The legislative session officially came to a close on May 5, and Arkansas continued to turn a blind eye to the new moms who fall into a postpartum coverage gap. But why? That's the question I keep coming back to.
Why didn't Arkansas pass the postpartum Medicaid extension when there was clear bipartisan support?
When 40 percent of new mothers in Arkansas lose Medicaid coverage just 60 days after giving birth, why did our state decide they didn't need more help?
Why were we able to commit $45 million for maternal health initiatives while refusing to take the single most obvious next step?
According to the Arkansas Department of Human Services, 1,850 of the 4,779 women who gave birth in the last quarter lost their Medicaid coverage by the end of the 60-day postpartum period. These new mothers--all still healing and some navigating conditions like postpartum depression or perinatal cardiomyopathy--are cut off from care in one of the most dangerous states to give birth.
And what happens after they fall off coverage? The state doesn't know where they go. They aren't suddenly earning more money. The vast majority aren't making it to the private insurance marketplace because national data show that just under 4 percent of all adults successfully transition to the marketplace. In fact, national data also show that more than 95 percent of people who lose Medicaid don't immediately transfer to any other type of health-care coverage.
So why would we expect overwhelmed new mothers--and women recovering from miscarriages and traumatic stillbirths--to beat those odds?
When Arkansas House Bill 1004 failed in the Senate Public Health Committee--after passing the full House--women who had come to tell their stories left in tears and with their voices ignored. They came to share their stories of hemorrhages, infections, untreated depression, confusing letters about their coverage, terminated coverage, and nowhere to turn. One woman came to testify three times about losing coverage. She waited, patiently, nursing her infant, for hours waiting for the bill to be heard for days. She left in tears.
One woman held up a picture of her best friend who died 71 days after giving birth from a preventable health issue. She left hurt and angry--wondering what it will take for Arkansas to care about what happens to women after they give birth.
I grieve for these hardships, for the clinicians trying to care for patients whose insurance is ripped away mid-treatment, and for the advocates--inside and outside the Capitol--who have worked for years to fix this.
Most of all, I grieve for the mothers who lawmakers failed to protect.
Let's be clear: Women are losing coverage. Some tried to re-enroll. Some didn't realize their coverage had ended. Others were too overburdened or confused to navigate the red tape. This bill would've simplified the process for families--and for the agency itself. But the urgency was dismissed. The need was downplayed. The opportunity was lost.
Yes, Arkansas passed other important maternal health reforms this session that I am thrilled about. Lawmakers increased OB-GYN reimbursement rates. They approved Medicaid coverage for doulas and breastfeeding support services. They took steps to address leading causes of maternal death, including expanding remote blood-pressure monitoring for rural women. These are huge wins that advocates have worked for years to achieve, and we should celebrate those hard-fought victories.
But what good are these newly covered services to a new mom who has just lost her insurance?
What if you're a mom who, like one woman we heard from in our statewide maternal health focus groups, earns just $4 over the Medicaid income limit--but still can't afford private insurance? What if you're one of the 40 percent suddenly cut off from postpartum depression treatment?
Arkansas is the only state that has not opted to extend postpartum Medicaid coverage. Every other state has acted--red states, blue states, Medicaid expansion states, non-expansion states. In a country worried about falling birth rates and rising maternal deaths, policies that help women recover from childbirth and stay alive should be a no-brainer.
Arkansas stands alone. Not in excellence.
Why was it politically expedient to leave these women behind?
Instead of leading, we chose to end another legislative session without acting. In the meantime, new mothers will keep losing health care until we fix this.
I ask this question once more: What will it take for Arkansas to care about what happens to mothers after they give birth?
Camille Richoux, MPH, DrPH(c), is health policy director at Arkansas Advocates for Children and Families.