Why is Arkansas holding out on a Medicaid expansion for new moms? : Shots

Six weeks after her emergency C-section, and with her newborn twins still in the neonatal intensive care unit, Maya Gobara went to a pharmacy in West Little Rock, Arkansas, to pick up a prescription.

“The pharmacy told me I didn’t have insurance,” Gobara said.

Arkansas is The only state States have not taken steps to expand so-called postpartum Medicaid coverage, a state option funded almost entirely by the federal government that allows poor women to continue their health insurance coverage without interruption for a year after giving birth. Forty-six states currently have such provisions, encouraged by the Biden administration, and Idaho, Iowa and Wisconsin plan to enact legislation or have bills pending in their state legislatures.

Nationwide, 41% of births Fewer than 1,000 were eligible for Medicaid in 2021. Under federal law, states are required to provide pregnancy-related Medicaid coverage for 60 days after birth, but maternal health advocacy groups say Arkansas often begins the process of removing women from the program six weeks, or 42 days, after giving birth.

Gobara believes something similar may have happened to her: She was switched to a different health plan with a different doctor, but she said she wasn’t notified of the change.

“A ton of bricks”

Ms. Gobara, 38, a freelance copywriter, said the change in her health insurance plan came at a time when past health issues, including an autoimmune disease, postpartum depression and rheumatoid arthritis, were resurfacing.

“After my sons were born, it felt like everything I knew just fell apart,” she said.

Maternal health advocates say many low-income women in Arkansas face common health care disparities.

Arkansas has one of the highest maternal mortality rates in the nation, measured by the number of women who die from any cause related to pregnancy or childbirth, including within the first few weeks of giving birth. Between 20% and 29% of women in Arkansas are uninsured at some point from before pregnancy to after birth.

In March, Arkansas Governor Sarah Huckabee Sanders, a Republican, signed an executive order creating a commission of experts tasked with improving the state’s dire maternal health conditions and better educating women about their health insurance options.

“This particular group, which we’re establishing through executive order, will be exploring all options,” Gov. Huckabee Sanders said at a press conference announcing the plan.

When asked by a reporter at a press conference whether she supported expanding postpartum Medicaid coverage to 12 months, as other states have done, the answer was a resounding “no.”

“I don’t think creating duplicative programs just for the sake of creating programs is actually going to solve the problem,” she says. “There are already a lot of women who don’t have access to existing insurance, and adding more insurance programs isn’t going to translate into more women seeing a doctor.”

Huckabee Sanders, 42, is the youngest governor currently serving and the mother of three school-age children.

When Sarah Huckabee Sanders was White House press secretary in 2018, she was seen playing with one of her sons in the press room during “Take Your Daughters and Sons to Work Day.”

Nicholas Kamm/AFP via Getty Images

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Paperwork hurdles

In Arkansas, women can sign up for other insurance six weeks after giving birth, but they have to submit a paper application, said Zenobia Harris, executive director of the Arkansas Birthing Project, a mentoring program that helps pregnant and postpartum women.

“Women are being told their documents have been misplaced or lost, they have to resubmit their documents, and when they call to try to get through to a human being, they’re put on hold,” Harris said. “So some of them give up.”

Low-income women like Maya Gobara ARHOME, a state program Huckabee Sanders’ recommendation would be to use Medicaid funds to buy private health insurance.

By the time Gobara was switched to new health insurance, her twins, Amir and Bryson, were on breathing tubes and had required multiple brain surgeries, and she herself needed emergency gallbladder surgery.

“I was scheduled to have my gallbladder removed in a week, but under this new plan I needed a referral for that procedure, but my doctor wasn’t on my plan so I couldn’t see him anymore,” she said.

Gobara, who suffered gallbladder pain, spent days sorting out what happened to her postpartum Medicaid coverage.

“I felt like the system was rigged to make me give up,” Gobara said, “and honestly, if my mom hadn’t been sitting next to me and helping me every step of the way, I probably would have given up.”

What supporters say

Mothers of newborns shouldn’t have to jump from one insurance plan to another or go uninsured while caring for their own health and their newborn, said Health Policy Director Camille Richeau. Arkansas Children and Families Support Organizationa nonprofit advocacy and policy group. Governor’s Maternal and Child Health InitiativeA committee tasked with developing recommendations to improve maternal health and increase access to maternal health services.

Richieu said switching to a new health plan could disrupt continuity of care at a time when it is essential, “especially when there are so many pregnancy-related deaths occurring after the 60-day period of coverage after delivery,” she said.

The committee making recommendations to Huckabee Sanders met this summer and recently drafted its recommendations.

But expanding Medicaid coverage after birth is not on the list, even though medical groups and state maternal mortality review committees widely agree that doing so would reduce pregnancy-related deaths.

In an emailed statement last month, Alexa Henning, a spokeswoman for Huckabee Sanders, said one of the missions of the Maternal and Child Health Initiative is to “help Medicaid better educate postpartum women about the health insurance options that already exist today and ensure they can enroll and get the coverage they need.”

“The data shows that most women have continuous coverage, they just need access to it,” Henning said. “But if gaps are found, the governor will explore all options to help mothers and babies.”

Final recommendations are expected to be released this month.

KFF Health News is a national newsroom that produces in-depth journalism on health issues. KFF .