(Getty Images)
The committee that Arkansas Gov. Sarah Huckabee Sanders created in March to develop a plan to improve the state’s maternal health infrastructure and outcomes issued its required progress report Thursday.
The report includes a range of recommendations to achieve the stated goal and a list of actions state agencies are already taking based on six months of committee work.
Recommendations include wider use of telehealth services and mobile health units, adding more obstetrics and gynecology residency positions at hospitals, and improving pregnant Arkansans’ access to transportation so they can get to and from doctors’ appointments.
Representatives of dozens of organizations worked with the committee to develop the recommendations and a “unified health roadmap,” according to a state Department of Human Services news release.
“We will act on these changes as quickly as possible because we know they have the potential to improve the health of countless women and babies, and to save lives,” DHS Secretary Kristi Putnam said in the news release.
Sanders in a statement thanked the committee for its work and said she looks forward to turning “these ideas into action.”
Many of the recommendations involve Medicaid, such as implementing presumptive eligibility for pregnant Arkansans, developing a Medicaid reimbursement system for doulas and community health workers, considering higher reimbursements for existing care providers, and building digital platforms to track women’s Medicaid eligibility and application processing, among other things.
“For far too long, Arkansas has languished at the bottom of every maternal health measure,” Arkansas Advocates for Children and Families Executive Director Keesa Smith-Brantley said in a statement. “The plan released today is a starting point for our state to begin to address the deficiencies in our women’s health care system. We are encouraged to see solutions, like the addition of maternal mobile units and expanded home visiting in historically underserved areas of our state.”
More than half of births in Arkansas are covered by Medicaid. A 2023 bill in the Arkansas Legislature would have required presumptive eligibility for pregnant Arkansans but did not advance due to cost concerns.
Arkansas Legislature saw wide range of maternal and reproductive health legislation in 2023
Presumptive eligibility assumes 60 days of Medicaid eligibility and shortens the process of applying for coverage. The Centers for Medicare and Medicaid Services (CMS) would have to approve a waiver for Arkansas to implement the policy.
Another proposed law would have extended postpartum Medicaid coverage from 60 days to 12 months after birth. Arkansas is the only state that has taken no action to adopt this federal option. 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.
AACF supports presumptive Medicaid eligibility for pregnant women and continues to advocate for the 12-month postpartum extension. Smith-Brantley noted that the governor’s committee did not recommend the policy “despite the suggestion from participating stakeholders in committee meetings.”
“It is critical we address the numerous barriers many women face, especially women in rural Arkansas,” she said. “The report notes the needed improvement in identifying and referring pregnant and postpartum women at risk of losing coverage, but it does not address how that will be done.”
Maternal-Health-Recommendations-Final-09.05.2024
Care shortages
Sanders’ executive order creating the committee authorized a pilot program in five rural counties — Phillips, Crittenden, Scott, Garland and Polk — to examine how to improve maternal health care in areas with high rates of pregnant Arkansans who do not visit a doctor at all before giving birth.
Four of the counties now have access to a home visiting program for pregnant women, created as a partnership between the Arkansas Department of Health and Arkansas Children’s Hospital, the report states. Scott County is the exception.
ADH has also partnered with the University of Arkansas for Medical Sciences “to ensure continuity of care for mobile services,” the report states.
UAMS announced in July its plans to provide contraceptives, prenatal health care and reproductive health education to women in 14 rural counties “in an effort to prevent unintended pregnancies and to improve access to women’s health care.” Mobile health units, or vehicles with the equipment to provide health care services, are UAMS’ means of delivering these tools to rural areas.
Arkansas maternal health care landscape needs more coordination and teamwork, physicians say
Only 35 hospitals in Arkansas have labor and delivery units, and four units have closed since the onset of the pandemic in 2020. Some Arkansas counties have no hospitals at all, according to the Arkansas Foundation for Medical Care.
UAMS hosted a panel in February at which medical professionals agreed the maternal health landscape in Arkansas needs improvement. Arkansas has one of the nation’s highest maternal mortality rates and the third highest infant mortality rate, according to the Arkansas Center for Health Improvement.
Arkansas received an overall ranking of 47 and ranked last in maternity care providers per 100,000 women ages 15 to 44 with a rate of 52.1, according to the 2024 State Scorecard on Women’s Health and Reproductive Care, published in July. The national average is 78.9 providers per 100,000 women.
More action items
The strategic committee has drafted a request for proposals for an advertising campaign to promote maternal and prenatal health care and reduce the state’s teenage pregnancy rate, according to the report.
Arkansas had almost double the national rate of teen pregnancy in 2022, and the vast majority of teen pregnancies were unplanned due to a lack of adequate sex education and access to reliable contraception, according to AACF.
Additionally, DHS “is reviewing all options for transportation that would allow mothers to bring their newborns/children with them when they attend postnatal and pediatric appointments,” the report states.
Rural and low-income mothers might not be able to access childcare or take time off work to go to their postpartum appointments, Dr. Nirvana Manning, chair of UAMS’ Department of Obstetrics and Gynecology, said last year.
Meanwhile, ADH will submit a Transforming Maternal Health (TMaH) grant application to CMS by Sept. 20, according to the report.
The TMaH model provides funding and technical assistance to state Medicaid agencies with the goal of improving maternal health outcomes, according to CMS. The 10-year program has a three-year pre-implementation phase and a seven-year implementation phase.
Smith-Brantley praised the state’s decision to apply for the grant, saying it “has the potential to help Arkansas develop a holistic approach to how women receive care.”
Many of the program’s goals align with the strategic committee’s recommendations, such as increasing access to telehealth care, doulas and community health workers.
The TMaH program also 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 first bundle has been the safe reduction in primary cesarean section, and work is underway to develop and implement a safety bundle to address congenital syphilis,” the committee’s report states.
Manning said Thursday afternoon that she was “extremely pleased” with the report.
“It addresses many areas of concern from loss of insurance coverage, to access, to education, to Medicaid reimbursement and many items in between,” she said. “It allows for more people working towards the same goal of improving maternal health care in our state. It’s going to have to be a collaborative process, and this document helps outline the short and long term goals.”
GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX