Alabama lawmakers pass legislation that could give pregnant women more access to health care

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By Safiyah Riddle

MONTGOMERY, Ala. (AP) — Alabama legislators unanimously passed a bill on Tuesday that would expedite access to Medicaid for pregnant women, as more states across the South attempt to stem high maternal and infant mortality rates.

The “presumptive eligibility” legislation states that Medicaid will pay for a pregnant woman’s outpatient medical care for up to 60 days while an application for the government-funded insurance program is being considered.

The bill will now go to Republican Gov. Kay Ivey’s desk for her signature.

Many Republican legislators endorsed the bill as “pro-life.” Democratic lawmakers said that it was essential for addressing Alabama’s delivery health outcomes that lag behind the rest of the country.

Other states have adopted a similar strategy for addressing some of the highest infant and maternal mortality rates nationwide. Legislators in Mississippi and Arkansas have passed laws that would offer similar coverage to expectant mothers.

One study found Alabama had a maternal mortality rate of 64.63 deaths per 100,000 births between 2018 and 2021, nearly double the national rate of 34.09 per 100,000 births. That jumps to 100.07 deaths for Black women in the state.

Hospital closures in rural parts of the state have left many women without access to prenatal care. Last year, nearly 1 in 5 pregnant Alabama women didn’t receive prenatal care until after five months of pregnancy, or otherwise received less than 50% of the appropriate number of the recommended visits throughout her pregnancy, according to The March of Dimes.

That is in part because one in six women of childbearing age fall within the coverage gap, making too much to qualify for Medicaid but too little to afford private insurance, according to Alabama Arise, an advocacy group for low-income families.

Alabama is among 10 states nationwide that have not expanded Medicaid, which means many low-income women are only eligible for Medicaid once they become pregnant.

A pregnant woman in Alabama with no dependents can qualify for Medicaid if she makes $21,996 or less, or up to $37,704 if she is part of a household of three.

Medicaid was used to pay for 45% of all births in Alabama in 2023, according to the most recent report published by the Alabama Department of Public Health. More than half of all infant deaths were to mothers who used Medicaid.

The Alabama bill would increase Medicaid spending statewide by about $1 million annually over the course of three years, with about two-thirds coming from the federal government.

Another bill that advanced in March seeks to expand access to medical care for expectant mothers by allowing midwives to provide care outside of hospitals in freestanding birth centers. But recent amendments to the legislation prohibits midwifes from performing many standard medical screenings for newborns that are necessary to detect genetic disorders.

The Alabama Midwives Alliance said that the legislation “started as a good bill” in a video posted on Facebook in April, but added that the amendments “take it in the wrong direction.”

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Safiyah Riddle is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.