Care about babies and moms? This Big Beautiful Bill cut should scare you

Miami Herald

6 days ago

An unseen provision in the recent congressional overhaul of Medicaid will bankrupt poor families with sick newborns — and raise costs for us all.
Hidden within the 940 pages of the One Big Beautiful Bill Act is a reduction in Medicaid's ability to pay for care retroactively (care that has already been delivered) from 90 to 60 days. Shortening this window of payment targets parents of newborns, and will burden families with thousands of dollars of medical debt.
Neonatologists and pediatricians care for critically-ill babies, including those with prematurity or congenital heart or intestinal defects. Many of the premature infants we care for have missed an entire trimester of development. Weighing 1 to 2 pounds at birth, they must overcome underdeveloped lungs, brains and immune systems. Their complex and expensive care begins in the first seconds of life. There is no time to apply for Medicaid.
The previous 90-day retroactive period accounted for the practical aspects of applying for health insurance while being a new mother. Parents face obstacles negotiating the Medicaid system, especially in the context of a traumatic birth. A new mom recovering from a complicated delivery or cesarean section, and dealing with postpartum complications while trying to learn how to care for a newborn is not well positioned to immediately submit a Medicaid application.
Additionally, it takes states — which control Medicaid enrollment — time to confirm parental income, residency and other requirements to qualify for Medicaid. The process can be cumbersome and is prone to backlogs. Nationally, roughly 15% of Medicaid applications are excessively delayed, meaning even if superhuman mothers applied the day their infant was born, many would be forced to pay for the first two weeks of neonatal intensive care, which costs $10,000 to $20,000 a day — too expensive for all of us.
Ironically, this measure comes at a time when the White House is actively trying to increase the U.S. birth rate through baby-friendly policies such as one-time cash incentives of $5,000 per baby and federally subsidized fertility education.
The problem is significant. Medicaid remains the largest single insurer of children, and pays for 40% of all newborns. Critically ill babies are overrepresented in Medicaid, as almost half rely on the program for coverage. Now, parents will receive astronomical medical bills when in the past Medicaid covered babies from their birthday.
Parents of healthy newborns will be affected too. A healthy newborn spends 2 to 4 days in the hospital and typically has three or more outpatient visits in the first month of life. All these medical services risk being unpaid under the shorter retroactive period. Our fellow pediatricians are already worried the newborn care they provide will be unpaid, and they will have to limit the number of babies they see.
The consequences will impact us all. Children's hospitals are tied to Medicaid payments, as the overwhelming majority of hospital care is paid for by Medicaid. This means children's hospitals run on incredibly small margins and will not be able to absorb the expected millions in uncompensated care that will result from this policy. The inevitable consequence will be reduced newborn services, especially in rural and underserved regions.
The policy's defenders argue that shortening this period of coverage would reduce state costs and improve efficiency. But this ignores other reforms placed on state Medicaid offices. Not only have states been unable to verify all Medicaid recipients within 60 days, but they now will deal with tens of thousands of re-applications filed by patients every six months as part of new regulations. The increased bureaucracy requires agencies to verify more information about applicants, such as work requirements and immigration status. Our medical colleagues and even state Medicaid officials are concerned about the ability of these offices to handle the increased workload.
Cost savings are similarly illusory. Uncompensated care does not disappear — it shifts. Hospitals forced to bear unpaid bills will inevitably raise costs elsewhere, usually from those of us with private insurance. That forces insurance carriers to raise premiums, copays and costs for things such as lab work or CT scans on all of us. Further, private insurance will likely follow Medicaid's lead in shortening retroactive coverage, which would pass along even more expense.
This new Medicaid restriction has not received much attention compared to the massive spending cuts and deficit increases created by the new law. Unnoticed by the public, shortening retroactive coverage will impact neonatal intensive care, newborn health and force all of us to pay more over time.
For babies, families and those who care for them, this legislative measure proves the devil really is in the details.
Neonatologist Shetal Shah and pediatrician Marsha Spitzer are both past presidents of local chapters of the American Academy of Pediatrics.