A new report released Tuesday found children and mothers are dying in Idaho at an increasing rate.

And reforming Medicaid coverage in the state could make a difference, it suggested.

All key health indicators have worsened since last year, when Idaho Kids Covered released its first report on the health of Idaho children and mothers.

The mortality rate for mothers rose 121.5%, while the rate for children rose 18%, the report found. Idaho’s maternal mortality rate in 2021 was 40.1 deaths per 100,000 births, compared to 18.1 deaths per 100,000 births in 2019. Seventeen Idaho women died while pregnant or within one year of pregnancy in 2021. Idaho’s maternal mortality rate is below the national average, which has grown in recent years. 

One hundred seventeen infants died in Idaho in 2021, compared to 97 in 2019, according to state records.

“Moms and children in Idaho are dying at an alarming rate,” said Ivy Smith, health policy associate at Idaho Kids Covered.

The report recommended overhauling Medicaid coverage for children and pregnant women by updating income cutoffs that haven’t been adjusted in decades and extending postpartum coverage to match what other states are doing.

The report painted a grim picture for Idaho mothers:

• One in 5 Idaho moms didn’t receive prenatal care in the first trimester of their pregnancy. Women of color got prenatal care even less. 
• Three in 10 Idaho moms lacked health insurance before becoming pregnant. 
• One in four Idaho moms had moderate to severe postpartum depression soon after birth — above the national average of 13%.
• One in five Idaho moms weren’t screened for depression during prenatal visits. More than half of pregnant women with depression never sought treatment.

And for Idaho children:

• More than one in 10 Idaho infants and toddlers did not see a doctor for a well-child exam in 2021. 
• Eighty-five percent of Idaho kids aged 9-35 months didn’t get a recommended developmental screening.

Idaho Legislature disbanded maternal death review committee this year

The report comes months after Idaho lawmakers this June disbanded a committee to review maternal deaths, making Idaho the only state without such a committee. The committee previously found that most maternal deaths were preventable. The report called for the committee to be reinstated.

More than half of all pregnancy-related deaths in Idaho in 2021 happened between 43 days and a year after birth, the report said. In Idaho, pregnant women only receive Medicaid coverage up to 60 days after they give birth. That’s not the norm. Forty-six states offer postpartum coverage one year after birth. In all states except Idaho, pregnant women also have higher income eligibility cutoffs for Medicaid.

As US maternal mortality rates surge, Idaho abandons panel investigating pregnancy-related deaths

Early work to implement at least one of the report’s findings is already underway. The Department of Health and Welfare, Idaho’s largest government agency that runs Medicaid, requested funds in its budget request to implement 12 months postpartum Medicaid coverage, agency spokesperson AJ McWhorter told the Idaho Capital Sun.

Budget requests are only one step of the process. Idaho Gov. Brad Little still needs to draft his proposed budget. And the Idaho Legislature needs to appropriate the funds 

The state health department also agreed that bringing back the maternal mortality committee would help.

“We agree that the reinstatement of the Maternal Mortality Review Committee would help in the identification of the causes (of) Idaho-specific maternal deaths and Idaho-specific recommendations that could be made to prevent future deaths and potential maternal morbidity due to pregnancy-related issues,” McWhorter said.

Idaho’s House Majority Leader Megan Blanksma told ProPublica earlier this year that she was working on bills to improve prenatal and postpartum care.

Why is Medicaid important for Idaho children and mothers?

Medicaid offers insurance to people with low incomes and disabilities. The program has wide-reaching impacts for mothers and children. 

Nearly one-third of Idaho mothers were on Medicaid when they gave birth last year. Medicaid coverage is even higher for births in rural Idaho. For instance, 48% of births in Lemhi County involved mothers covered by Medicaid. And half of all people enrolled in Idaho Medicaid are children.

Children have higher income eligibility cutoffs, but the report says they don’t go far enough. Medicaid coverage should be revamped for children and pregnant women in a number of ways, the report recommended — including extending postpartum coverage and raising income eligibility cutoffs to get more in line with policies in other states.

About half of all Idahoans on Medicaid are children, the report said. And for patients who become pregnant, Medicaid is a crucial option because anyone can enroll any time, Smith said. That’s unlike private insurance, where people have a window of a few weeks each year to enroll.

“In Idaho right now, it is really hard to find quality and timely access to maternal health care and reproductive health care,” Smith said. “And with the statewide provider shortages, we must do all we can to ensure that Idaho moms have access to health care when they need it.”

Idaho, like other states, is re-evaluating the eligibility of all people on Medicaid for the first time since the pandemic, after federal protections barring eligibility reviews ended. Idaho officials have reportedly removed at least 121,000 people from Medicaid. But recently, thousands of Idahoans removed from Medicaid have gotten back on the program.

Seventy-thousand Idahoans removed from Medicaid this year were children, the report said. At least 51,000 kids were removed for not replying to the state’s requests for information, Smith said. That means state officials weren’t able to verify that they were ineligible for Medicaid. And that’s likely growing the number of Idaho children who are uninsured, Smith said, which was last recorded at 28,100.

Idaho children are eligible for Medicaid if their household income is at 190% of the federal poverty limit. But in more than one-third of states, families could earn 300% of the federal poverty limit — or a little more than one-third more — and children would still be eligible for Medicaid.