Every three months, Arkansas publishes a report tracking what happens to women after pregnancy Medicaid ends. Every three months, we hope to see any signs that the state’s transition numbers are improving. Instead, each report tells the same story: things are getting worse.
The most recent report shows that 45% of new moms lost Medicaid coverage after 60 days postpartum. Only 145 of the 2,173 women who lost Medicaid had another source of insurance by the end of the postpartum period. That means roughly 94% of these women losing Medicaid were not transitioning to another insurance option. If other options were available and accessible, we would expect to see women transitioning into other forms of insurance. They aren’t. More than 2,000 new moms became uninsured just a few weeks after giving birth.
Digging more into the report, other points stood out to me. Nearly 1 in 5 moms were dropping off of coverage due to income limits. As a little background, pregnancy Medicaid covers women at slightly higher incomes than non-pregnancy Medicaid coverage. Many new mothers earn a little too much income for traditional Medicaid but not enough to afford private insurance. These moms are left uninsured during the first year after childbirth.
Postpartum health care doesn’t end at the 6-week postpartum visit. The first year of health is a vulnerable time when women are recovering physically and mentally, all while caring for a newborn. Health issues like gestational diabetes, postpartum depression, and pregnancy-associated hypertension don’t disappear after discharging from labor and delivery. Moms need ongoing support, chronic disease management, doula and lactation support, and mental health services. Recent call data from the UAMS postpartum call center showed that 1 in 5 moms called had urgent maternal health warning signs that required medical attention and nearly 1 in 10 screened positive for postpartum depression.
Where are these women supposed to go? What are they supposed to do?
Complications on the Horizon
As I write this, I’m also thinking about shifts coming to Medicaid. Beginning in 2027, adults enrolled in ARHOME will also have to navigate new work reporting requirements. While pregnant women and parents with children in the home under age 14 are exempted, some women in difficult circumstances who transition into ARHOME after those 60 days may soon face additional paperwork and eligibility requirements. Consider a woman recovering from a stillbirth, pregnancy loss, or the death of an infant. It’s not hard to imagine in a state with the third highest infant mortality rate in the country. Without a postpartum extension, she could find herself navigating a Medicaid transition and, depending on her circumstances, required to comply with work reporting requirements or seek an exemption during one of the most difficult periods of her life. Extending postpartum Medicaid would eliminate that transition entirely during the first year after pregnancy. That seems like a no-brainer to me.
We Can’t Afford to Keep Waiting
I understand there have been differing opinions from Arkansas leaders on the need for a postpartum Medicaid extension over the past few years. But we now have a year’s worth of data from these quarterly postpartum transition reports and other new sources of information like the postpartum call center and focus groups. The takeaway is clear and irrefutable: we need a postpartum Medicaid extension. Forty-nine other states have done it — red states, blue states, purple states. States with Medicaid expansion and states without Medicaid expansion.
It’s heartening that we’ve made some incredible strides over the past few years to invest in addressing maternal and infant health. Maternal health is a complex public health problem that no one policy can solve. That’s why we need every tool at our disposal. It is worth noting that the Arkansas Department of Human Services could pursue extending Pregnancy Medicaid administratively, without relying on action from the legislature. We simply can’t afford to keep stalling — every quarter we wait puts more women at risk. Pregnant women and moms in Arkansas are counting on us to implement a 12-month Pregnancy Medicaid extension.