In February, Kenychi Badue of Laurel found out she was pregnant. At 22, she had no health insurance and could not afford to pay out of pocket for doctor’s visits as she awaits the birth of her first child. But thanks to a new Mississippi law, Badue didn’t have to forgo prenatal care.
Kenychi Badue, 22, of Laurel, is one of about 300 low-income pregnant Mississippians who have received prenatal care earlier than they likely would have without the policy, called Presumptive Eligibility for Pregnant Women. Photo courtesy of Kenychi BadueBadue is one of about 300 low-income pregnant Mississippians who received prenatal care earlier than they would have without the policy, called Presumptive Eligibility for Pregnant Women, which lawmakers passed last year, according to the Mississippi Division of Medicaid.
The law went into effect in July of last year and allows pregnant women to be presumed eligible for Medicaid while their applications are pending. The change brings Mississippi in line with 29 other states.
The American College of Obstetricians and Gynecologists credits this form of Medicaid coverage with improved maternal health outcomes, especially in states that have not expanded Medicaid such as Mississippi. The state’s strict eligibility requirements exclude many poor people from health care. Women in states that have expanded Medicaid are more than twice as likely to be enrolled in Medicaid before pregnancy, compared to those in non-expansion states, according to a report by KFF, a national, nonprofit health policy research and polling organization.
“It makes me feel safer about my pregnancy,” Badue said about the routine check-ups she now receives at Family Health Center in Laurel as a result of the policy.
Who qualifies for presumptive eligibility under Medicaid?
Eligible women must be pregnant and have a household income up to 194% of the federal poverty level, or about $31,000 annually for an individual. They do not need to show proof of income to receive care at a participating provider. The temporary coverage lasts until Medicaid approves the patient’s official application, however long that takes. But the patient must submit a Medicaid application before the end of her second month of presumptive eligibility coverage. Once enrolled in Medicaid, a pregnant patient is guaranteed coverage through 12 months postpartum, according to state law.
Many low-income women are ineligible for Medicaid in Mississippi until they become pregnant. That’s because Mississippi Medicaid doesn’t insure childless adults and has much stricter income requirements for caretakers who aren’t pregnant. Since officials can take months to process and approve a Medicaid application, eligible pregnant women sometimes end up missing prenatal care in their first and second trimester.
Presumptive eligibility is designed to remove red tape that stands in the way of care, explained Usha Ranji, the associate director of women’s policy at KFF.
“Medicaid eligibility has a good amount of paperwork, and that can take time,” Ranji said. “Presumptive eligibility allows somebody to get access to care while that verification of income and paperwork documentation is happening.”
In August, state officials declared a public health emergency over Mississippi’s rising infant mortality rate. A recent report from Centers for Disease Control and Prevention also shows that Mississippi is one of 36 states that showed a significant increase in late or no prenatal care between 2021 and 2024. That lack of care can lead to more complicated interventions and costlier medical bills once an issue is identified. It also can hold life-threatening consequences.
Health care providers told Mississippi Today presumptive eligibility, which costs the state a total of about $567,000 a year across all patients to administer, is a minimal investment that will cut down on the number of premature infants who end up in intensive care units. Prenatal care has been shown to mitigate preterm birth, in which Mississippi leads the nation.
Staying in the neonatal intensive care unit can lead to traumatic experiences for infants and parents, but it also costs the state millions, said Dr. Susan Buttross, former chief of the Division of Child Development and Behavioral Pediatrics at the University of Mississippi Medical Center.
“Mississippi would save so much money if we would intervene early,” Buttross said. “I have no doubt that this will ultimately help Mississippians.”
While 300 Mississippians is “a good start,” Buttross said it is not enough. Early prenatal care can help diagnose and manage complications that are pervasive in Mississippi, such as diabetes and high blood pressure, she said, as well as infections that lead to preterm birth.
“If every clinic would take a few patients who have this presumptive eligibility, it would make a huge difference in our state,” said Buttross.
The majority of women using presumptive eligibility are receiving care at county health departments, according to the Division of Medicaid. Thirteen other clinics and federally qualified health centers are signed up to participate, but only five of them have served women under the new program.
Room to grow
At Family Health Center in Laurel, Badue receives her prenatal care. Staff at the facility are serving about 12% of the women who are using this policy statewide, according to the Division of Medicaid. Nurse Mia Walker supervises the clinic’s obstetrics unit and said she is surprised to hear that.
“It’s exciting to know that out of 300 registered women in the state of Mississippi, Family Health OB-GYN clinic has 35 and is leading the pack,” Walker said.
Walker said that her clinic serves women who are on the Medicaid family planning waiver, which allows women to access Medicaid for family planning purposes such as birth control – even if they don’t qualify for general Medicaid coverage. Walker said she informs those women of presumptive eligibility, so they can come back to receive prenatal care if they become pregnant.
But many Mississippians are not aware they are eligible for Medicaid once pregnant and without filling out a Medicaid application. And women who don’t think they have Medicaid coverage stay home from the doctor, said Khaylah Scott, program manager for the Mississippi Health Advocacy Program, a consumer advocacy organization aimed at improving access to health care in the state. In order to reach those Mississippians, clinics will need the help of statewide agencies, she said.
“If there’s anything that the Division of Medicaid can do to really ramp up communications around this program, they should definitely consider it,” said Scott.
To spread awareness, Scott recommended that state and local public health officials place flyers in public spaces with information about the program and advertise on billboards and across social media.
In the meantime, clinics interested in participating in the program can follow instructions online to submit a provider application.
There is no risk for clinics if they offer Medicaid coverage through presumptive eligibility, said Tricia Brooks, a Medicaid expert and research professor at the Center for Children and Families at Georgetown University. Regardless of whether the patient is approved for Medicaid, providers are reimbursed by Medicaid for the services they offer pregnant women under presumptive eligibility.
“Even if the individual doesn’t file an application, or if they file an application and are determined ineligible, the payment for the service is still federally matched and the provider gets paid,” Brooks said. “There is no kind of penalty.”
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