Healthy Moms, Healthy Babies: Young Legislators Lead Maternal Health Breakthrough in Arkansas

By Elizabeth Rosen

In the summer of 2024 at a quiet coffee shop in West Little Rock, Arkansas state Reps. Aaron Pilkington, R-Knoxville, and Ashley Hudson, D-Little Rock, sat down for what would become a transformative bipartisan exchange. Both lawmakers—co-chairs of the Arkansas Future Caucus—had spent months grappling with how to improve maternal and infant health outcomes in their state. But their sense of urgency gained new momentum after the 2024 Future Summit, where they co-moderated a panel on technological breakthroughs in maternal care with industry experts and women’s health practitioners, including Jennifer Law, maternal health venture leader at Philips, and Dr. Nadav Schwartz, professor of obstetrics and gynecology at the University of Pennsylvania.

By the end of the conversation, Hudson and Pilkington were eager to learn more about the tools and services they believed could help eliminate longstanding barriers to care in Arkansas—and they returned home ready to act.

That experience catalyzed a wave of legislative activity. As Future Caucus Prenatal-to-Three Innovation Fellows, both Pilkington and Hudson began pre-filing a series of freestanding bills based on national best practices and input from on-the-ground practitioners. Many of those proposals were eventually consolidated into a single, sweeping piece of legislation: H.B. 1427, the Healthy Moms, Healthy Babies Act.

Signed into law by Governor Sarah Huckabee Sanders on February 6, 2025, the Act directs $45.3 million toward maternal and infant health initiatives across the state. Its provisions include presumptive Medicaid eligibility for pregnant women, expanded telehealth for prenatal care, separate Medicaid reimbursements for up to 14 prenatal and postnatal visits, and funding for doulas and community health workers. It also requires public schools to provide breastfeeding accommodations and share information about local childcare services for student parents.

Arkansas consistently ranks among the worst states in the country for maternal and infant mortality. According to the Arkansas Department of Health, the state’s maternal mortality rate is nearly double the national average, and access to maternal care is especially limited in rural areas. Pilkington says that in an ideal world, pregnant women would all be able to visit their doctors in person for prenatal care like ultrasounds, non-stress tests, and blood-sugar monitoring to manage the risk of gestational diabetes, but that’s not practical in a largely rural state where 38 out of 75 counties have no obstetric provider, hospital, or birthing center.

“I don’t know exactly how many people will benefit from this yet,” said Pilkington of the bill’s telehealth provisions, “but I think about the pregnant mother of two who will no longer have to choose between dragging her kids three towns over for an appointment with her OB, or having no prenatal care at all, and I know this is going to make a difference for a lot of folks.”

Though Hudson and Pilkington approached the crisis from different political frameworks, they found common ground in the belief that the state must do more to support expecting and new mothers. “We [Republicans] claim to be pro-life, so why wouldn’t we help these young women be able to go to doctors appointments, court appointments, or wherever they need to go—we should help them do that,” asserts Pilkington, a father of three.

Hudson also brought a personal perspective to the process. Having grown up in a small town in Illinois with high rates of teen pregnancy, she saw firsthand the challenges faced by young parents and sees the relatively young Arkansas state legislature—which now includes two Gen Zers, Rep. Alyssa Brown, R-Heber Springs, and Rep. Nick Burkes, R-Bentonville, both of whom voted for H.B. 1427—as well positioned to address these issues.

“A lot of the older members are so far removed from that part of life, either by time or geography, that they don’t have a good perspective,” she said. “Because we are state legislators, we are closer to our constituents than any of the federal officials, and so that allows us to be really responsive on the ground.”

“Older lawmakers would see these provisions for new technology and tell us, ‘when I had kids 30 years ago, we didn’t have any of this,’” added Pilkington. “Times have changed, even since I had my first kid. It’s okay to refer to your own experience when making policy, but you also have to see and understand the constant, rapid changes in the market. It cost about $5000 to have each of my children!”

Pilkington, who holds a master’s in healthcare administration from the University of Arkansas for Medical Sciences, served as the bill’s lead sponsor, with Hudson as its sole Democratic cosponsor. They were joined by key allies, including fellow co-chair Sen. Breanne Davis, R-Russellville, Sen. Missy Irvin, R-Mountain View, and Rep. Denise Garner, D-Fayetteville,.

Davis, who in 2018 became the first member of the Arkansas General Assembly to give birth while in office, played a critical role, leveraging her leadership position as Senate Majority Whip, her strong relationship with Governor Sanders, and her conservative bona fides to attract co-sponsors and get the bill over the finish line.

Still, the path to passage was anything but smooth, as the authors consulted with doctors, doulas, Medicaid administrators, social workers, and colleagues to revise the bill repeatedly. Some provisions from their original bills had to be dropped or moved into separate legislative vehicles. Others were reworded to align with federal Medicaid rules or to address fiscal concerns raised by legislative leadership and budget officials.

One of the most politically sensitive elements involved expanding Medicaid services. Some early language proved too ambitious to gain majority support, and the sponsors had to narrow or restructure several sections. And while adopting the federal option to extend postpartum Medicaid coverage from 60 days to 12 months after birth didn’t make it into H.B. 1427, Pilkington and Davis have continued to pursue the expansion through separate legislation.

“We had to be realistic about what we could get through in one session,” Hudson said. “But that didn’t mean compromising the core intent. We stayed focused on what would have the greatest and most immediate impact.”

Hudson, a healthcare and employment attorney and mother of four, pushed for provisions that extended beyond medical care to address the broader ecosystem of support that young families need—school accommodations, transportation, mental health services, and breastfeeding access—not all of which made it into the final text of the bill. Some of those priorities, however, advanced through separate legislative vehicles, including H.B. 1333, which Hudson led as the House sponsor and which was signed into law during the same session. The bill requires Medicaid and private health plans to cover lactation consultants—an essential but often inaccessible service for new mothers—and reflects the same holistic approach to maternal health that shaped the Healthy Moms, Healthy Babies Act. In the Senate, the bill was championed by Sen. Jamie Scott, D-North Little Rock, a co-chair of the Arkansas Future Caucus.

Pilkington cited the 2022 Dobbs v. Jackson Women’s Health Organization decision, which triggered Arkansas’s near-total abortion ban, as a major motivator. “The decision changed the conversation into making sure that these women are not falling through the cracks and that they won’t get left behind,” he said. “Women who may have wanted to terminate before are not going to be able to, so we have to make sure that there is a safety net provided by the state that takes care of them. That, to me, is part of the social contract.”

The Healthy Moms, Healthy Babies Act is now seen as a landmark policy win in Arkansas. But for its architects, its value lies also in the legislative process that brought it to life. A bipartisan coalition of young lawmakers didn’t just pass a bill—they demonstrated the viability of a model for cross-partisan lawmaking rooted in pragmatism, empathy, and shared responsibility.

“We are approaching it from different sides, but we are both getting to the same point,” Pilkington said. “That, to me, is the ideal way to do bipartisan legislation. Neither of us were giving up on our principles to do this, but we both accomplished something that is good for our constituents. I know people on the right like that bill. I know people on the left like that bill. That’s kind of incredible.”

The bill will take effect on July 1, 2025.

Additional reporting by Juliet Zucker.