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At the request of @AlysonKNorthrup, I'll be live tweeting the @macpacgov discussion of the draft recommendations to Congress to extend #postpartum Medicaid coverage. The commissioners will be voting on these recommendations tomorrow. Thread 
Outstanding issues up for consideration include: 1) Should the mandatory extension apply to all postpartum individuals or should the extension of coverage be mandatory up to 133 percent of the federal poverty level (FPL) and optional above that threshold?
And 2) What level of enhanced federal funding (90% or 100% match) should be provided to states? Outside of these outstanding items, the commissioners have previously agreed that any extension should be mirrored for women covered under #CHIP (would apply to 6 states).
The draft recommendations also include 1) Extending the postpartum coverage period for individuals who were eligible and enrolled in Medicaid while pregnant to a full year of coverage, regardless of changes in income. (FMAP rec still unknown).
And 2) Congress should require states to provide full Medicaid benefits to individuals enrolled in all pregnancy-related pathways. This is significant; there has been a lot of prior debate among commissioners about whether this coverage should be mandatory or optional for states.
@macpacgov's official position is that all pregnant & postpartum individuals should be provided comprehensive coverage & states should not have the option to limit coverage to pregnancy-only services. This aligns with the position of @acog and others.
The recommendations are now open for discussion by the commissioners. Chairwoman Melanie Bella begins by saying this issue is paramount to improving the health of our nation's mothers and children. Asks for comments around 90 vs 100% FMAP.
In past meetings, the commissioners have been relatively split on the federal match. Some worry about precedent of 100%, but recognize that states will need significant financial support.
Commissioner Sheldon Retchin throws out the idea of mirroring the match scenario from the #ACA. That would be 100% FMAP for 5 years, tapering off to 90% in perpetuity. Notes that now is a tough time to expect even a modest (10%) share from the states.
Commissioner Peter Szilagyi concurs with Retchin's ACA-style recommendation. Also notes that the overall budget figure ($1 billion over 10 years) is cheap. Need to invest these resources to improve maternal and child health.
Bill Scanlon identifies himself as "an outlier" on FMAP and notes he will abstain from voting on this issue. He is more comfortable leaving this issue to Congress to decide (would rather @macpacgov make broad recommendation without including a specific match rate).
Commissioner Fred Cerise raises an important question regarding maintenance of effort. If states are expected to contribute 10% match, will they cut back eligibility? Staffer Martha Heberlein notes that would be unlikely, but can't say it wouldn't happen.
Chuck Milligan flags that most other instances where 100% FMAP is applied are for certain services, administrative costs, etc. Hesitant to recommend 100% for a coverage expansion.
Kit Gorton correctly states that, at its core, this policy will keep people from dying and will enable them to live healthier lives. A fundamental purpose of the #Medicaid program! Encourages bold use of language in the recommendations and emphasis on the wide body of evidence.
Sheldon chimes in again to note that improving coverage for pregnant women (and moving from optional to mandatory) is not unprecedented. Congress has made changes overtime, and it has not negatively impacted the partnership between states and the feds.
Commissioner Stacey Lampkin appears to have had a change of heart from earlier discussions. Now falls behind the recommendation to make this coverage mandatory with 100% FMAP. Favored option and 90% in earlier public meetings.
Commissioner Kisha Davis urges 100% for now, given looming budget crises states are facing, but supports 90% in perpetuity. Tom Barker says Retchin's arguments re: precedent very persuasive.
Chairwoman Melanie Bella summarizes remarks and provides her recommendations for moving forward with the draft chapter. She favors 100% FMAP. They are splitting hairs at this point. Taking official vote.
7 votes for 100% FMAP. 6 votes for 90%. 3 votes for compromise, ACA-style solution. Commissioner Kisha Davis immediately chimes in to notes that 6 of the 7 female commissioners voted for 100%. Notable gender divide. Men start changing their votes, relying on experts (aka women).
WOW - multiple male members change their votes after the gender divide is explicitly called out by Commissioner Kisha Davis (not only a female member but also the only Black commissioner). Now clear backing of 100% FMAP recommendation, though still some hold outs.
While formal vote isn't until tomorrow, sounds like the Commission will be recommending 100% FMAP. Importantly, this is just a recommendation. The FMAP (if any) is ultimately the prerogative of Congress.
Discussion of this topic has concluded. The Commission will be taking public comment at 12 noon ET and will be voting on the final recommendations tomorrow afternoon. (End)
