Six weeks after an emergency cesarean section, with her newborn twins still in neonatal intensive care, Maya Gobara went to a pharmacy in West Little Rock, Arkansas, to fill a prescription.
“The pharmacy told me I didn’t have insurance,” Gobara said.
Arkansas is the only state that has not taken the step to expand what’s called postpartum Medicaid coverage, an option for states paid for almost entirely by the federal government that ensures poor women have uninterrupted health insurance for a year after they give birth. Forty-six states now have the provision, encouraged by the Biden administraion, and Idaho, Iowa, and Wisconsin either have plans in place to enact legislation or have bills pending in their legislatures.
Nationally, 41% of births were covered by Medicaid in 2021. Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days after delivery. But maternal health advocates say Arkansas often begins the process of moving women out of the program after six weeks, or 42 days.
Gobara said she thinks that’s what happened to her: She was transferred to another health plan with a different slate of doctors, and she didn’t receive notice of the change.
"A ton of bricks"
Gobara, who is 38 and a freelance copywriter, said the health plan switch happened to her just as a cascade of previous health problems — an autoimmune disorder, postpartum depression, and rheumatoid arthritis — flared up.
“Everything that I had before hit me like a ton of bricks at once after I had the boys,” she said.
Maternal health advocates say many lower-income women in Arkansas have fallen into that familiar health care gap.
Arkansas has one of the highest rates of maternal mortality in the nation, a grim tally of women who die from any cause related to pregnancy or childbirth, including weeks after delivery. In Arkansas, 20% to 29% of women are uninsured at some point over the period before they conceive to after they give birth.
In March, Arkansas Gov. Sarah Huckabee Sanders, a Republican, signed an executive order creating a committee of experts charged with improving the state’s dismal maternal health outcomes and better educating women about their health insurance options.
At a press conference announcing the initiative, Gov. Huckabee Sanders said, “This specific group that we’re establishing through the executive order, they’re going to look at every option on the table.”
When asked by reporters at the press conference about whether she would support expanding postpartum Medicaid to 12 months of coverage as other states have done, the answer was a firm “no.”
“I don’t believe creating a duplicative program just for the sake of creating a program is actually going to fix the issue,” she said. “We already have so many women who aren’t taking advantage of the coverage that exists. Creating more coverage doesn’t get more women to the doctor.”
Huckabee Sanders, 42, is the youngest governor currently serving, and she is the parent of three school-age children.
Paperwork hurdles
In Arkansas, postpartum women can apply for other insurance coverage six weeks after delivery, but they must send in a paper application, said Zenobia Harris, executive director of the Arkansas Birthing Project, a mentor program that works with pregnant and postpartum women.
“Women get told things like their paperwork got misplaced or lost or they have to resubmit paperwork. They get put on hold when they make phone calls in trying to connect with people,” Harris said. “So, some people, they quit trying.”
Lower-income women, like Maya Gobara, are shifted into ARHOME, a state program touted by Huckabee Sanders, that uses Medicaid funding to buy private health insurance.
The shift to new health coverage happened to Gobara while her twins, Amir and Bryson, were on breathing tubes and needed multiple brain surgeries and she required urgent gallbladder surgery.
“I was supposed to have my gallbladder taken out in one week, but with this new plan I needed a referral for that surgery, but I no longer could see my primary care doctor because she wasn’t under that plan that they put me under,” she said.
Seized with gallbladder pain, Gobara spent days sorting out what had happened to her postpartum Medicaid coverage.
“It felt like the system was set up so I would give up,” Gobara said. “And, honestly, if it was not for my mother sitting next to me and helping me go through step by step by step, I probably would have given up.”
Advocates weigh in
New mothers shouldn’t be shuttled from plan to plan or uninsured when they are dealing with their own health and their newborns, said Camille Richoux, health policy director for Arkansas Advocates for Children & Families, a nonprofit advocacy and policy group. Richoux is part of the governor’s maternal health initiative, a committee tasked with developing recommendations to improve maternal health and increase access to maternal health services.
Richoux said the switch to a new health plan can disrupt the continuity of care when health care is vital. “Especially when so many pregnancy-related deaths occur after that 60-days-postpartum coverage,” she said.
The committees tasked with making recommendations to Huckabee Sanders have been meeting this summer and recently prepared draft recommendations.
But missing from the list is an expansion of postpartum Medicaid coverage, despite widespread agreement by health organizations and the state’s Maternal Mortality Review Committee that doing so would reduce pregnancy-related deaths.
One of the tasks of the maternal health initiative is “making sure Medicaid does a better job of educating women postpartum on their health insurance options that already exist today, to ensure they get enrolled and have the coverage they need,” said Alexa Henning, communications director for Huckabee Sanders in an emailed statement last month.
“The data indicates that most women have continuous coverage, they just need to access it,” Henning said. “But if we identify gaps, the governor is open to all options to help moms and babies.”
The final recommendations are expected to be released this month.
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