Sanders' maternal health plan would make it easier to get Medicaid — but not to keep it

Gov. Sarah Sanders on Thursday announced legislation aimed at improving Arkansas's worst-in-the-nation maternal health statistics by easing the Medicaid enrollment process for pregnant women, guaranteeing coverage of certain services, and boosting payments to doctors and hospitals, among other changes.

But the governor once again rejected the idea of giving new mothers the opportunity to keep their Medicaid coverage for 12 months after giving birth. Every state in the country except Arkansas has taken the federal government up on an offer to extend pregnancy Medicaid eligibility to a year postpartum, rather than the two-month coverage window the program traditionally allows.

Sanders' said in a press release Thursday her new plan would invest "an estimated $45.3 million in maternal health annually," though most of that would come from the federal government. The state's share would be $13 million.

(Medicaid is a joint federal-state program; in Arkansas, the federal government pays about 70% of the costs of pregnancy Medicaid and the state pays about 30%, thanks to program rules that give a more generous match rate to poorer states.)

The governor announced the "Healthy Moms, Healthy Babies Act" at a press conference with the new bill's two lead legislative sponsors, Sen. Missy Irvin (R-Mountain View) and Rep. Aaron Pilkington (R-Knoxville). Co-sponsors include several other Republicans and Democratic Rep. Ashley Hudson (D-Little Rock). The proposal is contained in two identical bills, Senate Bill 213 and House Bill 1427.

The bill's most direct impact on everyday Arkansans would be the establishment of "presumptive eligibility" for women who are pregnant. To receive pregnancy Medicaid in Arkansas currently, an expectant mother first must apply to the state Department of Human Services and prove she qualifies under the program's income threshold and other requirements. Presumptive eligibility means an applicant could begin receiving prenatal care right away, rather than waiting on DHS to process her application.

The bill would also allow doulas and community health workers to get paid by Medicaid and require the program to cover certain telemedicine services, including remote ultrasounds and blood pressure monitoring.

But the bill would also make major, behind-the-scenes changes to how Medicaid compensates health care providers.

Sanders' press release says her plan would "increase reimbursements for traditional deliveries and c-sections by 70%, investing an additional $25.7 million in care for pregnant women and encouraging more providers to participate in the Medicaid program." In other words: Hospitals and doctors will be paid more by the state. That's good news especially in rural areas where maternal health care is hard to come by (though it sits oddly alongside Sanders' recent announcement that she'll be pursuing a Medicaid work requirement that many providers warn will lead to more uninsured Arkansans and more uncompensated care).

Along with directly increasing reimbursements, the bill would "unbundle" Medicaid payments for prenatal and postnatal care, which could also boost compensation for hospitals and doctors.

Some states' Medicaid programs, including Arkansas's, bundle together payment to providers for certain health episodes — such as a pregnancy and a period of time postpartum — rather than paying separately for every individual doctor visit or medical test. The idea is that such a "global" payment structure can reduce providers' incentives to overbill the system.

The bill from Irvin and Pilkington would reverse course on such reform, at least regarding maternal health. It would require Arkansas Medicaid to reimburse providers "for prenatal, delivery and postpartum services separately in lieu of a global payment or an all-inclusive payment methodology for maternity services."

Irvin said those changes would drive better outcomes for mothers. "Unbundling and increasing payments for prenatal, delivery and postpartum care is necessary, way past due and will make a huge impact in stabilizing our healthcare access for expecting mothers," she said in a statement.

Pilkington said later on Thursday that bundling of Medicaid payments can disincentivize providers to take on patients with more complex health conditions because they know they could lose money in the process.

Under the current system, "if you've got a high-risk birth, you've got a lot of [primary care providers] who say, 'I want nothing to do with that,'" he said.

One provision of the bill went unmentioned in the governor's press conference. Its final section would shorten the statute of limitations on a lawsuit brought on behalf of a child who suffered medical injuries during birth — another apparent boon to doctors and hospitals.

Currently, state law requires medical injury lawsuits involving children to be brought by "the later of the minor's 11th birthday or two years from the act, omission or failure" of the medical provider. The new bill would add an exception: "If an alleged medical injury occurred during childbirth, the minor or his or her representative shall have until the minor's fifth birthday to commence an action."

Pilkington said the purpose is to make it more affordable to practice maternal medicine in Arkansas. Typically, he said, a health care provider must keep malpractice insurance for 18 years after a given birth in case of a lawsuit related to that birth.

"Hospitals say they're paying malpractice insurance for providers who retired 10 years ago," Pilkington said. The goal is less about limiting lawsuits than about reducing the need for such insurance long after the fact, he said.

"Chances are, if there's a complication that arose during birth, you're going to see that emerge in the first five years after birth," Pilkington said. Lawsuits involving a birth-related injury that only emerges after a child is 5 or older "are super rare, but you have to have the [malpractice] coverage."

When a reporter at Thursday's press conference asked Sanders why she still didn't support the 12-month Medicaid extension for new mothers, she waved the question away.

"As I've answered probably 20 different times from this very spot, we feel like that access to coverage exists, but we have to do a much better job of raising awareness and making sure moms are connected to it," the governor replied.

Sanders has said in the past that the 12-month extension would "create a redundant program" because ample health insurance options already exist for new mothers who've reached the end of the current two-month postpartum coverage period. Many could qualify for a different type of Medicaid, for example, under ARHOME, the state's Medicaid expansion program for low-income adults.

