Arkansas Senate committee rejects 12-month postpartum Medicaid coverage

Above: Elizabeth Pitman (left), director of the Division of Medical Services for Arkansas Medicaid, and State Medicaid Director Janet Mann (second from left) speak against House Bill 1004, co-sponsored by Sen. Breanne Davis (right), R-Russellville, before the Senate Public Health, Welfare and Labor Committee on Wednesday, April 9, 2025. (Tess Vrbin/Arkansas Advocate)

Human Services Department opposed the bill; Arkansas remains only state without some version of this coverage option

By Tess Vrbin, Arkansas Advocate

An Arkansas Senate committee voted down a bill that would have extended Medicaid coverage for women to 12 months after giving birth if they do not already qualify for the state’s Medicaid expansion program.

House Bill 1004 passed the House April 1 with a bipartisan 71 votes but failed in the Senate Public Health, Welfare and Labor Committee on a split voice vote Wednesday. More than half of births in Arkansas are covered by Medicaid, the federal-state health insurance system for low-income Americans.

Arkansas’ Medicaid expansion program covers people up to 138% of the federal poverty level, but since Jan. 1, 2023, Medicaid covers pregnant Arkansans with incomes of up to 214% of the federal poverty level, or about $45,200 for a family of 2 or $68,700 for a family of four. This coverage expires two months after birth, leaving many postpartum Arkansans to “fall through the cracks,” said Sen. Breanne Davis, a Russellville Republican and HB 1004’s Senate sponsor.

Davis mentioned that Arkansas has one of the nation’s highest maternal mortality rates and the third highest infant mortality rate. Maternal mortality is measured by the rate at which women die during childbirth or within a year of giving birth.

“We have got to address this holistically, and I think there’s been a lot of really good work done, but it has not included this group of women,” who do not qualify for Medicaid expansion, Davis said.

Extending postpartum Medicaid coverage has the support of legislative Democrats, and House Minority Leader Andrew Collins of Little Rock sponsored House Bill 1008, which is similar to HB 1004 but has not been heard in committee.

Without the policy outlined in the bills, Arkansas remains 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.

Davis told the Public Health committee that the bill was “narrowly tailored” and would not create any “duplicative” services.

Gov. Sarah Huckabee Sanders and Human Services Secretary Kristi Putnam said repeatedly last year that 12-month postpartum Medicaid would be “redundant” and “duplicative,” since the state has other insurance coverage options for postpartum low-income Arkansans. A maternal health task force convened by Sanders did not include the 12-month policy in its September 2024 list of recommendations to improve the state’s maternal health care landscape.

State Medicaid officials Janet Mann and Elizabeth Pitman expressed DHS’ opposition to HB 1004 Wednesday. Mann mentioned that DHS estimated it would cost more than $11.2 million to add 10 months of coverage to existing programs.

DHS’ assessment of the bill’s overall fiscal impact states that the federal government would cover more than $8.8 million of the cost, leaving the state to cover less than $2.4 million. Davis told the committee that Children’s Health Insurance Program (CHIP) funds would support the proposed coverage extension.

From July 1 to Dec. 31, 2024, roughly 60% of postpartum Arkansans remained Medicaid-eligible after the 60-day limit, according to two quarterly reports that a 2024 law requires DHS to submit to the Legislature. Putnam and Mann presented the first report in October, and the Advocate received the second report from DHS in February via a public records request.

Of the 1,787 women who did not qualify for Medicaid past 60 days postpartum between Oct. 1 and Dec. 31, 42% of them had income above 138% of the federal poverty level, and 38% were not U.S. citizens, according to DHS’ second quarterly report.

By July 1, Arkansas’ Medicaid program will include presumptive Medicaid eligibility for pregnant Arkansans, reimbursements for doulas and community health workers and pregnancy-related Medicaid coverage for specific treatments, Mann said Wednesday.

In February, Sanders signed the Healthy Moms, Healthy Babies Act to put these policies into effect. The legislation had bipartisan sponsorship, including from Davis and HB 1004’s House sponsor, Knoxville Republican Rep. Aaron Pilkington.

Public testimony
The five Arkansans who spoke in favor of HB 1004 were all Black women; Arkansas’ Black maternal mortality rate more than doubled from 1999 to 2019, according to a 2023 study published in the Journal of the American Medical Association.

Extending postpartum Medicaid coverage is essential for “helping families heal and remain together,” said Stephanie Garner, CEO of the Arkansas River Valley Area Council, a Russellville-based assistance organization for low-income families.

“Substance use disorders and mental health conditions don’t resolve in two months,” Garner said. “When coverage ends, I’ve seen women relapse, return to unsafe environments or even lose custody of their children, not because they didn’t want to get better, but because they lost access to care that was helping them recover.”

Danielle Wright, a single mother from Jackson County, said she lost Medicaid coverage after having her third child via an emergency Caesarean section that led her to seek mental health care.

“At one point [I was] even finding myself crying in a DHS office because I was having to prove a difficult moment that I was not ready to experience and relive in that moment,” said Wright, who also supported HB 1004 before the House Public Health committee in March.

Maternal mental health “cannot be separated” from maternal health as a whole, and untreated mental health issues during pregnancy can lead to poor birth outcomes and increased maternal mortality, therapist and social worker Mackenzi Foreman said.

Foreman and Arkansas Birthing Project executive director Zenobia Harris both said they have worked with women who unexpectedly lost their Medicaid coverage while they were pregnant.

Registered nurse and Arkansas Birthing Project Executive Director Zenobia Harris (left) expresses support for House Bill 1004, co-sponsored by Sen. Breanne Davis (right), R-Russellville, before the Senate Public Health, Welfare and Labor Committee on Wednesday, April 9, 2025. (Tess Vrbin/Arkansas Advocate)

Latoya Morgan said she supported HB 1004 on behalf of her friend, Helena Stanton, who died after the complicated premature birth of her third child.

“Shortly after giving birth, Helena began experiencing severe difficulties with her mobility, struggling to move her limbs and ultimately [to] breathe,” Morgan said. “She didn’t have access to a doctor until it became an emergency because she didn’t have access to Medicaid.”

After the committee voted down the bill, Morgan expressed frustration with the outcome in an interview, saying DHS officials and the majority of the committee lacked empathy for low-income pregnant Arkansans.

“[Lawmakers] claim to be Christians and believers of Christ, but you’re unwilling to take care of all of the people, the sick, the women that create life… because of what, funding?” Morgan said. “Because it’s not your sister, because it’s not your wife, because it’s not your daughter?”

A 2023 bill similar to HB 1004 never received a committee hearing, and Pilkington was the House sponsor of both bills. He said Wednesday that he was disappointed HB 1004 did not advance.

“I promised that I wouldn’t leave these women behind, and I did all I could,” he said. “The fact that I had to fight back against so many lies was the most disheartening part about this whole process. One day we’ll get these women covered, and I’m sure people will ask what took so long.”

The Arkansas Advocate is a nonprofit, nonpartisan news organization dedicated to tough, fair daily reporting and investigative journalism that holds public officials accountable and focuses on the relationship between the lives of Arkansans and public policy.