How many women have to die before the state extends pregnancy Medicaid coverage?

That was the question that came to mind after seeing statistics for the number of new mothers in Arkansas who lost their Medicaid coverage 60 days after giving birth. That information is updated quarterly from the state, and it seems to get worse every time.

Statistics are an effective but cold way to describe death. So as you read on, put some faces with the numbers – a postpartum depressed mother and the overdoses and suicides that sometimes go with that common condition, or a new mom who develops cardiovascular problems. And then imagine them, not only ailing but with no hope.

Arkansas is the only state in the country that doesn’t extend such coverage to postpartum moms. Women who meet certain criteria can get Medicaid during pregnancy and birth and for 60 days after. 

On day 61, however, women who earn too much or are otherwise ineligible under the more restrictive non-pregnancy Medicaid eligibility requirements need to have hooked up with some other kind of coverage, or face going without. 

A report out this week from Arkansas Advocates for Children and Families drills down on the state’s most recent report. Of the 2,173 Arkansas women who qualified for Medicaid to cover their pregnancies and births but did not qualify for regular Medicaid, only 145 had another insurance option lined up and waiting for them on day 61. The rest, 94% of these new moms, were left without health coverage.

“The need for postpartum health care does not end at the six-week postpartum visit,” said Camille Richoux, health policy director at Arkansas Advocates for Children and Families. “The first year of health is a vulnerable time when women are recovering physically and mentally, all while caring for a newborn.”

Arkansas already has one of the highest maternal mortality rates in the country with a rate of 38 out of every 100,000 dying from pregnancy related problems — health issues directly related to the pregnancy — and about 94 out of every 100,000 dying from pregnancy associated deaths, which include other factors relating to the pregnancy. The vast majority of these deaths are preventable, according to a fact sheet produced by the state. Lots of pregnancy-related illnesses and deaths happen within that first year postpartum, when this extended coverage would be of the most help.

The very real problem comes down to money. To get Medicaid for pregnancy and birth and a couple of months after, a woman can make as much as 214% of the federal poverty level. But after 60 days, to qualify for Medicaid, they can make no more than 138% of that poverty level. 

“They qualified for the one program, but they make too much for the other,” Richoux said. “And with the federal cutbacks in the marketplace insurance coverage, which turned a $400 a month plan into a $100 a month plan, many of those mothers can’t afford replacement insurance coverage.” It should be noted, Republicans allowed those premium subsidies to expire.

There are numerous healthcare services and programs within Medicaid and through the state that are beneficial to new moms, but as Richoux said, “You can’t access those if you lose coverage a few months after giving birth.”

The part that doesn’t click is the cost. Richoux said Arkansas’ share of the extended Medicaid coverage would be $2 million, which doesn’t seem like an overwhelming amount considering the state is sitting on a surplus in the hundreds of millions. And with that $2 million, the state could leverage something in the neighborhood of $8 million to $9 million in federal help, Richoux said.

“All of that we could be using to make mothers healthier,” she said. “They would be able to make routine follow-up visits to hospitals, which also need revenue. It would be good for everybody.”

Standing in the way has been Gov. Sarah Sanders, who has explained her recalcitrance to the idea by saying these women should be transitioning to other coverage. For the sake of argument, let’s assume that’s a not-bad idea. But it also flies in the face of the facts that show it’s not working. 

Even when the subject starts getting some traction in the Legislature, here comes Sanders to tamp it down, and it seems quite out of step for someone who holds press conferences and buys TV advertising touting her pro-mom-ness.

There is another option for extending Medicaid to these mothers, Richoux said, and it is for the Department of Human Services to ask the federal government directly for a waiver. 

“There was a bill – it didn’t pass, but in it, it laid out how the DHS could take care of this administratively,” Richoux said. “It would not require action by the Legislature. So we don’t need to wait until 2027 session; we could do this tomorrow.”

The thing is, she said, “It would require the governor’s blessing.”