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A new law to improve pregnancy outcomes took effect Monday. But how someone can receive timely prenatal care is still unclear.

Despite presumptive Medicaid eligibility for pregnant women going into effect Monday, it’s still not clear how low-income pregnant women can get the timely prenatal care the law is supposed to make possible.

House Bill 539, which was signed into law by the governor on March 12, allows eligible, low-income pregnant women to receive immediate care covered by Medicaid while they wait for their application to be officially approved by the Division of Medicaid. Applications are supposed to take no longer than 45 days to process, though recent data shows nearly a third of applications in Mississippi took longer than that, bringing pregnant women well into their first trimester – when about 80% of miscarriages occur

The policy, which Mississippi lawmakers hope will help mitigate the state’s poor maternal and infant health metrics – some of the worst in the country – exists in 29 other states and Washington D.C. 

Mississippi Today reached out to the Division of Medicaid in late May to request an interview over the next month with an agency official to discuss what the process of presumptive eligibility and timely care for pregnant women would look like once the law went into effect July 1. The reporter continued each week to reach out to spokesperson Matt Westerfield, who on June 10 said the agency was “exploring some options” for the interview.

On June 28, Westerfield said implementation is “complex” and that the agency would only communicate through “written exchanges.”  

The agency on Tuesday issued a general statement about its commitment to implementing the policy – with no details about any outreach, public education or provider training to date.

“The Mississippi Division of Medicaid will continue to do the necessary due diligence to ensure providers interested in making presumptive eligibility determinations are qualified and trained,” Westerfield said in an email.

Not all providers who accept Medicaid will be automatically able to participate in presumptive eligibility, according to a brief explainer on Medicaid’s website posted at the end of June. 

Doctors and other qualifying providers must complete an application and undergo eligibility determination training, in addition to submitting a memorandum of understanding with the agency once approved. Then, a pregnant woman whose income falls below 194% of the federal poverty level – about $29,000 annually for an individual – can bring proof of income to the doctor and, if approved, receive prenatal care the same day. 

Westerfield said in an emailed statement in May that the agency would communicate to the public which locations are participating in the program, but said that they were “still working on what that outreach will look like.”

As of Tuesday, it is still unclear which, if any, providers are participating and whether Medicaid has sent any communication about the steps they must take if they want to participate.

House Medicaid Committee Chairwoman Missy McGee, R-Hattiesburg, said the passing of legislation that would extend postpartum Medicaid coverage from two months to a year, by the committee is “the right thing for women and babies in Mississippi,” Tuesday, Feb. 28, 2023, at the Mississippi Capitol in Jackson. (AP Photo/Rogelio V. Solis)
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House Medicaid Committee Chairwoman Missy McGee, R-Hattiesburg, Tuesday, Feb. 28, 2023, at the Mississippi Capitol in Jackson. (AP Photo/Rogelio V. Solis)

“Medicaid clearly knows that the intent of the Legislature is for pregnant women to get in to see their doctor as early as possible, and they are working to stand up this program that is now the law,” said House Medicaid Chair and the bill’s author Missy McGee, a Republican from Hattiesburg. “As the author of this legislation, I will be closely monitoring the rollout of this new program and am optimistic that it will be done in a timely manner.”  

The Legislature made the bill broad enough that the Division of Medicaid would have the freedom to implement it in whatever way it saw fit, McGee explained.

“ … The Legislature’s job is to create the policy. Now that it is law, it is Medicaid’s job to implement it.”

Mississippi Today reached out to University of Mississippi Medical Center – Mississippi’s largest Medicaid provider – to determine what, if any, communication it has received about how presumptive eligibility will work.

“We are still checking into the process for this, but don’t have any comment at this time,” a hospital spokesperson told Mississippi Today on Tuesday.

In March, the number of Mississippi Medicaid applications that took more than 45 days to be processed was 29%, according to data from the Centers for Medicare and Medicaid Services, due to “unwinding.” State Medicaid divisions across the country began reviewing their rolls last year for the first time in three years after the end of COVID-19 restrictions that prevented them from unenrolling beneficiaries, and Mississippi at times had a significant application backlog.

Without presumptive eligibility, pregnant women are forced to pay out of pocket or go without care in this interim period. 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 – and preterm births, in which Mississippi leads the nation. 

The state received more than $2 million of federal funds and an additional $602,000 in state money to implement the program, according to the 2024 Medicaid appropriation bill

Advocates of the policy have said the program pays for itself when compared to how much it costs the state to care for 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. 

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 a soon as they find out they’re pregnant by showing proof of monthly income to a doctor at a qualifying location. 

While it’s not known which providers, if any, have chosen to participate so far, Mississippi Today will continue to monitor the Division of Medicaid’s implementation of the policy and report on qualifying providers as they sign up.

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