Nearly five months after a new law to make prenatal care more accessible to low-income women was supposed to go into effect, its fate remains unclear. 

The state is still in negotiations with the Centers for Medicare and Medicaid Services – the federal agency responsible for approving the state plan – according to Matt Westerfield, spokesperson for the Mississippi Division of Medicaid. CMS is supposed to take no more than 90 days to approve or reject a plan, but that 90-day clock has been suspended indefinitely since issues have been raised with legislation Mississippi lawmakers wrote last session. 

Presumptive eligibility for pregnant women allows temporary and immediate Medicaid coverage for low-income expectant mothers while they wait for their official Medicaid application to be approved – a process that can take months. 

Strict Medicaid eligibility requirements in Mississippi mean that a majority of low-income women are only eligible for Medicaid once they become pregnant. If a woman applies when she finds out she’s pregnant, that means a lengthy application process could cut well into her pregnancy and delay her seeking prenatal care, which is proven to lead to poor outcomes such as preterm birth – in which Mississippi leads the nation. 

Nicole Boyd, R-Oxford, who leads the Senate Study Group for Women, Children and Families, has been checking in weekly with Medicaid about the status of the policy. In a committee hearing Monday, Boyd followed up twice with newly appointed Medicaid Executive Director Cindy Bradshaw at the beginning and end of the meeting to try to gain clarity on the status of the policy. 

Boyd asked Bradshaw whether the 2024 legislation could be salvaged or whether lawmakers would need to redo legislation to enact the policy in 2025. Bradshaw said both that she hopes the state and federal agencies can come to an agreement, and also that she’d feel better with new legislation. 

“Well, I think we can come to a reasonable place that we will be able to get it,” Bradshaw said. “Am I 100% comfortable with that? No. I would prefer that we have legislation to shore up the concessions that we’ve had to make.”

It’s not clear what concessions the Mississippi Division of Medicaid has had to make, but it’s likely that CMS is requiring Medicaid to take out a proof of income and proof of requirement lawmakers included in the original bill. 

Federal guidelines state that while the agency may require proof of citizenship or residency, it should not “require verification of the conditions for presumptive eligibility.”

CMS will not comment on ongoing negotiations with individual states.

If 2024 legislation can’t be salvaged, lawmakers would have two options for rewriting the law next session. They could take out the requirements with which CMS has an issue, or they could take their chances hoping a Trump administration would grant a waiver allowing them to keep requirements at odds with federal guidelines – something lawmakers will likely bank on with a Medicaid expansion bill next session, as well. 

Insisting on the proof of pregnancy requirement doesn’t serve much of a purpose, since it wouldn’t be possible for a woman to fake a pregnancy and receive prenatal care, such as ultrasounds. As for the proof of income requirement, it can be cumbersome on low-income women already facing socioeconomic hurdles, explained 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.

“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?’”

In the meantime, the Division of Medicaid is continuing to accept providers who wish to participate in the program and conduct eligibility determination trainings, according to Westerfield. Until CMS approves the state plan, none of the providers that have been approved will be able to provide care under the policy to eligible women.

Below is a list of the 13 providers that have been approved to participate as of Oct. 18: 

• Physicians & Surgeons Clinic – Amory
• Mississippi Department of Health, Dr. Renia Dotson – County Health Department (Family Planning Clinic)
• Family Health Center – Laurel
• Delta Health Center Inc (Dr. H. Jack Geiger Medical Center) – Mound Bayou
• G.A. Carmichael Family Health Center Providers – Belzoni, Canton, Yazoo City
• Coastal Family Health Center Inc. – Biloxi 
• Delta Health System – Greenville
• Delta Medical Group – Women’s Specialty Clinic – Greenville
• Southeast MS Rural Health Initiative Inc. – Women’s Health Center – Hattiesburg
• University of Mississippi Medical Center – Jackson
• Jackson Hinds Comprehensive Health Center – Jackson
• Central MS Health Service – Jackson
• Northwest MS Regional Medical Center – Clarksdale

An expectant mother would need to fall under the following income levels to qualify for presumptive eligibility:

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.