Program aimed at increasing access to prenatal care pending federal approval

Pregnancy presumptive eligibility in Mississippi is still not in effect, despite becoming law July 1. However, the Division of Medicaid said it has cleared several administrative hurdles and is awaiting action from the federal government.

But a discrepancy between state and federal law may delay the process further.

Legislators wrote in the bill that pregnant women must provide proof of income when seeking prenatal care. Federal guidelines, however, state that while the agency may require proof of citizenship or residency, it should not “require verification of the conditions for presumptive eligibility.”

Matt Westerfield, spokesperson from the Division of Medicaid, said the “federal regulations could be open to multiple interpretations” and that the division doesn’t necessarily expect the discrepancy to become a problem.

“The Division can’t speak on behalf of lawmakers about what was drafted and why. But we do think the Legislature included a sensible provision that an individual seeking taxpayer-funded Medicaid benefits meet minimal requirements for presumptive eligibility,” Westerfield said.

House Medicaid Chair Missy McGee, a Republican from Hattiesburg and the author of the bill, did not respond to questions about the discrepancy by the time of publication.

House Bill 539 allows certain low-income, uninsured pregnant women to receive immediate prenatal care covered by Medicaid while they wait for their Medicaid application to be officially approved, which can take up to 45 days. The governor signed it into law in March, and it became law July 1.

Meant to tide women over in what is sometimes a “no coverage” window, the policy ensures that uninsured women receive timely prenatal care – proven to mitigate health risks like hypertension, one of the leading causes of maternal mortality in the state, according to a 2023 report by the Mississippi State Department of Health.

“I would suggest that requesting proof of income is requiring verification of the conditions for presumptive eligibility,” argued Tricia Brooks, a research professor at the Center for Children and Families at Georgetown University and the lead author on the KFF Annual Survey on Medicaid and CHIP Eligibility, Enrollment and Renewal Policies. “And I think that’s a barrier. I think it’s a barrier for individuals, and I think it’s a barrier for the provider offices.”

That’s because requiring that kind of proof can make the program less accessible for patients already facing socioeconomic hurdles, Brooks elaborated, as well as less efficient for providers.

“I remember when I first got pregnant, I thought I had the flu because I was nauseous for days on end,” Brooks said. “If I go to the doctor and find out that lo and behold maybe I am pregnant, and you want me to get enrolled, but now you’re asking me for paystubs … So now I have to come back in or somehow communicate or transmit proof of income to the provider. That just gives everybody pause of, ‘Oh my god, is this even worth it?’”

To participate in presumptive eligibility, 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.

So far, no providers have signed up to participate, and the only information available online is a brief explainer on Medicaid’s website posted at the end of June.

But the division plans to post more information on its website “in the next week or two,” Westerfield said on July 10. So far, nothing new has been posted.

“We will also communicate the policy along with other agency updates through various meetings and conversations with provider groups we are in regular contact with,” Westerfield said last week.

Mississippi Today repeatedly requested a phone or in-person interview with an agency official involved with the rollout of presumptive eligibility, but the Division of Medicaid said it would only communicate via email.

Mississippi Today reached out to University of Mississippi Medical Center – Mississippi’s largest Medicaid provider – on July 2 and again on July 11 to determine what, if any, communication it has received about how presumptive eligibility will work.

A hospital spokesperson declined to comment both times. On July 16, the spokesperson said the hospital “intends to apply” but declined to answer specific questions.

Ochsner Rush Hospital in Meridian and the Hattiesburg Clinic declined to comment.

North Mississippi Medical Center in Tupelo and Merit Health Central in Jackson did not respond to Mississippi Today’s questions about what, if any, information the Division of Medicaid had sent by the time of publication.

Delta Health Center, a Federally Qualified Community Health Center in Mound Bayou, said the clinic received information about signing up from the Division of Medicaid on July 3, and the clinic plans to participate.

“Waiting for Medicaid determination has been a huge barrier to accessing early prenatal care for many of our maternal health patients,” a spokesperson from the clinic told Mississippi Today via email.

To educate the public on participating locations, Westerfield said the division will publish and continually update a list of participating providers.

He also said they will use social media to promote what doctors and clinics are participating in the program.

Applicants can potentially get same-day coverage if they know the number of people in the household and can show proof of monthly income, according to the division.

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 as soon as they find out they’re pregnant by showing proof of monthly income to staff 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.

The post Program aimed at increasing access to prenatal care pending federal approval appeared first on Mississippi Today .