This article by Tess Vrbin was published in the Arkansas Advocate on October 28, 2024
Roughly 60% of postpartum Arkansans who qualified for Medicaid between July 1 and Sept. 30 retained some form of Medicaid coverage 60 days after giving birth, Arkansas Department of Human Services officials told a legislative panel Monday.
DHS found that most of the remaining 40% were ineligible for Medicaid by 60 days postpartum, Secretary Kristi Putnam and state Medicaid Director Janet Mann told the Joint Public Health, Welfare and Labor committee.
More than half of births in Arkansas are covered by Medicaid, the federal-state health insurance system for low-income Americans. Medicaid covers pregnant Arkansans with incomes of up to 209% of the federal poverty level, but this coverage expires two months after birth.
Act 161 of 2024 requires Arkansas Medicaid officials within DHS to “redetermine eligibility for postpartum mothers receiving coverage under a Medicaid eligibility category within eight (8) weeks of giving birth” and enroll those still eligible for Medicaid into another category before the 8-week deadline. The mandate was part of the appropriation bill for DHS’ Division of Medical Services for fiscal year 2025, and Gov. Sarah Huckabee Sanders signed the law in May at the end of the fiscal session.
The law went into effect July 1, and Putnam and Mann’s report Monday was the first required quarterly update to the Legislature. Putnam and Mann were scheduled to deliver the report to the Arkansas Legislative Council, as specified in the law, on Oct. 18, but the report was not ready then, they said.
During the third quarter, 4,234 Arkansans were on Medicaid before and shortly after birth, Mann said Monday. Of those:
-1,711 stayed in the same eligibility category 60 days postpartum
-901 qualified for a different eligibility category 60 days postpartum
-1,451 were not eligible for coverage 60 days postpartum
-DHS could not find enough eligibility information for the remaining 171.
Arkansas is the only state that has taken no action to adopt the federal option of extending postpartum Medicaid coverage from 60 days to 12 months after birth. Putnam and Sanders have said this expansion would be “redundant” and “duplicative,” since the state has other insurance coverage options for postpartum low-income Arkansans.
Arkansas has one of the nation’s highest maternal mortality rates and the third highest infant mortality rate, according to the Arkansas Center for Health Improvement. Only 34 hospitals in Arkansas have labor and delivery units, and some of the state’s 75 counties have no hospitals at all.
Five maternity wards, most recently in Newport, have closed since the onset of the COVID-19 pandemic in 2020.
In March, Sanders issued an executive order creating a strategic committee of state officials with the goal of developing a plan to improve the state’s maternal health infrastructure and outcomes. Both Putnam and Mann are on the seven-member committee.
The committee’s six-month progress report in September included a wide range of recommendations, including considering higher Medicaid reimbursements for existing care providers and implementing presumptive Medicaid eligibility for pregnant Arkansans.
Presumptive eligibility assumes 60 days of Medicaid eligibility and shortens the process of applying for coverage. The U.S. Centers for Medicare and Medicaid Services (CMS) would have to approve a waiver for Arkansas to implement the policy.
Rep. Aaron Pilkington, R-Knoxville, sponsored legislation in 2023 that would have implemented both presumptive eligibility and 12 months of postpartum Medicaid coverage. Neither bill advanced due to cost concerns, but Pilkington has said he hopes to draft more legislation related to maternal health care for the 2025 legislative session.
Pilkington sponsored Act 161 and is a member of the Public Health committee. He said Monday that he was “very disappointed” not to have received DHS’ postpartum Medicaid data on Oct. 18 as required, or in the form of a more thorough report.
“We’re trying to change this, so we [should] actually measure it, because I think a lot of times in this discussion, we’ve been looking around in the dark without a flashlight,” Pilkington said.
Having less than a month to compile data for the committee was difficult, Putnam said, but DHS’ goal is having the correct data. Staff will hopefully be able to automate the report instead of collecting data manually after multiple reports, she added.
Mann said DHS and the Arkansas Insurance Department (AID) are trying to connect with the 1,451 people who were not eligible for Medicaid 60 days postpartum in order to determine their eligibility for insurance coverage in the private marketplace.
“There [are] some marketing and some direct contact things that we are prohibited from doing through the insurance laws, so we’re working with one partner in AID on how to reach them,” Mann said.
Committee co-chair Sen. Missy Irvin, R-Mountain View, said she wanted to know the ages of the Arkansans DHS found ineligible for coverage. Irvin and Mann agreed that pregnant teenagers could be eligible for Arkansas’ child Medicaid programs.
Arkansas had almost double the national rate of teen pregnancy in 2022, and the vast majority of teen pregnancies were unplanned due to a lack of adequate sex education and access to reliable contraception, according to Arkansas Advocates for Children and Families.
The strategic committee has drafted a request for proposals for an advertising campaign to promote maternal and prenatal health care and reduce the state’s teen pregnancy rate, according to the September report.