Alabama bill seeks to expand prenatal Medicaid coverage
HB 89, sponsored by Rep. Marilyn Lands, D-Huntsville, proposes 60 days of prenatal Medicaid coverage for low-income pregnant people, aimed at improving health outcomes. (Getty)
Alabama lawmakers have reintroduced a bill to provide prenatal care to low-income pregnant people for up to 60 days during pregnancy.
HB 89, sponsored by Rep. Marilyn Lands, D-Huntsville, aims to improve maternal and infant health outcomes by expanding access to prenatal care. It would provide 'presumptive Medicaid eligibility' for pregnant people, allowing them to receive Medicaid coverage for up to 60 days before formal approval of their Medicaid applications.
'Our maternal healthcare outcomes are among the worst in the country, infant mortality as well,' Lands said in an interview Monday. 'This bill, in particular, seems like it's one that a lot of people would see as a first step toward improving outcomes in this state. It's not going to have much of a cost associated with it, and the cost savings potential is pretty amazing.'
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Alabama has long struggled with high maternal mortality rates and poor infant health outcomes. Alabama's infant mortality rate increased to 7.8 deaths per 1,000 live births in 2023, the highest since 2016. Alabama's infant mortality rate jumped from 6.7 per 1,000 live births in 2022 to 7.8 per 1,000 live births in 2023, a statistically significant increase and above the national provisional rate of 5.6 for the same period. Low birth weight and preterm births remain key risk factors.
Additionally, 143 of the 1,112 babies born on average each week in Alabama are born preterm, defined by the CDC as births that happen before 37 weeks of pregnancy. Of those, 22 babies a week are born 'very preterm,' or under 35 weeks gestation. The earlier a baby is born, the higher the risks for breathing problems, feeding difficulties, cerebral palsy, developmental delay, or vision and hearing problems.
While some lawmakers expressed concerns about funding, Rep. Terri Collins, R-Decatur, said she supports the bill not only because it may potentially save the state money in the long run but also because it 'promotes children being born healthier, and mothers being able to take care of themselves.'
'I think that the healthier we can have our babies, and the mamas are taken care of, the better it is for our state, and so I am supporting this bill,' Collins said.
Although a fiscal note was not attached to the legislation, Lands said that it was estimated to be around $1 million. Both Lands and Collins said that it could be an overestimation, but the state's share of Alabama's Medicaid budget, expected to exceed $1 billion in the fiscal year beginning Oct. 1, could pose a challenge.
'When you're on a budget committee, and you're actually looking at every single expenditure, it's a hard thing to include an increase in a budget when you know you're already at the line,' Collins said.
Lands said that the bill could have a cost-savings potential of over $400 million, not included in the original $1 million potential cost, by reducing preterm births. Alabama has 58,000 births per year, with 12.9% being preterm, costing an average of $60,000 per birth.
'We were calculating a reduction in what we thought would be an achievable reduction in preterm births, and what that would look like. So it's pretty big,' Lands said.
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