Legislators Agree on Postpartum Medicaid Expansion

Assembly Speaker Robin Vos, R-Burlington, left, addresses the Wisconsin Assembly on Jan. 24, 2024, at the State Capitol in Madison, Wis., during a floor session. As 2025 starts, Vos is standing in the way of a bill expanding postpartum Medicaid coverage. (Andy Manis for Wisconsin Watch)

The fate of postpartum Medicaid expansion, a bipartisan effort in the state Legislature, yet again falls in the hands of Assembly Speaker Robin Vos, who said Tuesday that it’s “unlikely” his chamber will get to vote on it.

Congress previously gave states a permanent option to accept federal funds for 12-month extensions of postpartum Medicaid coverage. Wisconsin and Arkansas are now the only two states that have turned down the federal extension. Wisconsin’s coverage currently lasts 60 days after birth, far shorter than what health experts recommend.

Extending the coverage has emerged as a way for states to fight maternal mortality rates. Though pregnancy-related deaths are rare,  a third of them in Wisconsin occur beyond the 60-day coverage window, according to the Department of Health Services.

Rep. Patrick Snyder, R-Weston, on Tuesday reintroduced a bill that would expand coverage to 12 months. The legislation mirrors the extensions that have been introduced in previous sessions, yet have failed to pass the Legislature. That same day, Vos, R-Rochester, said a vote on the 12-month extension would be “unlikely.”

“Our caucus has taken a position that expanding welfare is not a wise idea for anyone involved,” Vos told reporters.

Republican lawmakers previously agreed to a three-month coverage period. Democratic Gov. Tony Evers’ 2021-23 state budget proposal asked for a 12-month extension, but Republican lawmakers on the powerful Joint Finance Committee amended it to instead require DHS to request federal approval to extend postpartum Medicaid eligibility to 90 days instead of the 60 mandated by federal law.

Vos accused the Evers administration of not applying for the 90-day extension the Legislature already granted, which isn’t true — something Vos acknowledged in response to a follow-up question to his office. DHS submitted the application for the extension, but the federal Centers for Medicare and Medicaid Services last year said it would not approve a waiver request for coverage shorter than one year.

“I’m glad that I was wrong and it has been submitted,” Vos responded. “The waiver request should be resubmitted to the Trump administration.”

“Going from the 60 to 90 days is pretty negligible,” said Rep. Clint Moses, R-Menomonie, chair of the Assembly Committee on Health, Aging and Long-Term Care.

During the last legislative session, the Republican-controlled Senate passed a bipartisan bill in a 32-1 vote that would have extended postpartum coverage to 12 months. The lone opponent was Duey Stroebel, who lost his re-election bid in November. In total, 73 lawmakers cosponsored the bill — over half of the state Legislature. The bill authored by Snyder this session is currently circulating for cosponsors.

Interest groups from both sides of the aisle came out in support of the previous legislation, including Pro-Life Wisconsin, the Wisconsin Catholic Conference, the American College of Obstetricians and Gynecologists, and Kids Forward.

“It made sense to me because if I am pro-life and I don’t want people to abort their babies, why would I not do everything I could to support those mothers to have the babies,” former Republican Rep. Donna Rozar, who authored the bill last session, told Wisconsin Watch.

But despite bipartisan support, the Assembly never scheduled it for a hearing before adjourning for the rest of the session in February last year.

Rozar said she and other lawmakers couldn’t get Vos on board. “He dug his heel in, there was no doubt about it,” she said.

Moses put the bill on the agenda for a hearing. But in addition to Vos blocking it, the committee was jammed near the end of the session and didn’t have time to schedule it, he said.

“There’s 132 people in this building. I don’t think we should legislate by one,” Sen. Mary Felzkowski, R-Tomahawk, said of Vos. “It’s up to his caucus to elect a different speaker or change his mind. So his members have to put enough pressure on him to get it done.”

Without Vos’ approval, Moses said it’s not likely that lawmakers will secure a 12-month extension, but he’s hopeful that an extension of at least six or nine months can be agreed to in this year’s state budget, despite the Centers for Medicare and Medicaid Services’ indication that anything less than 12 months would not be approved. Moses is willing to schedule a hearing for the upcoming bill, but if Vos remains opposed, it may not get referred to him, he said.

“When it comes to the budget, if there’s something that we want that would be attractive to negotiate this out with, I think that’s a possibility,” Moses said.

A fiscal estimate last session estimated the bill expansion would cost $21.4 million per year, including $8.4 million in state taxpayer funds with the rest coming from federal taxpayers. It would increase monthly Medicaid enrollment by 5,290 members. Felzkowski, who sponsored the Senate version, said it’s an extension for those who are already covered rather than an expansion that puts more people on Medicaid. She also said it’s good for taxpayers.

“The reason states have done this — blue states, red states, purple states — is it’s a return on investment for the taxpayers and it makes sense to do it,” Felzkowski told Wisconsin Watch. “We see the number of complications that happen in that first year, and those complications, by not being covered, cost money — cost a lot of money.”

Wisconsin’s 306% Medicaid income eligibility limit for the 60 days of postpartum coverage is one of the highest in the country — something Vos has pointed to.

“When you make a choice to have a child, which I’m glad that people do, it’s not the taxpayers’ responsibility to pay for the delivery of that child,” Vos said in 2023. “We do it for people who are in poverty. We’ve made the decision to go to 300%, that’s the law. But to now say beyond 60 days, we’re going to give you free coverage, no copayment, no deductible, until a year out, absolutely not.”

A 2021 version of the bill failed to get a floor vote in both the Senate and the Assembly, yet had only one lobbying group registered against it.

That group was Opportunity Solutions Project, the lobbying arm of the Florida-based Foundation for Government Accountability. The conservative advocacy group did not respond to Wisconsin Watch’s requests for comment. FGA has a track record of lobbying against Medicaid expansion and other bills in Wisconsin.

“I think it’s a little premature to have any discussions about the Medicaid budget right now. We have a brand new administration coming into D.C.,” Rep. Tyler August, R-Walworth, said in a Tuesday press conference with Vos. “I think the Trump administration is actually going to put some common sense into some of these programs federally.”

Republicans and Democrats agree on postpartum Medicaid expansion — Robin Vos says it’s unlikely was originally published by Wisconsin Watch.