JEFFERSON CITY, Mo. — Missouri moved Monday to expand health coverage for pregnant and postpartum women and to sharpen the state’s review of pregnancy-related deaths, actions officials say are aimed at reversing troubling trends in maternal mortality.
New coverage and monitoring requirements
Gov. Mike Kehoe signed several bills that will take effect Jan. 1, 2027. Among the measures, the state will:
- Cover doula visits under Medicaid, allowing trained birth companions to be reimbursed for services that can improve prenatal and postpartum outcomes.
- Require private insurers to pay for blood pressure monitoring equipment for pregnant and postpartum policyholders, a step officials say targets hypertensive conditions that contribute to maternal deaths.
Strengthening the review board
The legislation also changes the makeup and duties of the state’s Pregnancy-Associated Mortality Review (PAMR) Board. Senate Bill 999 raises the board’s maximum membership from 18 to 22 and mandates at least one representative from each congressional district. The board must now consider whether a maternal death occurred in or was affected by a maternity care desert, and it must disaggregate reported data by race, ethnicity, language, nationality, age, ZIP code and by the level and timing of prenatal and postnatal care.
Those changes expand the board’s ability to identify patterns and local gaps in care that could inform prevention strategies.
Why the changes came now
State data from the PAMR Board covering 2019–2023 showed that an average of 68 women died each year while pregnant or within one year of pregnancy, with a pregnancy-related mortality ratio of 31.2 deaths per 100,000 live births. The board determined that 79% of those deaths were preventable. Cardiovascular disease and mental health conditions, including substance use disorders, were listed as the leading underlying causes.
“What we don’t know, we can’t properly and adequately address,”
said Martha Smith, director of maternal-child health at the Missouri Department of Health and Senior Services, reflecting the board’s rationale for gathering more detailed, disaggregated information.
Racial disparities remain a key concern
The report also highlights a persistent racial gap: the pregnancy-related mortality ratio for Black women was 2.5 times that for white women during the five-year review period. That disparity mirrors national trends and underscores why state leaders and health advocates have pushed for both better data and targeted interventions.
| Measure | Value |
|---|---|
| Average deaths per year (2019–2023) | 68 |
| Pregnancy-related mortality ratio | 31.2 per 100,000 live births |
| Percent deemed preventable | 79% |
Local impact and next steps
Expanding Medicaid reimbursement to include doulas could change how birthing support is delivered in rural parts of Missouri where access to providers is limited. Requiring blood pressure monitors for pregnant and postpartum patients aims to catch hypertensive emergencies earlier, particularly in communities where follow-up care is inconsistent.
The enhanced PAMR Board membership and reporting requirements are intended to give the state a clearer picture of where and why women are dying in relation to pregnancy. Health officials say improved data will guide prevention efforts; critics will be watching how quickly those data translate into on-the-ground services.
All provisions of the signed bills become law Jan. 1, 2027, setting a timeline for insurers, Medicaid administrators and the PAMR Board to implement the new coverage and reporting rules.
