The state Medicaid director and a hospital CEO — neither of them doctors — bucked recommendations from health care professionals and delayed a vote that could have made it easier for expecting Mississippians to receive timely prenatal care.

The move comes just days after the release of a maternal mortality report that shows Mississippi is still one of the most dangerous places in the country to give birth. 

The Mississippi Medical Care Advisory Committee heard presentations from Dr. Anita Henderson, former president of the state pediatric association, and Dr. Jaleen Sims, a Jackson-based OB-GYN. The two said at the committee’s Friday meeting that establishing pregnancy presumptive eligibility for Medicaid could make it easier to receive timely prenatal care in Mississippi.

The committee —made up of 11 members appointed by the governor, lieutenant governor and speaker of the House — is tasked by state law to advise the Division of Medicaid, which covers most births in Mississippi. The committee’s recommendation to the state Legislature this past year to extend postpartum Medicaid coverage was influential in the legislation’s subsequent passage.

Medicaid Director Drew Snyder, appointed by former Gov. Phil Bryant and reappointed by Gov. Tate Reeves, has not supported Medicaid expansion and was reluctant to endorse expanding postpartum care to mothers despite the urging of doctors this past year, in line with Reeves. On Friday, Snyder urged the committee to hold off on recommending presumptive Medicaid eligibility for expectant mothers. Kent Nicaud, a hospital CEO who is a strong political supporter of Reeves, aided Snyder in the effort by amending a motion that would have recommended the policy’s adoption.

Pregnancy presumptive eligibility allows people to receive health care when they’re pregnant, even if they’re not on Medicaid because it’s presumed that they qualify.

It’s an important step to reducing barriers to timely care. It can be complicated to get pregnancy Medicaid coverage, and those complications can mean the difference between a preventable pregnancy-related death and a safe delivery. 

Though Medicaid policy states a person can qualify by simply attesting they are pregnant, most doctors and expecting people are under the impression a pregnancy test from a health care provider is required to be covered. Sims previously told Mississippi Today that despite the division’s policy, her patients applying for Medicaid have been asked for further confirmation to verify they’re pregnant.

That means Mississippians generally must pay out-of-pocket for a doctor’s pregnancy test test because they’re not presumed eligible for Medicaid. Then they must wait for their Medicaid application to be approved to receive care, unless they’re willing to continue paying out-of-pocket. Some doctors won’t even see them before they’re insured. 

The division does retroactively reimburse prenatal care after applications are approved, but Matt Westerfield, spokesperson for the Division of Medicaid, told Mississippi Today last year that it takes the agency about 24 days to approve pregnancy applications.

Following the doctors’ presentations at the committee meeting, State Health Officer Dr. Daniel Edney made a motion for the committee to recommend the adoption of pregnancy presumptive eligibility to the Legislature or the division. 

“Give these women a chance to have their babies,” Edney said. “Why wouldn’t we do it if we’re in such a crisis?”

After the motion was seconded, however, Snyder spoke up in opposition.

“Twenty minutes of discussion from two presenters is not enough on this complex issue,” Snyder said. “Rather than saying, ‘Let’s do everything we can,’ let’s do what’s smart and what works and what’s actually connected to improving outcomes.”

Snyder, an attorney, asked the committee if the division could consider and research the policy and return to the committee with their findings. 

Dr. Billy Long, a gastroenterologist based in Madison, then expressed confusion about who had the power to establish the policy.

“I thought I heard you say, ‘Medicaid could not make this decision,’” he said to Snyder. 

Snyder replied, “That’s correct, we need to send this to the Legislature,” and then immediately declined to get into the “nuances.”

It’s not clear what agency has the power to establish presumptive eligibility. Snyder, appointed Medicaid director by former Gov. Phil Bryant and reappointed by Reeves, has said previously that the Division of Medicaid wouldn’t utilize pregnancy presumptive eligibility unless directed to by the Legislature. Westerfield previously told Mississippi Today that position is to avoid paying “providers for services for women who subsequently would not qualify for Medicaid.”

Nicaud then suggested that Medicaid bring more information to the committee at a special meeting in January and repeatedly stressed that “educating” patients might be more helpful to improving outcomes for mothers and babies in Mississippi than presumptive eligibility.

Nicaud, who also doesn’t have a medical degree, is the president and CEO of Gulfport’s Memorial Health System and has donated almost $125,000 to Reeves since 2017.

Nicaud encouraged Edney to modify his motion, which Edney declined to do. 

“We endorse the concept of presumptive eligibility unless there’s a reason we cannot,” Edney said. “If there’s an extra meeting, I’d be happy to attend.”

Nicaud then amended Edney’s motion to call a special meeting to discuss presumptive eligibility further and then make the committee’s recommendation to the division or Legislature. 

Following the meeting, Snyder quickly left the Capitol chamber where the meeting was held and refused to take questions.

Henderson later expressed disappointment about the committee’s decision. 

“Personally, I think it’s a no brainer,” she said. “I think this is an issue everyone should be on board with. If the rest of the country is, why aren’t we?”

Mississippi is one of 21 states as of January 2020 that doesn’t offer presumptive eligibility for pregnant people, according to KFF, and Mississippi is one of just three states that has not expanded Medicaid nor established presumptive eligibility.

According to a study commissioned with the University of Mississippi Center for Population Studies by the Center for Mississippi Health Policy, preterm births are less likely for low-income people when they live in a state with presumptive eligibility and expanded Medicaid. 

Sen. Kevin Blackwell, R-Southaven, and Sen. Nicole Boyd, R-Oxford, say they will co-author a bill this upcoming Legislative session about presumptive eligibility for pregnant women. A previous attempt to establish presumptive eligibility by Rep. Missy McGee, R-Hattiesburg, did not make it out of committee this past session.

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