At first, Alexandria Garner was just tired.
The Shannon native, 27, had given birth to her second daughter, Charleigh. For the first three months afterward, Garner was mostly sleep deprived from having to constantly pump breast milk. She brushed off her exhaustion as the normal “baby blues.”
The turning point came on suddenly. One day, while she and her husband were driving home after visiting her family, Garner felt as if she just couldn’t do it anymore. Any of it.
“I just had the strong urge to jump out of the car and jump off a bridge because it was just that terrible at that time,” Garner said.
Roughly three months post birth, Garner learned she was experiencing postpartum depression. Despite the severity, however, her first thought wasn’t to seek therapy. She had already been cut off from her postpartum Medicaid, meaning she was uninsured and could no longer afford to do so.
In Mississippi, the current postpartum Medicaid policy only offers 60 days of coverage, leaving very little wiggle room for new mothers to seek treatment before having to pay hefty out-of-pocket expenses. During the 2022 session, the Senate passed a bill to expand postpartum Medicaid to a full year, but it died in the House.
With the future of similar postpartum legislation uncertain, two family advocates and two mothers who’ve received postpartum Medicaid shared the potential need and impact of extending the period of coverage.
Not enough time
Patricia Miles, 27, was disappointed when postpartum Medicaid coverage wasn’t extended for a year. She knows firsthand how important treatment can be for mothers experiencing severe medical anomalies following birth.
“I think it’s a huge disservice to women in general,” Miles, an Alabama native who now lives in Tupelo, said of the legislation’s failure to pass the House.
The mother of five’s most extreme postpartum experience occurred nine days after the birth of her second child. It started as a stomachache. Within a half-hour, Miles turned blue and was shaking. Her husband rushed her to the hospital, where she learned she had gone into septic shock. She stayed in the hospital for five days.
After giving birth at the end of March, Miles already feels like she’s on the clock to squeeze in necessary postpartum care. Because of previous issues, her top priority is pelvic floor therapy. With about one visit per week for eight weeks, however, she has to move quickly to fit in all her planned appointments before the 60 day cutoff.
“Pretty much, I would have to start it the same week I had the baby for Medicaid to cover it all the way through,” Miles said.
However, Miles said she won’t be able to begin therapy for a couple more weeks, since she won’t have a doctor’s referral until after her six-week postpartum checkup.
Miles, who has managed her mental health her whole life, spoke with a doctor when she noticed her postpartum depression a few weeks after giving birth. Medicaid is currently covering medication to treat it. However, she knows others aren’t as experienced in recognizing when they need help.
“A woman could be six, eight months postpartum when she develops it and wouldn’t be able to get the help she needed because of not having insurance anymore,” Miles said. “I see that as a huge impact.”
Filling the gap
Sisters Lauren Jones and LaShay Melton co-founded the nonprofit Mom.ME in 2017 to assist underserved mothers who can’t afford therapy or other resources to deal with postpartum issues. Jones had her own experience with postpartum depression, postpartum anxiety, postpartum OCD and postpartum PTSD. Melton didn’t know what was happening at first, but the sisters used that experience to learn more about postpartum, researching other southern states.
“We were just seeing that they were doing screenings for the moms early, prenatal screenings and postpartum screenings, they were catching it quicker,” Melton said of what other states were doing. “We looked to say, why isn’t Mississippi doing this same exact screening to be able to catch these moms earlier?”
States like Louisiana, Tennessee, North Carolina and South Carolina have already implemented a 12-month extension, according to the Kaiser Family Foundation Medicaid postpartum coverage extension tracker. Alabama and Florida are planning to implement a 12-month extension, and Georgia provides cover for a period limited to six months.
The 2021 Florida Legislature approved the program, according to the Florida Phoenix. In April 2022, Alabama Gov. Kay Ivey signed into law the General Fund budget to include $4 million to extend postpartum Medicaid coverage, according to AL.com.
A large part of Mom.Me’s mission is helping mothers with therapy costs. The organization, which is based out of Jackson but helps mothers statewide, tries to provide at least six weeks of therapy for new mothers. They provide therapy to about 75 to 100 moms a year; another 400 to 500 take advantage of the peer support groups, where they come and go as needed.
The organization also provides some financial assistance, having set aside a small budget to help with bills or temporary shelter, and have provided diapers and car seats.
If Medicaid coverage was extended, however, they could expand the therapeutic program for longer, and their mothers could continue prioritizing their health.
“If you’re not going to expand Medicaid, at least give these moms a year with the postpartum bill to at least have some kind of insurance to kind of make sure that their medical needs are met during that time frame,” Melton said.
Don’t have choices
This is the second consecutive year House leaders have let a postpartum Medicaid bill die on the calendar, despite health care leaders largely endorsing the proposal.
Mississippi has the highest infant mortality rate in the nation. Between 2013 and 2016, there were 136 Mississippi mothers who died either during pregnancy or within one year of their pregnancy’s end, according to the Mississippi State Department of Health. Of those deaths, 86% of them occurred postpartum. Offering medical care and insurance coverage for one year postpartum could improve health outcomes, according to a maternal mortality report from the Mississippi State Department of Health.
“There’s obviously a disconnect between what the data is saying and what our body shape is choosing,” said Toni Hill, a community midwife and activist for Black families around birth equity.
Hill has long advocated for more resources for families who receive Medicaid. Medicaid doesn’t cover midwives or most doula services. Within her role, Hill regularly checks in on those she serves, ensuring they’re not battling any issues.
“These Medicaid mothers, they deserve that,” Hill said. “In a state where we don’t have nurse family partnership or home visiting programs across the board, we’re not taking care of mothers, period. We’re just taking care of their babies, and their babies, (only while) in their uterus.”
Once the 60 days of postpartum Medicaid coverage passes, mothers in Mississippi have limited choices, Hill said.
Garner and her husband fell into the gap of making too much to qualify for Medicaid, but not enough to cover medical expenses on their own.
“They gave it to my kids, which I’m grateful for,” Garner said. “I’d rather them have it, but we take care of them. If something happens to us, we still need it.”
When Garner finally asked for help, she reached out to Hill, her midwife, who saw that her daughter had tongue-tie, which was causing nursing issues. After addressing it, things gradually improved.
Within her role as a community activist, Hill looks toward basic needs, like monitoring blood pressure, providing diapers, offering low-cost services and occasionally providing preventative care, such as pap smears.
Not insurance can be a barrier for mothers to find providers who will see them, or they may opt to go to the emergency room and risk a longer wait and a significantly larger bill.
Care is not accessible, Hill said. While there are free clinics, they can become overcrowded. Medicaid would help soften the blow for those clinics, Hill said.
Even though Mom.ME tries to connect lower-income mothers to resources, they see a lot are sacrificing simple things, Melton said.
For some, that’s picking between formula and diapers. Others have lived in shelters or with family members because they couldn’t afford rent, or can’t work because they can’t afford daycare.
Facing these challenges, many mothers put personal health care at the bottom of their priorities.
“I think it will always be something that falls through the gap if they don’t have the insurance because as parents,” Melton said. “What we do: We figure it out.”