When Victoria Ferrell Ortiz gave birth to her daughter in 2017, she was covered by a limited form of Medicaid in Texas – which ended just two months after she gave birth. Losing insurance too soon is stressful. She’s advocating pushing Texas to expand Medicaid coverage for a full year after a baby is born.
Yfat Yossifor / KERA
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Yfat Yossifor / KERA
When Victoria Ferrell Ortiz gave birth to her daughter in 2017, she was covered by a limited form of Medicaid in Texas – which ended just two months after she gave birth. Losing insurance too soon is stressful. She’s advocating pushing Texas to expand Medicaid coverage for a full year after a baby is born.
Yfat Yossifor / KERA
Victoria Ferrell Ortiz found out she was pregnant in the summer of 2017. The Dallas resident is completing AmeriCorps work with a local nonprofit that provides her with a small but generous living allowance. no health insurance. She applied for Medicaid so she could be covered during her pregnancy.
“It was a time when I had to learn, change and turn around a lot, because we didn’t necessarily expect that kind of life change,” she said.
But applying for Medicaid doesn’t come with instructions for use. She was inundated with forms. She spent days straight on the phone trying to figure out what was covered and where she could actually go for care.
“It’s really a huge privilege because it takes a lot of time, and sometimes the agent I’m going to talk to doesn’t know the answer,” she said. “I’m going to have to wait and see and hope that they really did follow me.”
More 471,000 pregnant Texans now navigating that disjointed, bureaucratic system to find care. Medicaid provides coverage for approximately half of all births in the state — but coverage is so meager that many people lose their eligibility not long after giving birth.
Medicaid covers about half of all births in Texas. During pregnancy, many people rely on that Medicaid coverage to access everything they need—from doctor appointments to prenatal vitamins.
But pregnancy-related Medicaid coverage ends just two months after childbirth – and advocates and researchers say the drastic cuts contribute to high percentage on maternal mortality and morbidity in the state. They support a bill passing the current legislative session that would expand Medicaid coverage during pregnancy to the full 12 months, after delivery.
What Happened When Texas Didn’t Expand Medicaid
Texas is one of 11 states that have chosen not to expand Medicaid to the uninsured adult population – it’s a benefit provided under the Affordable Care Act, with 90% of the costs due to paid by the federal government. That leaves more 770,000 Texans in the coverage gap – they don’t have any work-based coverage, nor are they eligible for subsidized coverage on HealthCare.govFederal insurance market. In 2022, 23% of women aged 19-64 are no insurance in Texas.
The temporary pregnancy allowance helps fill the gap. Nearly half a million Texans are currently enrolled in the program. The majority are Hispanic and Latinx women between the ages of 19 and 29.
Undocumented Texans and lawfully present immigrants are Are not are eligible, although they may receive coverage that varies and ends immediately when the baby is born.
In states that have passed Medicaid expansion, coverage is available to all adults earning less than 138% of the federal poverty level. For a family of three, that means an income of $34,307 a year.
But in Texas, adults without children are completely ineligible for Medicaid. Parents may be eligible for Medicaid if they are caring for a child receiving Medicaid, but low income limit. For a household of three with two parents, they cannot earn more than $251 a month.
Pregnancy-related medical benefits in Texas are available to individuals earning less than $2,243 a month. It lasted through pregnant and two months after giving birthcovers everything from prenatal visits to postpartum visits.
For Ferrell Ortiz, the Medicaid-accepting hospitals and clinics near her in her Dallas neighborhood felt “uncomfortable, unattractive… and a space that wasn’t for me,” she said. But she discovered that Medicaid would pay for her to give birth at a registered birthing center.
“I went to Loves Lane Fertility Center in Richardson,” she said. And I’m so grateful I found them because they can connect me to other resources that the Medicaid office doesn’t have.”
Ferrell Ortiz is delighted that she has found such a friendly and supportive delivery team. But Medicaid coverage ended not long after her daughter arrived – just two months after giving birth. She said that losing insurance when her children were very young was very stressful.
“The two-month deadline just puts more pressure on women to tidy things up and isn’t necessarily beneficial.”
During the 2021 legislative session, Governor Greg Abbott signed a bill extending pregnancy Medicaid coverage from two months to six months postpartum.
