Missouri slow to extend coverage for postpartum depression despite lawmakers’ approval

Despite approval from lawmakers nearly 18 months ago, Missouri has yet to implement an extension of coverage for postpartum depression and other mental health conditions to low-income women in the year after they give birth, officials told a legislative committee Tuesday.

Instead, the Department of Social Services is waiting for lawmakers to set aside funds specifically labeled for that purpose, a year-and-a-half after the General Assembly passed a bill directing officials to take action.

Expansion of Medicaid coverage postpartum has long been proposed by health advocates as one way to reduce Missouri’s rate of maternal mortality, one of the nation’s highest. Extending coverage to one-year postpartum for all health conditions was recommended this year in a report by the Pregnancy-Associated Mortality Review board, a state health panel that analyzes the deaths of women during pregnancy or within one year of giving birth.

Under the traditional Medicaid program and an additional state health initiative, pregnant women receive health coverage if they make up to 300% of the federal poverty level — a little over $38,600 a year — and lose it 60 days after giving birth.

While many new mothers will be able to continue receiving coverage under the expansion of Medicaid for low-income adults this year, the Missouri Foundation for Health estimates about 6,200 of the roughly 24,000 receiving postpartum coverage would have incomes that remain too high to stay on the program beyond the 60-day period.

Missouri has taken a piecemeal approach to extending postpartum coverage. In 2018, lawmakers passed an extension specifically for new mothers diagnosed with substance use disorders to continue receiving Medicaid mental health coverage for 14 months postpartum.

The federal Centers for Medicare and Medicaid Services approved implementation of the plan this year and recipients can begin enrolling in that coverage in January, Caitlin Whaley, DSS director of legislation and communications, told lawmakers on Tuesday.

But the department has not yet sought CMS approval for the one-year extension covering other mental health conditions such as postpartum depression, which roughly one-in-seven women experience. Lawmakers passed that extension in 2020.

“This access for women who suffer from depression or some kind of mental health issue, we know that that has a dramatic negative impact on their children on their ability to work and support their families,” said Sen. Jill Schupp, a Creve Coeur Democrat who advocated for the extension. “It’s a concern because the legislature has clearly given its intent to make sure that women who suffer from postpartum mental health issues are taken care of.”

Whaley told lawmakers Tuesday they need to pass a budget specifying funds for the extended coverage before the department submits a plan to the federal government.

“Historically, the legislature has indicated their desire to specifically call out funding for those types of new programs” in the budget, she said.

A DSS spokeswoman could not be reached Tuesday afternoon to provide a cost estimate.

The Pregnancy-Associated Mortality Review board most recently analyzed the 68 pregnancy-related deaths recorded in 2018 (the latest year for which data was available). It found in a report released this year mental illness was an underlying cause in half of the deaths.

The report did not specify which conditions fall under the “mental health” category, but mentioned postpartum depression. The authors categorized addiction separately from mental health conditions.

Lawmakers discussed the issue with DSS officials Tuesday during a hearing of the Joint Committee on Child Abuse and Neglect that covered a range issues facing the embattled department.

The department has received heightened scrutiny from the legislature in the past year. Much of the focus has been on the Children’s Division’s handling of abuse claims at unlicensed religious boarding schools, along with low morale and high turnover among caseworkers.

House lawmakers last month held a hearing excoriating DSS leaders over a federal report finding the state does not adequately keep track of and report children who go missing from foster care. Gov. Mike Parson last month replaced the DSS acting director Jennifer Tidball, now the department’s chief operating officer, with his deputy chief of staff Robert Knodell.

Knodell told the committee Tuesday he was pledging “full cooperation” with lawmakers, “regardless of any past experience that you’ve had dealing with our department.”

He said the state is working with the consultant Accenture to develop a “comprehensive plan” on pay, recruitment and retention of caseworkers and is considering widespread information technology upgrades.

“We’re working on short term fixes to ease as much strain as we can, as well as working on a compensation strategy for recruitment and retention of team members to shrink case loads, to reduce or eliminate wait times and to improve morale,” he said.