Montgomery, Alabama — A legislative proposal aimed at improving Medicaid access and prenatal healthcare for low-income pregnant women is making strides as Southern lawmakers work to tackle the growing rates of maternal and infant mortality. The proposed legislation, known as “presumptive eligibility,” ensures that Medicaid will cover outpatient medical treatments for pregnant women for up to 60 days while their applications for insurance are being processed.
Rep. Marilyn Lands, a Democrat from Huntsville, introduced the bill, emphasizing the importance of reducing bureaucratic hurdles to provide timely care. She noted that Medicaid application processing can take weeks, yet timely prenatal care is essential for healthy pregnancies.
According to reports from The March of Dimes, in the past year, almost 20% of pregnant women in Alabama received their first prenatal care visit after five months of pregnancy or had less than half of the recommended prenatal visits throughout their term. The bill has received unanimous support in the Alabama House of Representatives and is now on its way to the Senate. Many Republicans praised the bill as a significant “pro-life” initiative.
Alabama currently faces alarming delivery health outcomes, with a maternal mortality rate of 64.63 deaths per 100,000 births reported from 2018 to 2021, significantly higher than the national average of 34.09 per 100,000. The situation is even more dire for Black women in the state, whose mortality rate is 100.07 deaths per 100,000 births.
Similar legislative efforts are underway in other states struggling with high maternal and infant mortality rates. Legislators in Mississippi and Arkansas have proposed bills offering comparable coverage for pregnant women. Mississippi had a similar law passed last year, but it was not implemented due to failed negotiations with the federal Medicaid agency, according to local reports.
Both Alabama and Mississippi are among the 10 states that have not opted to expand Medicaid, meaning that many low-income women can only qualify for Medicaid when they become pregnant. In Alabama, one in six women of childbearing age find themselves in a coverage gap where they earn too much to qualify for Medicaid but too little to afford private insurance, as highlighted by Alabama Arise, a low-income advocacy group.
To qualify for Medicaid in Alabama, a pregnant woman without dependents must earn $21,996 or less, whereas a household of three can earn up to $37,704. According to data from the Alabama Department of Public Health, Medicaid covered 45% of all births in the state in 2023, with over half of infant deaths occurring to mothers on Medicaid.
Dr. Max Rogers, an obstetrician-gynecologist who serves many low-income pregnant women in rural areas, stressed the critical need for early medical care during the first trimester. This care helps create a safe pregnancy environment and allows healthcare providers to identify serious health threats at the earliest stages.
“The longer you take to manage issues like high blood pressure or diabetes, the better the long-term outcomes will be,” Rogers noted. His own rural clinic recently became the fourth labor and delivery unit to close statewide in 2024, forcing him to relocate an hour and a half away while still caring for some former patients. This disruption has significantly limited prenatal care access for many women in the region.
While Rogers supports the current bill, he believes its effectiveness hinges on implementing additional measures to enhance overall access to care. “If we don’t ensure that patients can reach and utilize these services, the bill’s impact will be minimal,” he remarked.
