BY THE OPTIMIST DAILY EDITORIAL TEAM
In a unanimous vote on April 8, Alabama lawmakers passed legislation that could significantly improve maternal health outcomes in the state by giving pregnant women faster access to Medicaid coverage.
The bill, known as the “presumptive eligibility” measure, allows Medicaid to temporarily cover outpatient medical care for up to 60 days while a pregnant woman’s application for the program is under review. The legislation now heads to Governor Kay Ivey’s desk for final approval.
This move comes as Alabama and other southern states work to address persistently high maternal and infant mortality rates—especially among low-income and Black women. According to a Milken Institute study, Alabama’s maternal mortality rate reached 64.63 deaths per 100,000 births between 2018 and 2021, nearly double the national average. For Black women, the figure was even more alarming at 100.07 deaths per 100,000 births.
A bipartisan step forward
Support for the bill crossed party lines. Many Republican lawmakers called the measure “pro-life,” while Democratic legislators framed it as a necessary response to Alabama’s troubling delivery health outcomes.
“This is not just about ideology,” one Democratic lawmaker noted during discussion. “It’s about life-saving access to care.”
Other southern states, including Mississippi and Arkansas, have implemented or are considering similar measures in an effort to reduce preventable deaths during pregnancy and childbirth.
The March of Dimes recently reported that nearly one in five pregnant women in Alabama did not receive prenatal care until after five months of pregnancy or received fewer than half of the recommended checkups. Limited access to care is especially acute in rural areas, where hospital closures have made prenatal services increasingly difficult to reach.
Addressing the coverage gap
A significant factor behind delayed or missed prenatal care is the state’s ongoing refusal to expand Medicaid under the Affordable Care Act. Alabama is one of only 10 states that have not expanded the program. As a result, many low-income women fall into what’s known as the “coverage gap”—earning too much to qualify for traditional Medicaid but too little to afford private insurance.
Currently, a pregnant woman in Alabama with no dependents must earn less than $21,996 per year to qualify for Medicaid, or less than $37,704 in a household of three. Once they give birth, many women quickly lose coverage unless they requalify under different criteria.
According to data from the Alabama Department of Public Health, Medicaid paid for approximately 45 percent of births in the state in 2023. Alarmingly, more than half of infant deaths occurred among mothers who were enrolled in the program.
By creating a path to earlier coverage through presumptive eligibility, the new bill aims to improve outcomes for both mothers and babies.
Cost and oversight
The bill is expected to increase state Medicaid spending by about $1 million annually over the next three years. However, the majority of the funding—approximately two-thirds—will be covered by the federal government.
Health advocates say the modest investment could yield substantial returns in the form of healthier pregnancies and reduced long-term medical costs associated with complications from inadequate prenatal care.
Broader conversations about maternal care access
The presumptive eligibility bill is not the only effort underway to improve maternal care in Alabama. Another proposal currently under consideration would allow licensed midwives to provide care in free-standing birth centers outside of hospitals. However, recent amendments to the bill have drawn concern from supporters.
The Alabama Midwives Alliance stated that the legislation “started as a good bill” but that the added restrictions—particularly those that would prevent midwives from performing key screenings for newborns—undermine its effectiveness. “It takes it in the wrong direction,” the organization stated.
Despite such setbacks, the broader trend toward expanding access to maternal care is encouraging to many advocates. The presumptive eligibility bill, in particular, represents a rare and meaningful point of consensus in Alabama’s often divided political landscape.
While challenges remain, lawmakers, advocates, and care providers agree: getting women the care they need earlier in their pregnancies is an essential step toward reducing preventable deaths and ensuring healthier outcomes for mothers and babies alike.
