Sanders rejects 12-month Medicaid extension for moms, says Arkansas already has enough coverage

UPDATED: To include comments from DHS spokesman Gavin Lesnick.*

Gov. Sarah Sanders, mother of three, unabashedly rejected the idea of extending postpartum Medicaid coverage for women who recently gave birth. She said Arkansas already has the resources to care for new moms during the 12 months after birth, but “we just do a really terrible job” of transitioning people to other coverage after their 60 days of postpartum Medicaid runs out.

Arkansas is one of only four states that cuts off Medicaid to new mothers 60 days after they give birth; 46 states take advantage of federal funding to provide eligible new mothers health care coverage under Medicaid for a full year.

Sanders weighed in on the topic at a Wednesday roundtable on maternal health hosted by the University of Arkansas for Medical Sciences. U.S. Sen. John Boozman and U.S. Rep. French Hill were also present. The trio of Republicans shared a stage with a handful of medical professionals for a two-hour discussion.

During the talk, Dr. Nirvana Manning, an OB-GYN and leading advocate for improving medical care for new mothers and babies in the state, pointed out how difficult the health care world can be to navigate, especially in a compressed time period.

The year after giving birth is statistically dicey for new moms; one in three pregnancy-related deaths happen between one week and one year after childbirth.

“Navigating this postpartum period on top of having a newborn child they’re taking care of … when she’s falling apart, everything kind of falls apart,” Manning said.

Manning’s expertise wasn’t enough to sway the governor; Sanders maintained her opposition to extending coverage for a year even after Manning weighed in.

Instead of extending Medicaid for new moms, Sanders said increasing collaboration between the state and medical professionals would “move the ball significantly.”

That’s bad news for Arkansas women who meet the higher income eligibility requirement for Medicaid during pregnancy but don’t meet the lower income level to qualify for Medicaid generally. Pregnant women in Arkansas can get Medicaid coverage if their income is up to 214% of the federal poverty line. The income requirement drops to 138% of the federal poverty line at 60 days postpartum.

The Center for Disease Control and Prevention ranks Arkansas as the state with the highest rate of maternal deaths in the country, with 43.5 deaths per 100,000 births. The national rate is 23.5.

A December 2023 report from the state’s Maternal Mortality Review Committee determined that of 100 pregnancy-related deaths in Arkansas between 2018 and 2020, 92% were potentially preventable.

Manning said about one-third of the maternal deaths in Arkansas occur after the 60-day period of Medicaid eligibility, when new moms’ health coverage runs out under the state’s existing program. Other medical professionals agreed. Dr. William Greenfield, also an OB-GYN, said about 31% of the deaths happen after that 60-day window.

“When we look at the symptoms that occur … if the patients don’t know what to look for, or if the providers don’t know what to look for, nor what the resources are, there’s not only a lost opportunity, there’s a real potential to do harm,” Greenfield said. 

Arkansas Democrat-Gazette reporter My Ly had a story late last night on Wednesday’s roundtable discussion. In it, she shared that Department of Human Services spokesperson Gavin Lesnick said new mothers who no longer qualify for Medicaid should get on their employer’s health insurance or buy their own insurance from the federal health insurance exchange, aka Obamacare.

He has not responded to a series of questions we sent as a follow-up to Ly’s article. 

*Lesnick said that while DHS is committed to solutions that help save lives, extending the Medicaid services would provide duplicative coverage.

“It would be fiscally irresponsible for us to add duplicative coverage instead of identifying all existing resources and connecting women to those,” Lesnick said. “Duplicative coverage would take away from our ability to improve existing services. If during this process we identify true gaps, we will look at all options to address those gaps and ensure women receive the coverage and care they need.”

He also noted DHS was “committed to improving education aiming at helping women find and maintain care.”

Lesnick also told Ly most maternal deaths happen before that 60-day Medicaid window sunsets.

[Lesnick] said 68% of maternal deaths occur within 40 days of birth, “so it is likely that extending postpartum coverage to 12 months would not be as impactful as focusing on prenatal and postpartum care.”

Lesnick estimated the state’s cost share to extend Medicaid for eligible new moms for a year would be $2.8 million, with the feds covering the lion’s share of $7.2 million.

Arkansas lawmakers had a chance to approve the Medicaid extension for new moms during the 2023 legislative session, but chose to spend money on tax cuts, school vouchers and prisons instead.

State Rep. Aaron Pilkington (R-Knoxville) sponsored the bill to extend Medicaid, but it fell by the wayside as legislators wrapped up the session. Pilkington did have success with a separate bill, now Act 562, that requires Medicaid coverage and reimbursement for depression screenings for pregnant people.