Alabama postpartum depression bills fail but drive Medicaid policy changes

Yahoo

13-05-2025

Rep. Frances Holk-Jones, R-Foley, speaks on the floor of the Alabama House of Representatives on May 9, 2024 at the Alabama Statehouse in Montgomery, Alabama. (Brian Lyman/Alabama Reflector)
Legislation that would have required Alabama health care providers to screen for postpartum depression failed to pass this year.
But the sponsors of the bills – one a Democrat; one a Republican — feel they managed to move the issue forward.
'We may not have won the war on postpartum depression, but we certainly got a victory in the battle,' said Rep. Frances Holk-Jones, R-Foley.
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As originally filed, HB 322, sponsored by Holk-Jones, and SB 191, sponsored by Sen. Vivian Davis Figures, D-Mobile, would have required the Alabama Medicaid Agency to provide and cover postpartum depression screenings and to cover specific prescription drugs used to treat depression. The bills would also have removed a requirement that those suffering from postpartum depression go through separate 30-day treatment trials with at least two generic antidepressants before covering an FDA-approved therapy for postpartum depression like Zurzuvae.
Melanie Cleveland, a spokeswoman for the Alabama Medicaid Agency, said in an email Friday that the agency no longer requires patients with postpartum depression to try less expensive generic medicine before getting approved for pricier treatments. Cleveland said that FDA-approved medication for postpartum depression will no longer depend on two prior failed therapies.
'That's a step in the right direction,' Holk-Jones said.
Medicaid covers mental health treatment for low-income mothers up to a year after childbirth. But significant obstacles prevent many from receiving adequate care, forcing some women to go without treatment until they are in crisis. These barriers include Medicaid's underfunding, which leads to low reimbursement rates for therapists and limits the number who accept Medicaid, and issues with administrative requirements, lack of transportation and childcare, and limited telehealth accessibility.
The initial version of the bill would have mandated universal postpartum depression screenings for new mothers as part of the postnatal care model. The bill would also have required the Alabama Department of Public Health (ADPH) to develop educational materials on postpartum depression for health care professionals and parents of newborns.
Holk-Jones' bill was amended in the House Health Committee to focus only on educational material that would have been developed by ADPH, which the House passed unanimously. Figures' Senate bill was also amended in committee to reflect the changes in the House, but the Senate never voted on it.
Figures said that although the remaining educational provisions of the bill did not become law, it is something that the department could do without statute.
'They can do that on their website. If the bill does not pass, the health department can still do that, too,' Figures said, but she said that 'the major thing that needed to be done was done without a statute,' referring to the requirement that people not fail two prior medications.
Jennifer Harris, a health policy advocate at Alabama Arise, a nonprofit organization focusing on poverty issues, said that while some providers already provide screenings, the new policy allows providers to assess patient needs without being subject to cost-saving controls.
'One of the administrative changes they made was that the provider should be able to assess the needs for the patient, and if not, if it doesn't meet the criteria of being the least costly, less evasive, medication first, then they're able to prescribe that medication that the mother would need,' Harris said.
Despite changes in Medicaid's policy, Holk-Jones said there was still a critical need for the legislation, pointing to the prevalence of postpartum depression in Alabama.
'I do think this bill is absolutely needed, especially for all of the mothers with newborns who are dealing with the difficult mental health issue of postpartum depression,' Holk-Jones said.
Mental health care for new moms is critical. And hard to access.
Nearly 19% of mothers had frequent postpartum depressive symptoms in Alabama in 2021, compared to 12.7% of mothers nationwide, according to latest March of Dimes data.
Holk-Jones also said that untreated postpartum depression is not only damaging to the mother's health, but can also have more significant economic costs, including long-term health care costs from emergency intervention and 'long-term mental health issues that have damaging effects on both the mother and their child.'
She said this was 'a genuine attempt' to address an issue that affects more people in Alabama than in other states. She will pre-file the bill for the next legislative session, saying 'it is time we address this issue.'
'This bill … is about making sure every woman, no matter where she lives, gets screened and supported. That's the standard we should all be working toward and that is why I will be refiling this legislation again next session,' Holk-Jones said.
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