A watershed moment for Arkansas moms and babies

By Bobby Howard | Arkansas Times

The worst-kept secret in the state of Arkansas is that our Natural State has the worst maternal and infant mortality rates in the nation. 

Lack of access to pre- and post-natal care has long plagued Arkansas, and for generations the burden of poverty — especially in rural areas — has stretched our health care infrastructure beyond its ability to provide adequate care for some of the most vulnerable Arkansans: babies and their mothers.

But a pair of identical House and Senate bills seeks to change that: HB1427 and SB213, known as the “Healthy Moms, Healthy Babies Act.” This legislation, which appears on track to pass the Legislature and head to the governor’s desk as soon as next week, represents sweeping change. It is not perfect, but make no mistake: better is better. And in this case, better will save lives.

Some context

The “Healthy Moms, Healthy Babies Act” is sponsored by state Rep. Aaron Pilkington (R-Knoxville) and state Sen. Missy Irvin (R-Mountain View) and supported by Gov. Sarah Sanders. But it has bipartisan support, including one Democratic co-sponsor, Rep. Ashley Hudson (D-Little Rock). 

“Arkansas has the shameful distinction of being one of the worst states in the country to be pregnant,” Hudson said in an interview. “Our rates of preterm birth, infant and maternal mortality are some of the highest in the whole country. Taken together, Arkansas is in the middle of a massive maternal and infant health crisis.”

What’s she talking about? Half of Arkansas counties do not have maternal health services within their boundaries. According to a recent March of Dimes report  Arkansas’s infant mortality rate is 35% higher than the national rate, and Arkansas’s maternal mortality rate is a shocking 65% higher than the national rate. 

Arkansas’s mothers and babies are dying at much higher rates than nationally, and that is largely a function of distance to care, the ever-rising costs of care, recent hospital and health clinic closures, and the reality that for many providers maternal and infant health services are loss leaders. 

Put simply: It’s hard to deliver maternal health care in rural Arkansas, and many doctors and hospitals can’t meet their bottom line with current reimbursement rates.

These issues must be addressed from several different directions: expanding care networks into existing maternal and infant health deserts, ensuring that maternal and infant health services are part and parcel of a sustainable, 21^st-century business model for rural clinics and hospitals, and prioritizing innovative care solutions by giving them a place in our state’s budget.

In March 2024, Gov. Sanders signed the “Executive Order to Support Moms, Protect Babies, and Improve Maternal Health.” That kicked off a series of meetings that were held all over the state with subject matter experts, cabinet-level participants, and health practitioners — all geared toward finding ways to improve maternal health in Arkansas. The outcome of those meetings were published in a report of policy recommendations, found here. 

Some of those recommendations can be implemented through state agencies, but others require legislation. The “Healthy Moms, Healthy Babies Act” would do the following: 

• require Arkansas Medicaid to cover depression screening for pregnant women
• require Medicaid to cover prenatal, delivery and postpartum services
• implement presumptive eligibility for Medicaid for pregnant women in Arkansas, thus streamlining the enrollment process 
• require the Medicaid to cover self-measurement blood monitoring services,  remote ultrasound procedures, and home visitations by doulas and community health workers
• substantially increase reimbursement rates for deliveries
• require Arkansas Medicaid to stop “bundling” payments for pre- and post-natal care, reverting to a reimbursement model that will be more generous to care providers

These bills emerged from a place of bipartisan collaboration. Rep. Hudson explained.

“Rep. Pilkington and I were both at a Future Caucus conference last summer… and moderated a discussion among legislators, physicians, and other medical professionals discussing breakthroughs in remote access technology for pregnant women,” she said. “We both had an ‘aha’ moment when the discussion turned to some of the barriers to deploying these services to pregnant women, and we realized we had a need to bring these tools back home. Rep. Pilkington and I had pre-filed a handful of freestanding bills addressing these services, many of which ultimately were included in the Healthy Moms, Healthy Babies legislation.”

Though “Healthy Moms, Healthy Babies” will save lives, it’s worth noting that the policy is not perfect. It has two significant weaknesses. First, the bills incorporate language that reduces the statute of limitations for lawsuits brought on behalf of children who are injured during birth. That language has rightly drawn criticism.

And second, it fails to provide Medicaid coverage for 12 months after birth. For years, advocates for infant and maternal health in Arkansas have pushed for an expansion of postpartum Medicaid coverage for new moms who qualify. Today, Arkansas drops new mothers off of postpartum Medicaid coverage after just 60 days. This long-desired policy improvement was not included in the omnibus package.

Hudson spoke to that very issue, saying, “The proverbial elephant in the room is that the bill does not authorize 12 months of postpartum Medicaid coverage. As of today, we are the only state in the entire country that has not adopted this coverage — and as I mentioned before, we are also one of the worst states in the country to be pregnant. The governor’s bill does provide for presumptive prenatal coverage, but there’s still work to do to bring postpartum coverage to women who need it.”

At issue is the wisdom of requiring vulnerable women who’ve just given birth to navigate a complicated health care and administrative system. When coverage changes or lapses during this time period, women are sometimes forced to change doctors or cease seeking care altogether.

Hudson continued, “I’ve had four kids so I’m acutely aware of how hard those first few weeks and months after birth can be — we shouldn’t create another barrier to health care by requiring these new moms to try to navigate a complex and often frustrating Medicaid system when they are at their most vulnerable right after giving birth. No insurance means mom and baby aren’t going to their postpartum OB/GYN and pediatric appointments, which we know are critically important.”

One more step

Despite those flaws, the “Healthy Moms, Healthy Babies Act” represents significant progress toward addressing Arkansas’s infant and maternal health crises. Keeping with that same theme, in recent weeks Hudson filed HB1333, a bill to require insurance companies in Arkansas to cover lactation consultants. So far, the bill enjoys significant support, and a bipartisan coalition of women legislators have signed onto the bill as co-sponsors.

Hudson explained, “The Affordable Care Act requires that insurers cover breastfeeding support, counseling, and equipment, but not all insurance companies have interpreted that to include lactation consultants. Breastfeeding doesn’t come naturally to many new moms — including me! —and being able to access help may ensure moms are able to breastfeed their newborns longer — or at all.”

HB1333 is a good bill, and we celebrate the bipartisan interest in ensuring more babies and their mothers receive the well-documented health benefits of breastfeeding.

This is what progress in Arkansas looks like — imperfect, one policy step at a time, and one life outcome at a time. The 95th General Assembly has been a watershed moment for Arkansas moms and babies, and at Appleseed we’re here for it.

Bobby Howard is the executive director for Arkansas Appleseed Legal Justice Center, a nonprofit organization. Appleseed advocates for improved access to health care, pragmatic reforms to election systems and policies to spur economic opportunity in rural Arkansas. You can find out more at www.ARAppleseed.org.