Intense stress faced by new moms can also affect the emotional development of their baby. That's a good reason to expand Medicaid coverage to low-income mothers in states like Missouri, which didn't expand the program under the Affordable Care Act, a St. Louis child psychiatrist argued Tuesday.
“If you want to have healthy infants, you have to have healthy caregivers,” Dr. Cynthia Rogers told an assembly of physicians at Washington University. “And the preterm brain is particularly vulnerable.”
A baby's last weeks of growth in a mother's womb are important. Although modern medicine has saved countless premature infants who may not have survived decades ago, that care can be traumatic for both the child and the parents.
“I don’t think unless you’ve experienced it, you can understand what it’s like to have a child born two, three or four months early… and feeling like you can’t do anything to help your child,” Rogers said. “All of that makes these parents extremely anxious, and a lot of them do have symptoms of PTSD.”
Rogers and her colleagues have taken MRI scans of premature infants in St. Louis during their first years of life, and found a correlation between the mental health of new mothers and their children. Babies whose mothers’ mental health needs went untreated had a greater risk of attention problems, anxiety or even depression as they grew up.
A myriad of factors, including a person’s environment and their genetics, can influence their mental health, Rogers said. The difference is that a parent’s mental health can be improved.
“Some of those things we cannot change, but some of them we can,” Rogers said. “The goal is to focus on the things we really can intervene on. Treating maternal mental health symptoms, and intervening before those symptoms even start, is something we can do.”
Rogers’ research shows that mental health counseling can help. The problem is, it isn’t always available.
Under Missouri law, Medicaid coverage is available to pregnant women whose incomes fall below 185 percent of the federal poverty line, or $37,777 a year for a family of three.
In states that expanded Medicaid under the Affordable Care Act, many parents in a family of three who make less than $28,180 per year together – 138% of the federal poverty line – can keep Medicaid coverage.
For parents in those so-called expansion states, a wider variety of mental health services are available at low to no cost. A U.S. Government Accountability Office report from July found that in four expansion states – Iowa, New York, Washington, and West Virginia – one in three people covered under the expansion received mental health treatment.
But benefits are cut off for most new moms in Missouri 60 days after they give birth. That drives up the cost of their medical care, including mental health counseling and treatment.
Maternal health advocates aren’t very hopeful that the Missouri legislature will extend Medicaid coverage, given lawmakers' history of voting down Medicaid expansion.
“I know there’s interest … but I haven’t seen any movement to actually put that into practice, or even pilot it,” said Kendra Copanas, executive director of Generate Health. "One option the state could have is to try it out in a part of the state. But given the uncertainty federally, it may not be as open to considering broadening or enhancing the services."