That extension was rejected by the federal government in the fall of 2022; Texas Court report some lawmakers believe the application was rejected “because of language that could be construed to exclude pregnant women from having abortions, including medically necessary abortions.”
gorvernment’s Maternal Mortality and Mortality Review Committee tasked with creating statewide data reports on causes of maternal mortality and intervention strategies. Members of that committee, along with advocates and legislators, are hoping this year’s legislative session will extend Medicaid for pregnant women to 12 months postpartum.
Lack of health care coverage leads to worse outcomes for pregnant people in Texas
Kari White, an associate professor at the University of Texas at Austin, says the bureaucratic challenges Ferrell Ortiz faces are common among pregnant Texans on Medicaid.
White, who is also principal investigator with the Texas Policy Review Project (TxPEP), said that in Texas, maternal health care and Medicaid coverage for pregnant mothers “is a huge patchwork with some big holes are missing in the blanket”.
TxPEP studies the various effects of government policies on people’s reproductive health. TxPEP March 2022 learn surveyed nearly 1,500 pregnant Texans about public insurance. It found that “insurance shuffling” – when people lose health insurance in the months after giving birth – led to worse health conditions and problems in accessing after-care. born.
“People either have to wait until their condition gets worse, they give up care, or they might have to pay out of pocket,” says White. “There are people who die after pregnancy from pregnancy-related reasons, and almost all of them are preventable.”
For example, chronic illness accounted for nearly 20% of pregnancy-related deaths in Texas in 2019, according to the latest report. report from the Texas Maternal Mortality and Morbidity Review Commission (MMMRC). Chronic illness includes conditions such as high blood pressure and diabetes.
The report identified at least 52 pregnancy-related deaths in Texas in 2019. Severe bleeding (obstetrical bleeding) and mental health problems were among the leading causes of death. leading death.
“This is one of the more serious consequences of a lack of health care,” says White.
Black Texans, who make up nearly 20% of Medicaid recipients during pregnancy, also more than double likely As reported by the MMMRC, this is a Texas statistic that has been true for nearly ten years without much change.
Such a serious disparity can be traced back to systemic problems, including the lack of diversity in healthcare providers; Socioeconomic barriers for Black women such as costs, transportation, lack of childcare and poor communication with service providers; and even shortcomings in medical education and the implicit biases of providers themselves – this can “affect the ability of Blacks to listen to the Black experience and see them as partners.” equality in decision-making about their own care and treatment options,” according to a recent report. survey.
Maternal Health Bill moves to Texas Legislature in 2023
Diana Forester, health policy director for the statewide organization Texas Child Caresays Medicaid coverage for pregnant women is a “golden window” for care.
“It’s an opportunity to get access to healthcare to address issues that may have been in the making for a while, unresolved issues that will develop into a need,” she says. surgery or more intensive interventions later”. “It seems like it should be something that everyone can access when they need it.”
Extending health coverage to those who become pregnant, she says, is “the difference between having a chance of a healthy pregnancy versus not.”
As of February, 29 states have applied for a 12-month postpartum coverage extension so far, according to the Kaiser Family Foundation. reportwith 7 states planning to implement this extension in the future.
“We’re behind,” Forester said of Texas. “We’re behind at this point.”
“I feel like the motivation is there”
Several versions of the bill to extend pregnancy Medicaid coverage to 12 months were introduced to the legislature this year, including: House Bill 56 And Senate Bill 73. Forester says she feels “cautiously optimistic.”
“I think there are still some minor legal or landmine issues that we have to deal with,” she said. “But I feel like the momentum is there.”
Ferrell Ortiz’s daughter turns 5 years old this year. Amelie is artistic, intelligent and has a voice in her beliefs. When Ortiz thinks back about her pregnancy, she recalls how difficult that one year was, but she also learned a lot about herself.
“Having a baby was the hardest experience my body has ever gone through,” she said. “It was a really poignant moment in the history of my health – just know I was able to pass that time, and that could even be exciting – and obviously very special. because look what the world has in store for it.”
She just hopes that everyone, especially those who have given birth to children of color, can get the health support they need during this vulnerable time.
“If I could talk to people in the legislature about expanding Medicaid coverage, I would agree to do it,” she said. “It’s an investment in the people who are enhancing our future and totally worth it.”
