To reduce Arkansas' high rate of maternal mortality, Gov. Sarah Huckabee Sanders said Wednesday that the state does not need to expand postpartum Medicaid coverage from 60 days to 12 months but instead do a better job of transitioning mothers to other coverage after their eligibility in the pregnancy Medicaid category ends.
"We want to see that coverage continued, whether that's through the private marketplace or other Medicaid options," Sanders said. "Those are already available. We just need to do a better job of moving those moms onto those other coverage opportunities."
Sanders addressed the issue while speaking with reporters after a panel discussion on maternal health at the University of Arkansas for Medical Sciences in Little Rock.
Federal law requires states to provide pregnancy-related Medicaid coverage for women who qualify, based on their incomes, for at least 60 days after a woman gives birth.
The 2021 American Rescue Plan Act gave states an option to extend the coverage to up to 12 months.
According to KFF, formerly known as the Kaiser Family Foundation, 43 states and the District of Columbia had extended the coverage to 12 months as of Jan. 17, and three others were planning to do so.
The remaining states were Arkansas, Iowa, Idaho and Wisconsin, although Wisconsin had extended coverage to 90 days postpartum and had a bill pending in its legislature that would extend it to the full 12 months.
The eligibility category in Arkansas applies to women with incomes up to 214% of the federal poverty level -- $42,200 for a single expectant mother with no other children.
Otherwise, Arkansas' income eligibility cutoff for Medicaid for adults who don't fall into another eligibility category, such as because of a disability, is 138% of the poverty level, or $27,213 for a two-person household.
That's the income cutoff for the state's Medicaid expansion program, known as ARHOME. ARHOME stands for Arkansas Health and Opportunity for Me.
In an emailed response to questions from the Arkansas Democrat-Gazette on Wednesday, state Department of Human Services spokesman Gavin Lesnick also referred to subsidized coverage available through the federal health care exchange, healthcare.gov, under the 2010 Patient Protection and Affordable Care Act.
"If they no longer qualify for Medicaid, such as those who earn more than the ARHOME limit, they do have access to coverage through an employer or through the federal health exchange," Lesnick said. "There are credits and savings available through the exchange based on household income to ensure that plans are affordable."
He said 68% of maternal deaths occur within 40 days of birth, "so it is likely that extending postpartum coverage to 12 months would not be as impactful as focusing on prenatal and postpartum care."
According to the U.S. Centers for Disease Control and Prevention, Arkansas' maternal mortality rate, 43.5 deaths per 100,000 births, in 2018-2021 was the highest among states for which a rate could be reliably calculated.
Provisional data from the CDC also shows Arkansas also had the country's third-highest infant mortality rate in 2022, with 7.67 infant deaths per 1,000 births.
Extending pregnancy Medicaid coverage to 12 months was among the recommendations in a December 2023 report by the state Maternal Mortality Review Committee to reduce Arkansas' pregnancy related deaths.
A bill sponsored by Rep. Aaron Pilkington, R-Knoxville, during the 2023 legislative session would have required Arkansas to extend postpartum Medicaid coverage to 12 months, but it died in the House Public Health, Welfare and Labor Committee.
Pilkington said he plans on proposing the bill again in next year's regular session because people are "slipping through" and ending up without coverage.
"At the 61 day mark, you need to reenroll or get cut off and navigate DHS to find which plan you qualify for," Pilkington said.
"Women still aren't receiving the care they need," he said.
He added that extending coverage to 12 months would give women more time to find other coverage before their eligibility for pregnancy Medicaid ends.
In 2023, the estimated cost to extend coverage from 60 days to a full year was $10,148,267, Lesnick said.
At that time, the estimated federal share was $7,289,246, with an estimated state share of $2,859,020, he said.
At the panel on Wednesday, Sanders, along with U.S. Sen. John Boozman, R-Ark., and U.S. Rep. French Hill, R-Ark., spoke with Arkansas medical professionals about prenatal, delivery and postpartum care issues across the state.
One factor that contributes to Arkansas' poor maternal outcomes is a lack of education, Sanders said.
"One of the things I think is missing is people aren't aware of that access," Sander said. "There is no one in the state of Arkansas, if they are pregnant, that cannot receive care and cannot receive coverage for that care."
Boozman asked what could be done to "close that educational gap."
"We have to educate people that there are places you can go," panel member Lanita White, CEO of Community Health Centers of Arkansas, said.
"The Department of Health is one of them. Community health centers are another that you can walk into and get care, regardless of your ability to pay."
White added that not only a lack of access, but also fear and stigma, keep many women from receiving the prenatal and other care they need.
"When it comes to things like substance abuse or even behavioral health, we have to start incorporating those conversations in regular visits," White said. "It has to be a normal part of the discussion, just like we talk about blood pressure."
My Ly is a Report for America Corps member.