Arkansas governor says Medicaid extension for new mothers not needed

Six weeks after her cesarean section, with her newborn twins still in the neonatal intensive care unit, Maya Gobara went to a pharmacy in West Little Rock, Arkansas, to fill a prescription.

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

Arkansas is the only state that has not taken a step to expand so-called postpartum Medicaid, a state option paid for almost entirely by the federal government that provides poor women with uninterrupted health insurance for a year after giving birth. Forty-six states now have such a provision, encouraged by the Biden administration, and Idaho, Iowa and Wisconsin either have plans to pass legislation or have bills pending in their legislatures.

Federal law requires states to provide Medicaid coverage for pregnancy up to 60 days after delivery. But maternal health advocates say Arkansas often begins the process of withdrawing women from the program after six weeks, or 42 days.

Gobara said that’s what she believes happened: She was transferred to a different health plan with a different list of doctors and received no notice of the change.

Gobara, a 38-year-old freelance copywriter, said the change to her health plan came just after her previous health problems — autoimmune disease, postpartum depression and rheumatoid arthritis — flared up.

“Everything I had before came crashing down on me like a bolt from the blue when the boys were born,” she said.

Maternal health advocates say many lower-income women in Arkansas have found themselves in the same gap in access to health care.

Arkansas has one of the highest maternal mortality rates in the country, a grim tally of women who die from any cause related to pregnancy or childbirth, including the weeks after delivery. In Arkansas, between 20% and 29% of women are uninsured at some point between before conception and after delivery.

In March, Arkansas Gov. Sarah Huckabee Sanders, a Republican, signed an executive order creating an expert commission tasked with improving the state’s dismal maternal health outcomes and better educating women about their health insurance options.

At a press conference announcing the initiative, Governor Huckabee Sanders said, “This particular group that we are creating through executive order will consider every option on the table.”

Asked by reporters at a news conference whether she would support expanding Medicaid coverage after childbirth to 12 months, as other states have done, the answer was a resounding “no.”

“I don’t believe that creating a duplicate program just for the sake of creating a program is actually going to solve the problem,” she said. “We already have so many women who aren’t using the coverage that exists. Creating more coverage isn’t going to make more women go to the doctor.”

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

In Arkansas, postpartum women can apply for other types of insurance in Arkansas six weeks after giving birth, but they must 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 are lost or misplaced or that they need to resubmit them. They are being kept on hold while they call trying to get in touch with people,” Harris said. “So some people stop trying.”

Lower-income women like Maya Gobara are being moved to ARHOME, a state program touted by Huckabee Sanders that uses Medicaid funds to purchase private health insurance.

The change in health insurance affected Gobara when her twins, Amir and Bryson, used endotracheal tubes and needed multiple brain surgeries, and she needed emergency gallbladder surgery.

“I was supposed to have my gallbladder removed in a week, but the new plan required a referral for surgery. Unfortunately, I could no longer see my primary care physician because she was not part of the plan I was assigned,” she said.

Gobara, who suffers from gallbladder pain, spent days trying to sort out what happened to her Medicaid insurance after giving birth.

“I felt like the system was set up so that I would give up,” Gobara said. “And honestly, if it weren’t for my mother sitting next to me and helping me through it step by step, I probably would have.”

New mothers should not be shunted from plan to plan or be uninsured as they care for their own health and that of their newborns, said Camille Richoux, health policy director for Arkansas Advocates for Children & Families, a nonprofit advocacy and policy group. Richoux is part of the governor’s Maternal Health Initiative, a commission tasked with developing recommendations to improve maternal health and increase access to maternal health services.

Richoux said switching to a new health plan could disrupt continuity of care when health care is essential. “Especially when so many pregnancy-related deaths occur after 60 days of delivery,” she said.

The committees tasked with making recommendations to Gov. Huckabee Sanders met this summer and recently prepared draft recommendations.

But expanding Medicaid maternity coverage is absent from the list, despite widespread agreement by health organizations and the state’s Maternal Mortality Review Commission that doing so would reduce pregnancy-related deaths.

One of the goals of the maternal health initiative is to “ensure that Medicaid better educates postpartum women about the health insurance options available today to ensure they enroll and get the coverage they need,” Alexa Henning, Gov. Huckabee Sanders’ communications director, said in an emailed statement last month.

“The data shows that most women have ongoing coverage; they just need access to it,” Henning said. “But if we identify gaps, the governor is open to all options to help moms and babies.”

Final recommendations are expected to be published this month.

2024 KFF Health News. Distributed by Tribune Content Agency, LLC.