State House, Senate pass identical bills on Medicaid coverage of prenatal, postnatal care

The Arkansas House of Representatives and Arkansas Senate on Wednesday approved identical bills that would overhaul coverage by the state’s Medicaid program for pregnant and postpartum women with the aim of improving maternal health.

The House voted 86-6 to send House Bill 1427 by Rep. Aaron Pilkington, R-Knoxville, to the Senate for further action, with six members voting present.

The Senate voted 30-0 to send Senate Bill 213 by Sen. Missy Irvin, R-Mountain View, to the House for further action, with Sen. Jimmy Hickey, R-Texarkana, voting present and Sen. Bryan King, R-Green Forest, not voting.

Pilkington described HB1427 as a “targeted, conservative approach” to improving maternal health.

However, several House lawmakers spoke against the bill because of a section that would shorten the statute of limitations for when a physician can be held liable for injuries that occurred during childbirth.

Irvin meanwhile described SB213 as “healthy, targeted and smart.”

“The data has driven the reforms that are in this bill,” she said.

The measures would be known as the Healthy Moms, Healthy Babies Act, if they are enacted into law.

The identical bills are mostly aimed at the state’s Medicaid program, government-funded health coverage for low-income Arkansans that, according to the health policy research organization KFF, covers 41% of all births annually in the state.

The bills include several recommendations made by the Governor’s Strategic Committee on Maternal Health.

The measures would implement presumptive Medicaid eligibility determinations for pregnant women who are applying for the program to improve access to prenatal care and allow prenatal care to be delivered immediately while waiting for a full application to be processed. The program may designate one or more qualified entities to screen for eligibility and immediately enroll pregnant women into the program.

The bills would offer reimbursement pathways for doulas and community health workers and would establish pregnancy-related Medicaid coverage for remote ultrasounds, remote blood pressure monitoring and continuous glucose monitoring.

They also would unbundle Medicaid payments for pregnant care, which advocates for the bills say would make it easier for women to get coverage for up to 14 prenatal and postnatal visits.

The bills also would would shorten the statute of limitations for when a physician can be held liable for injuries that occurred during childbirth.

Instead of having until the child’s 11th birthday to file a malpractice lawsuit, parents would have to bring the suit before the child’s fifth birthday under the legislation.

Pilkington said that more would remain to be done to improve maternal health even if his bill became law, but that the bill reflected what he and his allies had been able to get consensus on.

“As I’ve told people, there’s no silver bullet to improving maternal health, but this is a host of silver bullets, a shotgun blast of silver to improve maternal health here in Arkansas,” he said.

Rep. David Ray, R-Maumelle, asked about documentation he expected to see filed concerning HB1427.

“Why would we not have a fiscal impact (statement) prepared?” Ray asked.

“I don’t have an answer to that question,” Pilkington answered. “I’m not the one who makes the rules.”

Rep. Lane Jean, R-Magnolia, said Arkansas lawmakers generally do not prepare fiscal impact statements for spending increases, and they have historically not been required to do so.

Ray said that, if the House Public Health, Welfare, and Labor Committee had requested one, he believes one would have to be provided.

King also spoke about SB213’s funding, expressing skepticism that the annual cost of the bill would remain static.

“What do you want to do, and how are you going to pay for this?” he asked Irvin. “Right now, revenues are going down.”

“I believe that the role of this government is to invest in the citizens of the state of Arkansas,” Irvin answered. “Arkansas is 50th in the country in maternal mortality and infant mortality. If you want to invest money somewhere else, that’s your prerogative.”

Mayberry and several other representatives expressed dismay over the section that shortens the statute of limitations regarding a physician’s liability for injuries incurred during birth.

“This is probably the hardest bill I’ve ever had to speak against,” Mayberry said.

The cut-off age of 5 years is also when many children are around teachers, therapists and others for the first time; those professionals may be the first to detect that something might be wrong with a child, according to Mayberry.

Rep. Jimmy Gazaway, R-Paragould, likewise said he believed the bill was great, except for the change to the statute of limitations. He described that piece as a “poison pill.”

“They have all of these wonderful things and they take that one thing and make you swallow it if you don’t vote for it,” Gazaway said.

He urged his colleagues to send the bill back to committee and remove the change to the limitations.

Rep. Mary Bentley, R-Perryville, cited the loss of maternity wards in parts of the state as one of the driving factors for the change. Liability insurance for medical professionals who deliver babies is “through the roof,” she said.

Pilkington said hospitals, such as one in Newport, have had to shut down their delivery units because the malpractice insurance was too expensive. The change in limitations is meant to “get them a little relief,” he said.

“We have to stop the bleeding. We have to stop seeing these labor delivery units shut down across the state,” Pilkington said.

Irvin likewise said lawmakers must take action to improve maternal health outcomes in the state.

According to the Centers for Disease Control and Prevention, Arkansas’ maternal mortality rate — 43.5 deaths per 100,00 births — was the highest in the nation in 2018-2021 among states for a rate that could be reliably calculated.

The state also has one of the highest infant mortality rates in the country, with 7.67 infant deaths per 1,000 births according to CDC data from 2022.

“We’ve got to do better,” Irvin said.

In announcing her maternal health plan on Thursday, Gov. Sarah Huckabee Sanders said Medicaid will increase reimbursements for traditional deliveries and C-sections by 70%.

Sanders described her plan as a $45.3 million annual investment with federal and state dollars in maternal health.

In the governor’s proposed general revenue budget for fiscal 2026, the governor said her proposed budget “includes $13 million for Medicaid to help fund our maternal health programs and an additional $100 million in set-aside funding for Medicaid sustainability.

“I know all of us want to find real solutions, not headline-grabbing programs that don’t actually solve the problem. This budget puts money behind that goal,” she said on Nov. 21 when she unveiled her proposed budget.

At that time, Sanders told state lawmakers “maternal health also has been one of our shared priorities,” and Arkansas lags the nation in maternal health statistics, and she convened the strategic committee on maternal health in early 2024 and her administration is implementing the proposals.

Information for this article was contributed by Neal Earley of the Arkansas Democrat-Gazette.