Low-income women in Mississippi have less access to health care in the months after giving birth than their counterparts in every state except Wyoming.

Mississippi and Wyoming are now the only two states in the country that have neither expanded Medicaid eligibility to low-income working adults, nor extended postpartum Medicaid coverage for new mothers beyond 60 days after birth, according to data compiled by the health nonprofit KFF. 

The other nine states that have not expanded Medicaid eligibility have all sought to extend postpartum coverage in recent years. Seven of them, including Alabama, Tennessee, Georgia and South Carolina, have extended coverage to a year after birth. Texas and Wisconsin have sought federal approval to implement shorter extensions of six months and 90 days, respectively. 

“We know infant mortality and maternal health are challenges for our state,” said Tennessee Gov. Bill Lee, a Republican who opposes Medicaid expansion, when he introduced his proposal to extend postpartum coverage in 2020. “One in two Tennessee births are covered through our Medicaid program.”

In Mississippi, that number is higher: about six in 10 births are covered by Medicaid.

During the ongoing COVID-19 federal public health emergency, states are not allowed to kick anyone off Medicaid. As a result, women who have given birth since March 2020 will have coverage until the emergency is lifted, potentially as soon as early 2023. 

But ordinarily, a Mississippi woman with two kids and a partner together earning $3,000 a month, for example, would lose her Medicaid coverage two months after her baby is born. 

The same woman living in Alabama, which has not expanded Medicaid eligibility but approved a 12-month postpartum coverage extension earlier this year, would have health insurance until her baby is a year old. And the same woman living in Arkansas, which has expanded Medicaid but not extended postpartum coverage, would have health insurance before and after her pregnancy, because she would be eligible based solely on her income. 

In Mississippi, women whose pregnancies are covered by Medicaid lose the ability to go to check-ups, get treatment for postpartum depression, and receive care for chronic conditions when their babies are just two months old.

House Speaker Philip Gunn, R-Clinton, has repeatedly rejected postpartum Medicaid extension, which easily passed the Senate last session. He has described the proposal as Medicaid expansion, though it would not make more people eligible for Medicaid. Almost every other state that has refused to expand Medicaid has nevertheless extended postpartum coverage. 

Last week, some of the state’s leading doctors told the Senate Medicaid Committee that extending postpartum Medicaid would not only improve abysmal maternal and infant health outcomes but also save money.

Mississippi has the country’s highest infant mortality rate and highest rate of premature births. Dr. Anita Henderson, a pediatrician and president of the Mississippi Chapter of the American Academy of Pediatrics, said the hospital cost of delivering a healthy baby at full term is typically around $5,000 to $6,000. But an extremely preterm baby requires a long stay in a neonatal intensive care unit (NICU), at an average cost of $600,000.

State Health Officer Dr. Daniel P. Edney mentioned that Mississippi is one of just two states that has neither extended postpartum coverage nor expanded Medicaid eligibility. 

“What I would beg us to consider is the fact it makes much more economic sense to let Medicaid pay for this rather than the state having to pay for it – either state agencies such as the health department paying, or hospitals paying for it with uncompensated care,” he said. 

Pregnant women in Mississippi qualify for Medicaid as long as their family income is below 194% of the federal poverty level– about $4,600 per month for a family of four. 

But after giving birth, a Mississippian with kids qualifies for Medicaid only if she has a very low income, earning $578 or less monthly for a family of four. 

With such a strict income eligibility requirement, it’s all but impossible for anyone with a full-time job to qualify for Medicaid coverage. (And healthy adults without kids never qualify for Medicaid in Mississippi.)

In states that have expanded Medicaid, including Louisiana and Arkansas, adults with incomes below 138% of the federal poverty level, or about $3,200 for a family of four, qualify for health insurance.

An analysis by the consulting firm Manatt found that expanding eligibility for Medicaid would cut enrollment in pregnancy Medicaid by about half, because many women would qualify based on income alone. 

Wil Ervin, deputy administrator for health policy for Mississippi Medicaid, told the Senate Medicaid Committee last week that extending postpartum coverage to a year would cost the state about $7 million. 

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