverty level for a household with a single person is $13,590 -- and increases by $4,720 for each additional person in the household.
Show-Me Healthy Babies offers health coverage for unborn children and their mothers; pregnancy care; such as doctor visits and prenatal vitamins; pregnancy-related care for up to 60 days after giving birth, which may include home visits, breastfeeding help and an electric breast pump; and healthcare coverage for the child from birth up to 1 year old.
Passage of his bill would extend coverage for a year for 4,000-6,000 women annually, Patterson said.
No witnesses testified against the bill. Ten testified in favor of it.
Mistie Mills, a Columbia gynecologist who sits on the Missouri Pregnancy-Associated Mortality Review Board, testified the issue is near and dear to her heart.
The board operates within the Missouri Department of Health and Senior Services, and looks at circumstances surrounding deaths of women who die within a year of their pregnancies ending. Last year's report identified three factors that contributed to pregnancy-associated deaths -- those that occurred within a year of pregnancy due to any cause. It identified substance use disorder, mental health conditions other than substance use disorder, and maternal obesity as the leading factors playing roles in the deaths in 2018, the most recent year available.
Mills offered examples of two women who would have benefited from receiving services beyond 60 days after their pregnancies ended, she said. The first woman's blood became thicker when she was pregnant and she had a stroke. She and her baby survived, but the woman lost her business and became homeless.
"Today, she still does not have the use of one of her arms," Mills said. "Her postpartum course was complicated by paralysis."
Mills said extended coverage would have helped.
The second was 30 weeks pregnant, when she had a "massive abruption" (when the placenta separates from the inner wall of the uterus before birth), Mills said. "The baby's life was lost."
The mother might have recovered physically within 60 days, but she would not possibly have recovered mentally.
"Our committee reviews deaths in the state," Mills said. "Eighty-two percent are preventable. Sixty percent occur outside that 60-day period."
Mills said professionals consider the time after the pregnancy as a fourth trimester.
"Included in recovery is her bonding with her baby," Mills said. "We talk about these hormones that are shifting -- things are out of her control. Things are amplified like mental health, postpartum depression. Some of the clotting things need to be addressed in that fourth trimester."
To stop coverage after 60 days "doesn't make any sense," Patterson said.
HB 2604: Medicaid services for pregnant women
Sponsor: Rep. Jonathan Patterson