Gov. Sarah Huckabee Sanders signed an executive order Wednesday establishing a committee tasked with mitigating the state’s poor maternal health outcomes.

The committee will work with multiple nonprofits and health agencies across the state to educate new mothers on their coverage options and increase access to care, Sanders said during a news conference.

However, Sanders reiterated that she doesn’t support increasing access by extending the amount of time the state’s Medicaid program provides postpartum coverage to 12 months, as most other states have done.

“Of the 35,000 pregnancies in Arkansas each year, 10,000 women wait until

after their first trimester to even see a doctor,” Sanders said. “Eleven thousand never see a doctor until they are in labor. That’s an education problem, not a coverage problem.”

According to the executive order, the Strategic Committee for Maternal Health includes the secretaries of the departments of Health, Human Services and Education, the Health Department’s deputy director for public health programs, the state Medicaid director, the state surgeon general and the chair of the state Maternal Mortality Review Committee.

The committee will “engage legislators, advocacy organizations, health care providers, and other stakeholders in a Maternal Health Working Group … to provide input and support the development of a statewide Strategic Maternal Health Plan,” the order says.

The plan will include strategies to improve education regarding women’s and maternal health, especially prenatal and postpartum visits; improve maternal health before, during, and after pregnancy; increase access to maternal health services; and improve statewide coordination for maternal health data and reporting, according to the order.

After developing the plan, the order says, the committee and working group will provide recommendations to the governor on actions or legislation needed to “facilitate this Order’s directive.”

“Some have suggested that the solution to this problem is to create a redundant program by expanding Medicaid,” Sanders said.

“It would make for a good headline, but it doesn’t actually solve the issue. That’s because Arkansas already has resources for pregnant women for all nine months of pregnancy and beyond.”

Lawmakers, advocates and others crowded into the governor’s conference room to watch Sanders and other officials named to the maternal health committee deliver their remarks.

“The strategic committee has been asked to serve because we all have the ability to remove barriers and change policies that may be impeding access to care and coverage,” Department of Human Services Secretary Kristi Putnam said.

The next steps for the committee will be to “explore strategies to expand telehealth, home visiting, doulas & community health workers,” according to a handout from Sanders’ administration.

“I think we are the only state in the country with a governor who’s charging us to work together as a state, a whole state, to make sure we have healthier women who go on to be healthier moms with healthier babies,” Putnam said.

Putnam said nearly half of births in Arkansas are funded by the state’s Medicaid program, which provides coverage for the mother for 60 days after the birth — the minimum amount of time required by federal law.

After that coverage ends, mothers have additional coverage options, and the committee hopes to bring awareness to these without extending the duration of pregnancy Medicaid coverage, Putnam said.

“We do provide access to healthcare coverage beyond that 60-day postpartum period,” Putnam said. “What we don’t do, and what this executive order will help change, is ensure that women and their families are aware of their options before that 60-day period ends.”

Following the executive order, the committee will “take action immediately on a number of items to improve maternal health,” Putnam said.

This will include the creation of a pilot program involving five counties with low rates of prenatal care — Phillips, Crittenden, Scott, Garland and Polk — with the goal of increasing the number of pregnant women who receive care during the first trimester, Health Secretary Renee Mallory said.

The Health Department and surgeon general’s office will start holding community meetings in these counties in the coming weeks, Mallory said.

Gavin Lesnick, DHS spokesman, said in an email that state officials will share “county-specific facts and data” during the community meetings to “begin a roadmap for local maternal success.”

“The Strategic Committee will bring together a broad group of stakeholders to identify gaps in services, collaborate on ways to close these gaps, and explore strategies to achieve these goals,” Lesnick said.

The committee also hopes to expand on services like telehealth, home visiting programs, doulas and community health workers, he said.

“It’s important that we hear from a variety of different perspectives on women’s and maternal health to inform how we as a state can prioritize and act to ensure no woman goes without care, before, during, or after pregnancy,” Lesnick said.

Keesa Smith, executive director of Arkansas Advocates for Children and Families, said her organization plans to work with the committee on recommendations.

“I was glad to hear the acknowledgment that there is little to no coordination for moms after 60 days, and there are several women who are dropping off after that time, and we’re very interested in hearing what is the state’s solution to that, if not the expanding coverage to a year,” she said.

Smith said Arkansas Advocates will push to ensure women have other coverage after the 60 days.

“What we are interested in is truly determining a policy change that will transition women into a coverage that will continue to allow them to have care and care for their child. When we come to the table it’s not going to be theoretical. It’s going to be, ‘How does the state plan to make that transition?’” Smith said.

The committee’s education efforts will include a “multi-agency maternal health education and advertising campaign,” according to the handout.

Smith said while education is a component in improving maternal health, it’s not a complete answer to the problem.

“While we need to educate women on what is available to them, we also have to have faith that Arkansas women understand that they need care — that’s not foreign to them — but we’ve got to be able to make sure their ability to access said care is made easier,” Smith said.

According to the U.S. Centers for Disease Control and Prevention, Arkansas’ maternal mortality rate, 43.5 deaths per 100,000 births, in 20182021 was the highest among states for which a rate could be reliably calculated.

Provisional data from the CDC also shows Arkansas also had the country’s third-highest infant mortality rate in 2022, with 7.67 infant deaths per 1,000 births.

Federal law requires states to provide pregnancy-related Medicaid coverage for women who qualify, based on their incomes, for at least 60 days after a woman gives birth.

The 2021 American Rescue Plan Act gave states an option to extend the coverage for up to 12 months.

Extending pregnancy Medicaid coverage to 12 months was among the recommendations in a December 2023 report by the Maternal Mortality Review Committee, which was established under a 2019 Arkansas law to review and make recommendations to prevent maternal deaths.

According to KFF, formerly known as the Kaiser Family Foundation, 44 states and the District of Columbia had extended postpartum Medicaid coverage to 12 months as of Feb. 23, and two others were planning to do so.

The remaining states were Arkansas, Iowa, Idaho and Wisconsin, although Wisconsin had extended coverage to 90 days postpartum and had a bill pending in its Legislature that would extend it to the full 12 months. Iowa also had pending legislation to extend coverage to 12 months while lowering the income threshold to qualify for coverage.

The eligibility category in Arkansas applies to women with incomes up to 214% of the federal poverty level — $42,200 for a single expectant mother with no other children.

Otherwise, Arkansas’ income eligibility cutoff for Medicaid for adults who don’t fall into another eligibility category, such as because of a disability, is 138% of the poverty level, or $27,213 for a two-person household.

That’s the income cutoff for the state’s Medicaid expansion program, known as ARHOME. ARHOME stands for Arkansas Health and Opportunity for Me.

A bill sponsored by Rep. Aaron Pilkington, R-Knoxville, during the 2023 legislative session would have required Arkansas to extend postpartum Medicaid coverage to 12 months, but it died in the House Public Health, Welfare and Labor Committee.

Pilkington has said he plans on proposing the bill again in next year’s regular session.