Expanding Medicaid Coverage for Pregnant Women in Alabama: A Step Toward Better Maternal Health

A Lifeline for Expectant Mothers in Alabama

In an effort to address rising maternal and infant mortality rates, Alabama lawmakers have advanced a bill that aims to expedite Medicaid coverage for low-income pregnant women. The legislation, known as the “presumptive eligibility” bill, would allow Medicaid to cover outpatient medical care for pregnant women for up to 60 days while their applications for the government-funded insurance program are being processed. This measure is designed to reduce bureaucratic delays and ensure that expectant mothers receive timely prenatal care, which is critical for improving health outcomes for both mothers and babies.

Rep. Marilyn Lands, the Democrat from Huntsville who introduced the bill, explained that the current processing time for Medicaid applications can take weeks, during which time pregnant women may go without essential medical care. This delay can have serious consequences, as early prenatal care is vital for identifying and managing potential health risks. According to data from the March of Dimes, nearly 1 in 5 pregnant women in Alabama in 2023 did not receive prenatal care until after the first five months of pregnancy, or received fewer than half of the recommended number of prenatal visits throughout their pregnancy. This lack of access to timely care contributes to Alabama’s alarmingly high maternal and infant mortality rates.

The Importance of Early Prenatal Care

The bill has garnered widespread support, including from Republicans, who have hailed it as a “pro-life” measure. Alabama’s maternal health outcomes are among the worst in the nation, with a maternal mortality rate of 64.63 deaths per 100,000 births between 2018 and 2021—nearly double the national rate of 34.09 deaths per 100,000 births. For Black women in the state, the rate is even higher, at 100.07 deaths per 100,000 births. These stark disparities underscore the urgent need for policies that expand access to prenatal and maternal health care.

Early prenatal care is essential for ensuring that women are in a safe and healthy environment for pregnancy and for identifying and addressing potential complications early. Dr. Max Rogers, an obstetrician-gynecologist who works with low-income pregnant women in rural Alabama, emphasized the importance of early intervention: “The longer you have to get blood pressure under control, or get diabetes under control, the long-term outcomes are going to be much, much better.” By expediting Medicaid coverage, the bill aims to ensure that women do not have to wait until their application is approved to begin receiving critical care.

Alabama’s Struggle with Maternal and Infant Mortality

Alabama’s high maternal and infant mortality rates are not just a public health crisis but also a reflection of broader systemic issues, including poverty and lack of access to health care. The state is one of 10 nationwide that has not expanded Medicaid under the Affordable Care Act, leaving many low-income women without health insurance until they become pregnant. Even then, eligibility is limited to those with incomes below a certain threshold—for example, $21,996 or less for a woman with no dependents, or up to $37,704 for a household of three.

This narrow eligibility criteria leaves many women in a coverage gap, where they earn too much to qualify for Medicaid but too little to afford private insurance. According to Alabama Arise, an advocacy group for low-income families, 1 in 6 women of childbearing age in Alabama fall into this gap. As a result, many women are forced to go without health insurance until they become pregnant, when Medicaid becomes available. Even then, access to prenatal care can be limited, particularly in rural areas where obstetric care providers are in short supply.

A Regional Approach to Addressing Maternal Health

Alabama is not alone in grappling with high maternal and infant mortality rates. Other Southern states, including Mississippi and Arkansas, are also taking steps to expand prenatal care for low-income women. In Mississippi, lawmakers passed a similar presumptive eligibility bill last year, but implementation stalled due to negotiations with the federal Medicaid agency. Arkansas has also introduced legislation aimed at improving access to prenatal care for expectant mothers.

These efforts reflect a growing recognition across the South that expanding access to prenatal care is crucial for reducing maternal and infant mortality rates. By providing presumptive eligibility for Medicaid, states can ensure that women do not have to wait until their application is approved to begin receiving care. This approach has the potential to save lives and improve health outcomes for mothers and babies across the region.

The Challenges of Rural Access and the Road Ahead

While the presumptive eligibility bill represents an important step forward, it alone cannot solve the complex challenges surrounding maternal health care in Alabama. One of the most pressing issues is the lack of access to prenatal care in rural areas, where many obstetric care providers have closed their doors in recent years. Dr. Max Rogers, who works with low-income pregnant women in rural Alabama, noted that his office was the fourth labor and delivery unit to close statewide in 2024. While he was able to relocate to a new practice, many women in rural areas are now forced to travel long distances to access prenatal care—or go without it altogether.

Rogers expressed support for the bill but emphasized that it will only be effective if it is accompanied by efforts to increase access to care. “If we don’t make sure that a patient can get there and take advantage of services, it doesn’t really have an impact, right?” he said. Expanding Medicaid coverage is a critical first step, but policymakers must also address the systemic barriers that prevent women from accessing the care they need. This includes investing in rural health care infrastructure, training more obstetric care providers, and ensuring that women have the transportation and resources needed to access prenatal care.

The presumptive eligibility bill offers a glimmer of hope for improving maternal and infant health outcomes in Alabama, but it is only the beginning. To truly address the crisis, state lawmakers must continue to prioritize policies that expand access to affordable, high-quality health care for all women, regardless of where they live. By taking these steps, Alabama can work toward a future where every mother and baby has the opportunity to thrive.