At stake in the Republican plan to replace the Affordable Care Act is whether pregnant women and new moms will be able to access treatment for drug addiction.
The GOP plan includes a gradual defunding of Medicaid expansion, including Kentucky's, by 2024.
Pre-expansion in 2014, women making up to around $20,000 a year qualified for Medicaid — the state insurance program for low-income and disabled people — if they became pregnant. But 60 days after giving birth, women lost their coverage.
Post-Medicaid expansion, women making up to 138 percent of the poverty limit – around $27,000 for a family of three – can stay on Medicaid after giving birth.
And that detail is crucially important for the 22 women who are currently in residential and outpatient drug treatment at Louisville’s Freedom House.
“We are concerned that any reduction to Medicaid will have a direct effect on our ability to deliver healthy babies to our community and our ability to welcome women into treatment because they now have coverage under Medicaid,” said Jennifer Hancock, president and CEO of Volunteers of America Mid-States, which runs the drug treatment programs.
Hancock said many of the women now in Freedom House’s programs have expanded Medicaid coverage. She said because of that, they’ve been able to rely less on private donations and more on reimbursements from Medicaid. Now, with the possibility of the expansion going away, Hancock is looking to the state for money to fill that potential gap.
Erika Ruth, an addiction psychiatrist at Freedom House, said most of the women there are recovering from opioid addiction. She said that recovery process can take years, and sometimes involves medication-assisted treatment to help wean women off. She recalled what it was like for clinicians and patients before the Medicaid expansion when they had a 60-day cutoff.
“For a lot of them it was, 'how do we get you off this medicine in the next six weeks.' And in my opinion that's not the appropriate time to taper them and make sure they have all the coping skills to stay sober,” Ruth said.
Medications like buprenorphine can help pregnant women and new moms gradually come off drugs, like heroin, and kill cravings. But Ruth said in her experience, it has to be done slowly.
“We’ll go down two to four milligrams for the month, and then we’ll see if they’re stable,” Ruth said.
Although pregnant women could get coverage prior to the Medicaid expansion, the process of gaining it was more complicated, according to Jamie Daw, a women’s health researcher at Harvard University.
“Pregnancy-related Medicaid may be too late,” Daw said.
She said that’s because the woman first has to realize she’s pregnant, then sign up for Medicaid, and then find a doctor or substance abuse help.
“A lot of the benefits of treatment that could prevent substance use resulting in poor birth outcomes could have been addressed if they’d had coverage,” said Daw.
Gov. Matt Bevin last summer submitted to the federal government several changes to Kentucky's Medicaid expansion. But if Republicans in Congress succeed in replacing the Affordable Care Act, and funding for Medicaid is phased out over time, it's unclear how Bevin's proposed changes and changes made by the federal government would play out.
