Louisiana leads on postpartum coverage

Louisiana leads on postpartum coverage

Tucked inside last year’s American Rescue Plan Act was a little-noticed provision that allowed states to offer a full year of postpartum Medicaid coverage for new moms, instead of the 60 days currently covered by the program. On Friday Louisiana became the first state to take advantage of this opportunity, which is welcome news in a state that has the second-highest infant mortality rate in the country. Maggie Clarke with the Georgetown University Health Policy Institute reports that other states are expected to follow: 

The need for action is clear: the latest data from the CDC shows that maternal death rates increased in 2020 for the second year in a row, and Black women continue to have a mortality rate twice as high as the national average. Medicaid is the source of coverage for about two thirds of births among Black women, so policy changes in Medicaid are especially impactful for the women most at risk of mortality and other serious, life-altering complications. Women of color are also more likely than their White peers to experience a coverage disruption during pregnancy, which can cut off their access to ongoing prenatal and postpartum care, access to medications or other support they need to manage their own health, which will support their health of their infant.

Check the boxes to keep people covered
Louisiana’s Medicaid enrollment has grown by more than 330,000 since the start of the pandemic, when Congress offered states an attractive deal: The federal government would agree to pick up a higher percentage of state Medicaid costs, but in return for the extra money states would be barred from taking anyone off the rolls for the duration of the Public Health Emergency. As the pandemic shows encouraging signs of improving, the federal agency that oversees Medicaid recently sent a checklist to states of things they can do to ensure that people don’t lose health coverage because of paperwork problems. Courtney Foster, Medicaid policy advocate for the Louisiana Budget Project, explains why Louisiana needs to check all the boxes: 

The process of reviewing eligibility for the entire Medicaid population will be a massive undertaking for state agencies, patient navigators, insurers, and advocates working to keep people covered. The guidance from the Centers for Medicaid and Medicare Services (CMS) encourages states to promote continuity of coverage, and the agency has pledged to work with states to make sure they have procedures in place to guard against wrongful terminations. While we don’t know for sure when the eligibility reviews will start, the state should take steps now to ensure that the state avoids inappropriate terminations and coverage losses. 

Fines and fees commission stalls
Activists in Louisiana have been pushing for years to reduce Louisiana’s overreliance on fines and fees to pay for its bloated criminal legal system, which disproportionately hurts low-income people and communities of color. A state commission, formed three years ago, was supposed to recommend a path forward. But as Kalena Thomhave reports for the digital magazine Bolts, the commission has failed to produce substantive recommendations, and is still struggling to compile basic information. At the root of the problem is opposition from local officials who stand to lose funding: 

States are starting to turn away from fines and fees in part because they are a lousy source of funding. A 2019 Brennan Center for Justice report found that it cost profiled Texas and New Mexico jurisdictions an average of $0.41 to collect fines and fees for every dollar raised. Funding from fines and fees is also volatile, and agencies dependent on them often see considerable fluctuations. The pandemic made this even more apparent, since reduced collections and closed court buildings meant fewer fines and fees collected. Here again, the impact is often felt by the more vulnerable. Most public defenders’ offices across Louisiana faced budget deficits as traffic tickets fell by more than a quarter during the pandemic.

The new flood insurance rules
With 500,000 policyholders, Louisiana is the largest participant in the National Flood Insurance program. As a set of “reforms” to that program take effect starting this month, many of them will face skyrocketing premiums in the coming years – putting a financial squeeze on people in coastal and low-lying areas who already have battled multiple disasters in recent years. The Advocate’s Mike Smith reports on why Louisianans are bearing the brunt of well-intentioned changes: 

For critics of the program who have long been seeking to slow construction in scenic but risky waterfront areas, they’re a good thing and long overdue. But, as has so often been the case, south Louisiana and its working coast may end up being an exception to the rule. If doomsday predictions prove accurate, parts of the housing market could be transformed. First-time homebuyers and working-class families may end up being hit hard in this part of the country, where water is never far away.

Programming note
In this week’s episode of the Didja Know? podcast, Jan Moller speaks with Ashley Shelton of the Power Coalition for Equity and Justice about last week’s veto override and the fight to draw fair legislative districts in Louisiana that ensure everyone has equal representation.

Number of the Day
$70.6 million – Amount collected in fines and fees by 77 Louisiana state agencies that responded to an information request by the legislative auditor. Fewer than 5% of the 1,500 agencies that collect fines and fees responded to the survey (Source: Bolts magazine)