The state's own data suggest that's not necessarily the case, however. During a three-month period last year, some 1,451 Arkansans were covered by Medicaid when they gave birth, but were no longer eligible for the program 60 days later.

DHS reluctantly gave those figures to a legislative committee in October at the prodding of Pilkington, who has sponsored legislation to require the 12-month extension. The data suggests there are thousands of mothers every year who could be helped by the additional coverage — along with presumptive eligibility, better access to doulas and the other changes in the bill that was introduced today and blessed by Sanders.

Asked whether he still planned to push for the 12-month extension despite the governor's position, Pilkington said he was focused for now on passage of the legislation introduced today.

Here's the full press release from the governor:

Governor Sanders Announces Healthy Moms, Healthy Babies Act

Plan invests an estimated $45.3 million in maternal health annually

LITTLE ROCK, Ark. – Governor Sarah Huckabee Sanders today announced the Healthy Moms, Healthy Babies Act to improve maternal health in Arkansas. Senator Missy Irvin (District 24) and Representative Aaron Pilkington (District 45) are the lead cosponsors of the bill.

"I'm a mom, so I know how important maternal healthcare is to helping healthy moms have healthy babies, which is why my administration has been focused on building a comprehensive, coordinated approach to maternal health in Arkansas," said Governor Sanders. "Along with the actions we have taken since I took office, the Healthy Moms, Healthy Babies Act will make real, lasting change to Arkansas' maternal health landscape and move the needle on this critical issue facing our state."

"Arkansas mothers and babies are our first priority. Today's announcement and subsequent legislation is intentional, targeted and smart. It is designed to help our mothers be healthier so they can deliver healthier babies. Unbundling and increasing payments for prenatal, delivery and postpartum care is necessary, way past due and will make a huge impact in stabilizing our healthcare access for expecting mothers," said Senator Missy Irvin. "I look forward to presenting this plan of action to prioritize and improve maternal health in Arkansas. I applaud the excellent work of our Governor, Secretary Putnam, our teams at DHS and the Governor's office."

"The Healthy Moms, Healthy Babies Act strengthens maternal care in Arkansas by unbundling the global payment, increasing provider reimbursements, and expanding access to telemedicine. This bill also improves pregnancy outcomes by empowering community health workers and ensuring Medicaid coverage for expectant mothers," said Representative Aaron Pilkington.

The legislation includes several reforms recommended by the Governor's Strategic Committee on Maternal Health, which she formed last year. It establishes Presumptive Medicaid eligibility for pregnant women, meaning pregnant women can receive prenatal care while they complete their Medicaid application. It offers reimbursement pathways for doulas and community health workers. And it establishes pregnancy-related Medicaid coverage for remote ultrasounds, remote blood pressure monitoring, and continuous glucose monitoring. These reforms will result in an additional $7.44 million investment in Arkansas moms.

Additionally, the legislation unbundles Medicaid payments for pregnancy care, paying for up to 14 prenatal and postnatal care visits, encouraging providers to work with pregnant women so they attend more appointments, and increasing Medicaid's investment in pregnant women by $12.2 million. The Governor also announced that Medicaid will increase reimbursements for traditional deliveries and c-sections by 70%, investing an additional $25.7 million in care for pregnant women and encouraging more providers to participate in the Medicaid program, increasing access to care.

Funding for these investments is facilitated by the $13 million commitment the Governor made to maternal health in her budget. That investment allows the state to access additional federal Medicaid funding.

"Since the Strategic Committee on Maternal Health met and submitted our report, a number of important initiatives and programs have been started or improved upon," said Dr. Kay Chandler, Arkansas Surgeon General. "It is exciting to continue this work and see these policy recommendations become reality. They will make important, positive impacts on the health of Arkansas moms and babies for years to come."

"The changes included in the Healthy Moms, Healthy Babies Act will go a long way toward ensuring women's access to essential care before, during, and after pregnancy," said Arkansas Department of Human Services Secretary Kristi Putnam. "I am grateful for the leadership from Governor Sanders, the Legislature, and our many stakeholder partners who have all worked collaboratively on improving our maternal health system and supports. I'm excited to see how these changes will improve the health of pregnant women, new moms, and babies across our state."

"The Arkansas Department of Health is privileged to see maternity patients in our Local Health Units every day, and we have seen first hand what these policy changes will mean for patients and providers in communities across the state," said Renee Mallory, Arkansas Secretary of Health."We look forward to continuing our efforts with our partners to improve maternal health in Arkansas."

"Medicaid covers approximately half of all births in Arkansas, so investing in changes that expand and improve maternal care within the Medicaid program will have profoundly positive impacts on our state," said Arkansas Department of Human Services Deputy Secretary for Programs and State Medicaid Director Janet Mann. "These reforms directly align with the recommendations from the Strategic Committee for Maternal Health, and we look forward to making them a reality."

Governor Sanders established the Strategic Committee on Maternal Health by Executive Order on March 6, 2024, initiating a six-month timeline for stakeholders to meet and discuss potential reforms. More than 100 stakeholders representing dozens of organizations met more than 20 times, crafted and discussed recommendations, and delivered their report to the Governor on September 5, 2024.

Since the establishment of the Committee, the Arkansas Department of Health and Arkansas Department of Human Services have taken a number of steps to improve maternal health outcomes, including expanding prenatal care at local health units, initiating an RFP for a statewide maternal health PSA campaign, launching a maternal health pilot program in five counties with poor maternal health outcomes, securing a $17 million Transforming Maternal Health Model grant from the U.S. Department of Health and Human Services, and more.