Presuming pregnant women are eligible for Medicaid and unbundling Medicaid payments to doctors have been key features of the Healthy Moms, Healthy Babies Act passed by lawmakers this year, Arkansas Department of Human Services Secretary-Designate Janet Mann said Wednesday (Aug. 6).
Mann made the comments as part of a panel discussion at the Arkansas Maternal Health Roundtable, which was hosted by the Arkansas Center for Women & Infants’ Health (ACWIH) and the Arkansas Hospital Association.
The event brought together more than 100 leaders from Arkansas’ delivering hospitals along with legislators, health officials and advocates.
Arkansas has the nation’s fourth highest maternal mortality rate in 2018-22 among the 39 states where data was available in 2018-22, according to KFF. The state’s rate was 38 deaths per 100,000 live births. The national average was 23.
The rate is defined as deaths while pregnant or within 42 days of a pregnancy’s end from any cause related to the pregnancy or its management.
The state had the third highest infant mortality rate in 2022 with 7.67 deaths per 1,000 live births, according to the Centers for Disease Control and Prevention. There were 272 infant deaths in Arkansas that year.
“Arkansas is at an inflection point in maternal health,” said Dr. Nirvana Manning, chair of Obstetrics and Gynecology at UAMS and director of ACWIH, said in a press release. “We are seeing an unprecedented level of coordination, from legislation at the Capitol to clinical care in each county, and this roundtable is our call to action. We’re thankful so many providers and leaders joined us to unify our efforts, share best practices and build a statewide system where every mother has the support and care she needs to thrive.”
Lawmakers passed the Healthy Moms, Healthy Babies Act earlier this year. Act 140 was sponsored by Sen. Missy Irvin, R-Mountain View, and Rep. Aaron Pilkington, R-Clarksville. Mann said the bill’s provisions went “live” July 1.
The presumptive eligibility part of the bill presumes that a pregnant woman will be eligible for Medicaid so that prenatal care can provided immediately rather than waiting for the application to be processed.
Another important piece was unbundling the Medicaid payments. Instead of paying doctors a lump sum at the end of the pregnancy, the program now reimburses them separately for prenatal, delivery, and postpartum services. Those include office visits, lab fees, testing, remote monitoring and other services.
Mann said the change is giving policymakers better data about when pregnant women are seeking care and how often. She said about 1,100 women a year weren’t going to the doctor at all until giving birth, and a large number didn’t seek care until the second trimester.
“Really, the thought process was, if we unbundle the payments where we get claim history data, we can see where the pregnant women are going to the doctor, how often they’re going to the doctor, what is the history with those doctor visits? Did they develop anything that made it a high-risk pregnancy, or was it a pretty steady and normal pregnancy?” she said.
Another change is that Arkansas has updated payment rates for the first time in close to 20 years. The law added $45 million in state and matching federal funds, the bulk of it for deliveries and office visits. Mann said 14 office visits is considered best practice pre- and post-partum. High-risk patients may need more.
She noted that Medicaid pays for roughly half the state’s births.
Mann said officials have received both positive and “constructive” feedback since the law took effect July 1. Coming next will be rules for lactation specialists, doulas and community health workers. The rules must be approved by the governor’s office and legislators. She said the goal is to have them ready by Oct. 1, but that date could be extended.
Also part of that discussion were other Arkansas initiatives to serve pregnant women. Arkansas was awarded a 10-year, $17 million Transforming Maternal Health Model federal grant that has the purpose of reducing disparities in access and treatment. Another Arkansas effort is the Life 360 model, which is an intensive home visiting program providing education and support for high-risk pregnant women.
Anna Strong, executive director, Arkansas Chapter of the American Academy of Pediatrics, praised the increasing collaboration among members of Arkansas’ maternal health community.
Dr. Pearl McElfish, associate provost, community health and research at the University of Arkansas for Medical Sciences, agreed.
“I do think Arkansas’ secret sauce is that we’re a state that operates like a small town, and so the ability to get things done collaboratively and quickly is wonderful,” she said.
Also discussed at the roundtable was Phillips Pregnancy+, an app that connects pregnant women to resources.
Anna Koelsch, director of Ingeborg Initiatives, said Pregnancy+ is the number one pregnancy app worldwide, with more than 80 million downloads and with users in more than 100 countries.
Ingeborg Initiatives, which was founded by Olivia Walton, has partnered with Phillips to create a free, Arkansas-centric premium version that will connect the state’s users to applications and content. Ingeborg invested in the application because there wasn’t a one-stop shop for pregnant women in Arkansas.
It can help users apply for Medicaid, enroll in the Supplemental Nutrition Assistance Program, or learn how to schedule an appointment with a local health unit. It provides information about topics ranging from doulas to how to use a car seat.
Other topics included bills passed in the legislative session, and the integration of doulas and midwives into clinical teams. Sen. John Boozman, R-Ark., spoke at the beginning of the session.