Arkansas Health Secretary Renee Mallory (center) explains part of the maternal health improvement plan that Gov. Sarah Huckabee Sanders (second from left) authorized in an executive order on Wednesday, March 6, 2024. (Screenshot courtesy of Facebook livestream)
This story originally appeared on Arkansas Advocate.
Arkansas will direct $17 million in federal grant funds to improving maternal health care outcomes, the state Department of Human Services announced Monday in a news release.
The Transforming Maternal Health (TMaH) Model comes from the federal Centers for Medicare and Medicaid Services (CMS) and provides funding and technical assistance to state Medicaid agencies with the goal of improving maternal health outcomes. The newest model, which launched Jan. 1, will focus specifically on aiding people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), both of which are administered by DHS.
As of Dec. 1, nearly half of the 863,117 Arkansans on Medicaid were children (414,678), according to DHS data. About half of Arkansas births are covered by Medicaid, which serves pregnant Arkansans with incomes of up to 209% of the federal poverty level, but this coverage expires two months after birth.
DHS applied for the TMaH grant in September after a strategic committee, which included DHS Secretary Kristi Putnam, issued a range of recommendations to improve Arkansas’ maternal health landscape. Gov. Sarah Huckabee Sanders convened the committee via executive order in March 2024.
Sanders expressed appreciation for the grant in Monday’s news release, saying it “will facilitate much of the rest of our work to increase the maternal care workforce, invest in technology and research to help new moms, and connect expecting moms with health care providers in all corners of the state.”
The 10-year TMaH program has a three-year pre-implementation phase and a seven-year implementation phase. Arkansas is among 14 states, plus the District of Columbia, that will participate in the program for the next decade, according to CMS.
Committee outlines recommendations, actions taken to improve maternal health in Arkansas
The grant has “three main pillars,” according to DHS:
Access to care, infrastructure, and workforce capacityQuality improvement and safetyWhole-person care delivery
One of the “specific investments planned in Arkansas” with TMaH funds is improving technology that will help collect and share maternal health data, according to the news release.
The strategic committee’s recommendations include several related to “technological deficiencies and needs, including data collection, data reporting, and software.” Two recommendations are the creation of online dashboards, one to track “key maternal health indicator criteria” and one to measure Medicaid eligibility determination and application processing for pregnant Arkansans.
Another goal of the TMaH program is to increase access to telehealth care, doulas and community health workers, which also aligns with the strategic committee’s recommendations. The committee suggested developing a Medicaid reimbursement system for doulas and community health workers, as well as considering higher reimbursements for existing care providers.
The TMaH funds will help DHS revamp its Medicaid reimbursement rates and payment structures, “including a focus on incentive payments to providers whose patients have healthier outcomes,” the news release states.
DHS will also use the grant to connect medical professionals with nonprofits or faith-based organizations that serve low-income pregnant and postpartum Arkansans.
The TMaH program involves implementing “patient safety bundles,” or maternal health care plans and best practices for providers to use in case of emergency. In 2022, Arkansas became the 48th state to join the Alliance for Innovation on Maternal Health (AIM), which creates these bundles.
The existing maternal Medicaid landscape
DHS’ application included letters of support from several entities, including all six of Arkansas’ members of Congress, ADH, the Arkansas Hospital Association, the University of Arkansas for Medical Sciences (UAMS), Community Health Centers of Arkansas, the Arkansas Minority Health Commission, Cherokee Nation Health Services, Tyson Foods and Walmart, among others.
Arkansas Advocates for Children and Families also supported the state’s application for the grant and was “very excited to hear” that the state received funding to address barriers to maternal health care, Executive Director Keesa Smith-Brantley said in a statement.
“As we continue to grapple with having the [nation’s] highest maternal mortality rate, the third highest infant mortality rate and with nearly half of Arkansas counties being classified as maternal health deserts, this grant is a critical step to strengthening the maternal health infrastructure and improving outcomes for our mothers and our babies,” Smith-Brantley said.
Only 34 hospitals in 23 of Arkansas’ 75 counties have labor and delivery units, and five maternity wards have closed since the onset of the COVID-19 pandemic in 2020.
For months, Arkansas has been the only state that has taken no action to adopt the federal option of extending postpartum Medicaid coverage from 60 days to 12 months after birth, according to KFF. Sanders and Putnam have said this expansion would be “redundant” and “duplicative,” since the state has other insurance coverage options for postpartum low-income Arkansans The strategic committee did not recommend this policy.
Arkansas DHS officials say they want to find insurance for low-income, Medicaid-ineligible new moms
A 2023 bill in the state Legislature would have created 12-month postpartum Medicaid coverage but did not advance due to cost concerns. Similar bills have been introduced for the legislative session that starts Jan. 13.
Sanders’ proposed fiscal year 2026 state budget proposes $13 million for Medicaid to support the maternal health committee’s recommendations.
In October, Putnam and state Medicaid Director Janet Mann, both of whom were on the committee, told lawmakers that almost 40% of postpartum Arkansans who qualified for Medicaid between July 1 and Sept. 30 were ineligible for Medicaid by 60 days after giving birth. As required by a 2024 law, DHS officials will report to lawmakers again this month about their efforts to enroll Medicaid-eligible postpartum Arkansans into another category before the 60-day deadline.
Mann will be in charge of managing the TMaH grant, according to the news release, and DHS will coordinate the efforts with ADH and UAMS.
“Over the last year, we have directed significant resources to addressing gaps in care for pregnant women, new mothers, and babies, and we remain committed to finding solutions that will improve and save lives,” Mann said in the release. “This grant is an important next step, and I know that this project will be a key driver in helping Arkansas become a leader in maternal health.”
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