MONTGOMERY, Ala. — Rep. Marilyn Lands, a Democrat from Huntsville who flipped Alabama House District 10 last year running on reproductive rights, filed a bill this week to provide presumptive health care to pregnant women in Alabama through Medicaid.
It has now garnered bi-partisan support.
House Bill 89, would extend Medicaid coverage for pregnant women for up to 60 days while their Medicaid application is pending, allowing for immediate prenatal care. While pregnant women whose annual income is below $21,996 are already eligible for Medicaid, coverage does not begin until an application is approved, which can often be a lengthy process, particularly for those with lower incomes in rural areas.
Lands told Alabama Daily News that shortly after being sworn into office last year in April, she became aware of a bill in Mississippi that would provide presumptive Medicaid coverage to pregnant women and sought to replicate it in Alabama.
“Maternal health is of course an issue near and dear to my heart, I think anybody that’s a mom feels that way,” Lands told ADN. “Looking at our numbers, being 50th in maternal mortality and 47th in infant mortality, I began to look at what we could do to create change here in Alabama.”
In a report from the Alabama Department of Public Health, 62.5% of maternal deaths in 2021 were deemed preventable.
Alabama’s infant mortality rate is also significantly higher than the national average, with there being 7.8 infant deaths per 1,000 births in 2023, the single-highest rate since 2016, compared to the national rate of 5.6 per 1,000 births. Around half of all births in the state are paid for through Medicaid.
Under existing law, pregnant women eligible for Medicaid must submit not only documentation verifying their income, but a pregnancy verification letter from a doctor. For lower-income Alabamians, some may not have the funds to schedule an appointment with a doctor, leaving their only recourse as scheduling an appointment with a local health department, which can often take weeks.
By offering immediate presumptive care to pregnant women, Lands argued that HB89 could improve Alabama’s maternal and infant mortality rates, and at the same time, save the state a significant amount of money.
“We have so many preterm births, and each preterm birth is estimated to cost about $60,000 on average,” she said. “So if we can eliminate a percentage of those, then we’re going to be saving a lot of money, and having better outcomes.”
A fiscal note about the bill’s potential cost is not yet available, but Lands told ADN the proposal is estimated to cost around $1 million annually, though only around $400,000 from that state. With that said, Lands argued that the state would end up saving “tens of millions of dollars” due to the reduction of prenatal births that would come with expanded Medicaid coverage.
The bill has nine co-sponsors, four of which are Republicans. Among them is Rep. Susan DuBose, R-Hoover, who told ADN that she viewed the proposal as a “pro-life bill,” as well as an opportunity to help improve the state’s maternal and infant mortality rates.
“We have a very high infant mortality rate, and I think it’s important for us to focus on that as a state,” DuBose told ADN.
“I think this is legislation that both Republicans and Democrats can get behind, I see this as a bi-partisan piece of legislation. The difficulty and the hurdle will be the fiscal note, so we’ll see if it’s going to be something that’s doable; the budget is going to be a little bit tighter this year than it has been in the past, so we’ll see how that turns out.”
Rep. Margie Wilcox, R-Mobile, is another Republican co-sponsor.
“I’m eager to try any solution that will help with the maternal mortality rate and how we can help children and families not just survive, but thrive,” Wilcox said. “There are always cost concerns, but I’ve looked at what I think is the cost and it’s a reasonable cost to try something new to combat this awful situation. We’ve got to help our mothers survive childbirth.”
Public health officials have frequently pointed to the loss of obstetrical services in Alabama’s rural communities as a leading driver of increased maternal and infant mortality. In 1980, 45 of the state’s 54 rural counties had hospitals providing obstetrical services, but by 2019 that number had shrunk to 16.
The bill has been assigned to the House Ways and Means General Fund Committee and the legislative session starts Tuesday.
Lands said she attributes the bill’s bi-partisan support to a universal desire to help mothers and infants.
“I think part of it is (that) women understand this issue, and I think because it’s something that can lift Alabama up and really show that we do care about our mamas and babies,” she said.