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Texas extended Medicaid coverage for new moms this year. Experts say it’s not enough

Desiray Felton went to her doctor’s office in June 2017, about six weeks after her son was born.

The checkup was the last appointment which would be paid for by Medicaid, which covered the Fort Worth woman’s medical care during her pregnancy and for the birth of her child but stopped within two months after her baby was born, as was typical for all Texas moms covered by Medicaid while pregnant.

She sat on the crinkly paper while her doctor checked her vital signs. Heart rate? Steady. Temperature? Fine.

Blood pressure? In stroke range, her doctor said, urging her to go to the emergency room immediately.

“I think that people were expecting me to just get it back together real quick,” Felton said. “And I couldn’t.”

Felton stayed in the hospital for several days, until her blood pressure had dropped low enough for her to leave and go home to her family.

But because her Medicaid health insurance coverage had expired, Felton was fully responsible for paying for her hospital stay. Four years later, Felton is still paying off the cost of the life-saving treatment, she said. The bill for her hospital stay continued to grow over the years, as the interest rate increased the original expense.

“I’ve got maybe $200 left (to pay off),” Felton said. “I’m trying to get my credit right, so we can actually buy a house. And that was holding me back big time.”

Felton’s case exemplifies what maternal health experts and advocates have long insisted: Not all new mothers experience illness or death during pregnancy, childbirth, or immediately after childbirth. Women can experience sickness and death because of their pregnancy for months after they’ve had their child. Advocates point to cases like Felton’s as evidence that new moms need health coverage for at least a full year after they have their child.

Texas lawmakers agreed during the 2021 legislative session to let moms like Felton stay on Medicaid for up to six months after the birth of their child. The extension, if it is approved by the federal government, will help moms in the future. But experts say that without extending Medicaid coverage to last for a full year postpartum, there will be other new parents who could get seriously ill and even die because of issues that started during their pregnancy.

“I’m grateful for any kind of bill or any kind of policy that extends care for women, especially women that have been without care,” said Amy Raines-Milenkov of Fort Worth, an expert in maternal and child health. “But I was disappointed that it wasn’t for the full year.”

Extending health coverage is particularly essentially for Black women like Felton, experts said, who are two to three times more likely to die from pregnancy-related causes than white women, according to the U.S. Centers for Disease Control and Prevention.

Medicaid’s role in Texas

In Texas, Medicaid pays for about half of all births annually, according to the Kaiser Family Foundation. In Tarrant County, that means about 10,000 births are paid for by the joint federal and state program each year.

During the 2021 legislative session, Texas lawmakers decided to extend Medicaid coverage for new mothers to up to six months after the birth of the child. The bill was the final piece of legislation to make it out of the Texas Senate before a key deadline. A priority in the House, House Bill 133 passed in the lower chamber with near unanimous approval.

“All pregnancies do not end up in some type of complication, but we want to make sure that women are secure in knowing that they have the health care that they need… to give birth to their children,” said Dallas Democrat Toni Rose, the bill’s author.

Although lawmakers agreed to the six-month extension, they still have yet to follow the main recommendation of the state’s Maternal and Morbidity Review Committee, which has repeatedly recommended extending Medicaid for a full year. Raines-Milenkov, who is an assistant professor of pediatrics at UNT Health Science Center, is also part the committee, which is tasked with studying all pregnancy-related deaths in the state.

In the committee’s most recent report, which studied deaths from 2013, Raines-Milenkov and her colleagues studied 137 deaths that occurred within a year of a woman’s pregnancy ending. Of those cases, at least 54 were directly related to the pregnancy, the committee found. About a third of these deaths occurred between 43 days to one year from the end of the pregnancy, according to the committee’s report.

And of all the deaths reviewed, the committee found that 89% of those deaths were preventable.

“It’s not like we don’t know how to prevent these deaths,” Raines-Milenkov said.

The reasons behind maternal deaths are complex, and include factors like access to health care, systemic racism, and health conditions or chronic diseases that might have cropped up or else gotten worse during a woman’s pregnancy.

Two options available to all Texas women between the ages of 15 and 44 are Health Texas Women and Healthy Texas Women Plus, two programs that offer some preventative health services as well as limited treatment options for mental health conditions, including postpartum depression.

But neither program offers completely comprehensive care, meaning that new moms who have an emergency or need more comprehensive coverage would have to pay out-of-pocket.

“If you are cut off from Medicaid and you need to go to the hospital for a surgery or for an emergency, that is not covered in Healthy Texas Women Plus,” said Adriana Kohler, policy director for the advocacy group Texans Care for Children.

Healthy Texas Women Plus didn’t exist in 2017, when Felton gave birth to her son. But even if it had, it wouldn’t have covered her multiple day hospital stay.

‘My health just went down’

Today, Felton and her family are doing well. Felton and her kids are on her husband’s private insurance plan, made available to them through his job at supermarket distribution center. Her blood pressure and other chronic conditions are under control, and she says she even gets better care from physicians and health care workers because she’s on a private, and not public, insurance plan.

But Felton said she remembers her pregnancy, and the months that follow, as a difficult time, both because of the physical toll carrying a baby, and the related hypertension, put on her body, but also because of the financial and social stressors that came along with an extended hospital stay and a hefty bill.

She encouraged new moms to get on a good insurance plan, if one was available to them, particularly one that covered the cost of their prescription medications, which she said were a burdensome cost for her and her family in the months after she had her son.