When an El Paso mother experienced headaches and high blood pressure in the months after giving birth, she turned to a discount program at University Medical Center to cover the costs of a checkup. Another El Paso mother with postpartum concerns scheduled an appointment with a health care provider in Ciudad Juárez.

Neither woman realized they were still entitled to benefits under the Medicaid for Pregnant Women program, which also covers the costs of postpartum health care.

These are some of the findings compiled by Carina Heckert, an anthropologist at the University of Texas at El Paso. Heckert was researching prenatal care in El Paso when she learned a troubling fact: Some women thought they lost their Medicaid benefits after giving birth, though federal law extended their coverage.

In March 2020, Congress extended coverage for current Medicaid enrollees through the COVID-19 Public Health Emergency, which was declared that January. When the emergency declaration ends, states will remove people who are no longer eligible to be on the national health insurance program.

But some women say it’s been unclear whether they had to manually renew their Medicaid enrollment during this time period, leading to confusion about how long they’re covered.

‘Many people told me different things’

Medicaid provides free health coverage to low-income pregnant women. More than 10,400 people in El Paso were enrolled in Medicaid during pregnancy, according to fiscal year 2021 data from the Texas Health and Human Services Commission.

Heckert didn’t intend to look at potential gaps in postpartum coverage. The associate professor is working on a broader project, a joint effort between UTEP and Texas Tech University Health Sciences Center El Paso that focuses on maternal health among Latinas in El Paso. Researchers surveyed 180 people between August 2020 and August 2022.

In more than a dozen follow-up interviews with mothers enrolled in the Medicaid for Pregnant Women program, several people thought their benefits had expired two months postpartum. This is when postpartum coverage would normally end if it weren’t for the Public Health Emergency.

Others were unsure of their enrollment status. While the sample size is small, Heckert suspects there are mothers outside the project who are unaware about the Medicaid extension.

This concerns her because complications after giving birth, from depression to cardiovascular disease, can occur later in the postpartum period.

“If people assume it (Medicaid) expired, they might just ignore things,” Heckert said. “Or not actively seek preventative measures or check up on things that are going on and things may escalate. The postpartum period doesn’t end at two months.”

Texas HHSC is unaware of anyone being inadvertently removed from Medicaid for Pregnant People during the Public Health Emergency, department spokesperson Tiffany Young told El Paso Matters.

The Public Health Emergency is scheduled to end mid-October, but the Biden administration will likely continue it for another 90 days.

Part of the confusion stems from conflicting or confusingly-worded information circulating about the Medicaid extension, Heckert said.

Texas HHSC sends renewal packets every six months to maintain the beneficiary’s current information, Young wrote in an email. While HHSC encourages enrollees to renew, the state is supposed to sustain people’s coverage – even if they don’t submit their renewal application. As of March 2020, the only reason the state would remove a person determined eligible for Medicaid would be if the person voluntarily withdrew, died, moved out of state or was not validly enrolled, Young said.

People may also get one phone call to remind them to renew, according to Heckert’s project, which includes interviews with state employees.

Ana-Jamileh Labrado, who was not part of Heckert’s project, told El Paso Matters she wouldn’t have known she had automatic, continuous coverage if it weren’t for someone close to her who works for the state. Labrado was a student at UTEP when she became pregnant and was unfamiliar with how Medicaid worked. She thought her coverage was supposed to end two months postpartum, but had questions when a renewal application came in the mail.

“Many people told me different things … I tried researching but was unable to find a clear answer,” said Labrado, who gave birth in early 2022.

Someone working for the state explained to her that she didn’t need to do anything because her benefits would automatically renew, Labrado said. She’s received multiple renewal applications over time, but hasn’t filled out a single one and has not experienced a gap in coverage. 

State Rep. Lina Ortega, D-El Paso, said she’s asked HHSC to simplify its communication with enrollees. Ortega obtained a copy of the letter people receive in their renewal packets and found it confusing. The date on the letter makes it seem like a deadline, she said, could lead enrollees to incorrectly believe that their coverage will end if they don’t renew on time.

Texas law extending postpartum Medicaid hits a snag

Meanwhile, Ortega is looking ahead to next year’s legislative session. Texas House members plan to refile a bill that would expand Medicaid coverage from 60 days to a full year for postpartum people.

This change would have a major impact on El Paso because the city has such a high rate of uninsured people, she said. Nearly a quarter of El Pasoans under 65 don’t have health insurance.

“We have a young population, we have mothers that if they didn’t have some sort of health coverage, would go without seeking care during a pregnancy,” Ortega said. “That impacts our community because we want to make sure we have others giving birth to healthy babies, and be aware of complications from mothers who don’t get OB-GYN care.”

Lawmakers are acting under the 2021 American Rescue Plan Act, which gave states the option to apply for a one year extension. 

Last session, the Senate amended the House bill from 12 months to six months. The federal government last month rejected the state’s application for a six-month extension.

Legislators believe the application was not approved because the bill only extended coverage to women who deliver a baby or have an “involuntary miscarriage,” The Texas Tribune reported. This language could be interpreted to exclude people who have abortions, including medically necessary abortions.

Horizon City resident Claudia Borunda, who participated in Heckert’s project, said she hopes Texas expands Medicaid coverage after the Public Health Emergency ends, so other new mothers can get the care she and her son got. Medicaid during pregnancy covers newborns for a year after they’re born.

Borunda relied on her postpartum Medicaid coverage for mental health care, including therapy and psychiatric support, plus OB-GYN checkups after giving birth in June 2020.

“There’s a whole stigma of mental health,” she said. “It’s not like I broke my arm, they fix it, and it’s fine in two to three months. It’s a process.

“If it (coverage) ended at two months I would be struggling more because there’s not a lot of affordable options for therapy or even medications. … All the specialists, all the treatment, all the doctors – I don’t think I could afford it any other way.”