JEFFERSON CITY, Mo. (AP) — New mothers in Missouri could gain Medicaid health care coverage for up to a year under legislation passed Thursday by the state Senate, part of a national movement of expanded care that began during the coronavirus pandemic.

The bill also would extend coverage to those who have miscarriages or abortions necessary to save their lives. Senators passed the legislation only after inserting wording intended to exclude women who get elective abortions. Missouri has banned most abortions since June.

The legislation seeks to add Missouri to a growing list of 28 states and the District of Columbia that have extended Medicaid health care coverage from the typical 60 days up to 12 months after a woman gives birth. The option was made possible under a pandemic relief law signed by President Joe Biden in 2021.

Supporters say it’s an important means of keeping both the mother and infant healthy, and of cutting down on mortality rates among new moms.

The Missouri bill, which passed 27-4, now goes to the House for consideration, where a committee endorsed a different version earlier this week. The House bill contains no wording regarding abortions. Both legislative chambers must pass the same version before their session ends in mid-May for a bill to go to the governor for approval.

Democratic Sen. Tracy McCreery of St. Louis County, who voted against the Senate bill, called the abortion-related exclusion a “poison pill” that could jeopardize the necessary approval from the federal Centers for Medicare & Medicaid Services.

“It really is a form of government policing and surveillance over low-income women, and it is unacceptable,” McCreery said after the vote. “I am amazed by what some will come up to try and make women into a different class of citizens. That language that was inserted is an example of government overreach.”

According to the state health department, the three top causes of death in postpartum women are mental health, cardiovascular disease, and injury. Missouri has the seventh-highest maternal mortality rate in the country. In a recent report, the Missouri Department of Health and Senior Services said that three out of every four pregnancy-related deaths were preventable. An average of 61 women dies each year in the state, either while they were pregnant or within a year of their pregnancy. 

“It’s not a political issue, it’s not a Republican, Democratic or bipartisan issue, it’s just something that is right,” said Sen. Lauren Arthur, D-Kansas City. “I’m sorry to say that I fear that what is right is now jeopardized for other reasons.”

The Senate bill states that the 12 months of Medicaid coverage begins on “on the last day of the woman’s pregnancy.” It doesn’t specifically mention “abortion” but instead says “no woman who knowingly receives services that are in violation of state law shall be eligible.”

Senate President Pro Tem Caleb Rowden, a Columbia Republican, said he didn’t believe the wording was necessary. But he said some Republicans wanted it to prevent Missouri residents who undergo abortions in other states from qualifying for the extended 12 months of Medicaid. He said he voted in favor of the legislation to keep the conversation going, as representatives are now in charge of the bill. 

“The weaponization of government to specific individuals, pregnant moms, in this case is something that gives me heartburn,” Senate President Caleb Rowden, R-Columbia, said Thursday to reporters. 

Missouri’s ban on most abortions took effect last June, moments after the U.S. Supreme Court overruled its 1973 Roe v. Wade decision establishing the nationwide right to abortion.

The bill also comes with some reform to the Medicaid program, requiring 4,700 people to be removed from Medicaid before the plan goes into effect. 

“This is a bill I consider not just conservative but written in a manner that’s going to protect taxpayers,” Sen. Bill Eigel, R-Weldon Spring, said. 

Eigel said he couldn’t support the bill until there was some short of reform in the legislation. He said he opposed the initial version but said he is “pleased with the final product.”

“The Biden Administration is not going to accept that, CMS [Centers for Medicare and Medicaid Services] is not going to approved that,” Senate Minority Leader John Rizzo, D-Independence said. “It’s a poison pull to make sure that women don’t get proper medical coverage after having a child.”

More than 4,500 women are expected to become newly eligible for Medicaid coverage under the legislation, according to the state Department of Social Services. The expansion is projected to cost more than $30 million annually in federal and state funds by the 2025 fiscal year.

Supporters include Republican Senate Majority Leader Cindy O’Laughlin, of Shelbina.

“Prior to now I would have probably said, `I don’t want to expand welfare,’” O’Laughlin told reporters. But she added: “If you have a new mom, and she does not have adequate health care, then it really stands to reason that the person that might suffer the most would be the child or the children.”

During his annual State of the State address, Gov. Mike Parson told lawmakers he is requesting more than $4 million for the Department of Health and Senior Services to implement a maternal mortality plan.