A legislative committee on Monday reviewed two Arkansas Department of Human Services (DHS) rules aimed at increasing early prenatal care access and improving maternal-care data collection.

The committee reviewed a new presumptive eligibility category that allows pregnant women to receive temporary prenatal Medicaid coverage based on self-attestation while the agency processes a full eligibility determination. The same meeting also covered a separate rule to unbundle the global payment for prenatal care and delivery and raise delivery reimbursement rates; DHS said the change will both separate prenatal visit billing from labor-and-delivery payments and increase overall rates by an average of about 70 percent. Both rules were recorded as reviewed without objection by the committee.

DHS said the presumptive category is intended to get pregnant women into care quickly. "This is a new category of Medicaid that we are implementing, and the purpose of this category is to provide temporary coverage for prenatal care to women who attest to being pregnant and meeting other eligibility requirements while we are determining the full eligibility," said Ms. Pittman (DHS official). She told the committee the category will be granted automatically when an application indicates pregnancy and will allow one presumptive period per pregnancy.

Why it matters: Advocates and committee members said earlier prenatal contact can prevent complications and help address Arkansas’ high infant- and maternal-mortality rates. DHS officials told lawmakers the rules are intended both to expand timely access to prenatal visits and to produce better, more timely data so the state and its partners can measure whether interventions reduce poor outcomes.

Key details
- Presumptive eligibility scope: DHS told the committee the presumptive category covers prenatal care services; the period is temporary — generally two months (60 days) — unless the agency is still processing the full eligibility. "It will be for 2 months unless we are still processing presumptive eligibility category," Ms. Pittman said.
- Application process: DHS said the same application form will be used for presumptive and full eligibility. If the application indicates pregnancy, DHS will automatically determine presumptive eligibility and simultaneously continue processing the full application. "The presumptive application is the same application for full coverage," DHS said. Providers will be able to check coverage status in real time via the provider portal.
- Retroactivity: DHS clarified that presumptive eligibility itself is not retroactive, but full pregnancy coverage can be applied retroactively. "Presumptive eligibility is not retroactive. However, if when someone is approved for the full coverage for pregnancy, that is retroactive," a DHS presenter told the committee.
- Provider payment and emergency care: Committee members raised questions about whether hospitals and emergency departments would be paid for same-day care when coverage is not yet finalized. DHS replied that when a patient applies the same day, presumptive eligibility can cover that visit; if full coverage is later approved, DHS can apply retroactive payments according to existing rules.
- Implementation timing: DHS said the presumptive eligibility category is scheduled to go live July 1, pending CMS approval and final codification of the rule. DHS also said it will work with communications teams, county offices, providers, federally qualified health centers and the Arkansas Department of Health to inform beneficiaries and clinicians.
- Data and outreach: DHS and health-department representatives said better data sharing is a central objective. The department said it has an existing memorandum of understanding with the Department of Health to match Medicaid records to vital records data (SHARE) and that it will attempt to make those matches more frequent. Maddy Gilmore of the Department of Health told the committee she sees no reason the SHARE match could not be provided more frequently than yearly once systems and agreements are in place.

Numbers cited to the committee
- Annual births: DHS staff said Arkansas has roughly 32,000–35,000 births annually.
- Medicaid share of births: DHS staff said Medicaid historically pays for about 48–50 percent of births in the state (roughly 17,000–19,000 per year).
- Delivery without prenatal care: DHS cited prior self-attestation data showing roughly 1,000 women presented for delivery with no prenatal care; DHS said the new category seeks to reduce that number.
- Estimated cost increase for delivery rates: DHS estimated the rate changes would increase spending for deliveries by about $25 million in the coming year (a mix of state and federal funds); DHS said the average across affected delivery-related fee codes is roughly a 70 percent increase.

Discussion and concerns raised
Committee members repeatedly pressed DHS on where and how pregnant women usually apply for Medicaid, and whether presumptive eligibility will reach women who currently do not apply until late in pregnancy or until delivery. DHS said applications arrive via paper, online portal (mobile friendly), phone and in county offices; the agency said it is still working to quantify which channels are most used and to collect baseline data so improvements can be measured.

Lawmakers and emergency-room clinicians warned that emergency care is protected under EMTALA (the federal Emergency Medical Treatment and Active Labor Act), which requires hospitals to provide screening and stabilizing care before asking about insurance. Those members said hospitals frequently bill after the fact, and they asked whether presumptive eligibility will reduce uncompensated care. DHS replied that when a woman applies and is approved for presumptive eligibility the same day, the visit can be covered, and full coverage later can be applied retroactively if the full eligibility determination supports it.

Several members also asked whether the higher delivery payments could unintentionally incentivize more C-sections. DHS representatives, the Department of Health and committee members discussed plans to pair payment changes with quality-improvement initiatives — including continued work under the federal Transforming Maternal Health grant (TEMA) — to encourage evidence-based practices and reduce unnecessary surgical births. DHS told the committee the state has begun working with the perinatal quality collaborative and other partners to implement AIM (AIM maternal-safety) bundles and to consider value-based payment levers tied to quality measures.

Implementation and next steps
DHS said the presumptive eligibility rule and the unbundling/delivery rate rule will be codified after the administrative review process and, for presumptive eligibility, following CMS approval. DHS staff said they will provide further data to the committee and coordinate with the Department of Health, hospitals, clinics and provider associations to communicate the policy changes and support provider enrollment and technical adjustments.

Ending note
After the discussion the committee recorded both rules as reviewed without objection. DHS staff told lawmakers they will return with additional data and with updates as the presumptive eligibility category goes into operation and as the state monitors claims and provider billing under the new payment structure.