Arkansas’s Title V Maternal and Child Health Services Block Grant

2019 Report/2021 Application

The healthcare delivery system in Arkansas is multi-faceted and includes a variety of private and public providers, and individual, private and public payers.  Consumers of healthcare have many choices and work continues throughout the state to ensure better health and better outcomes for women and children.

Sources of health insurance for women and children in Arkansas include the following:

Henry J. Kaiser Family Foundation estimates based on Census Bureau’s American Community Survey, 2008-2018

*Data may not sum to totals due to rounding.

Medicaid in Arkansas

In Arkansas, Medicaid provides publicly funded health insurance to almost 1,000,000 people including the disabled, the elderly, and children on ARKids, which is almost one-third of the state’s population. Health care financing reform has taken place in Arkansas and was driven by two main initiatives: The Affordable Care Act (ACA) and the Arkansas Works.  

Arkansas Works allows Medicaid to fund private insurance companies to provide insurance to Arkansans whose income does not exceed 138% of the federal poverty level (FPL).  As a result, Arkansas’s healthcare delivery environment significantly improved. As of May 2020, more than 260,000 people enrolled in healthcare coverage. No other state experienced a more rapid decline in its uninsured rate. The overall uninsured rate fell from 16% in 2013 to 8% in 2018. Almost 100% of children have health insurance, 69.8% of which is considered adequate for their needs.  This has far exceeded predictions.

Additionally, Medicaid has transitioned from a fee-for-service system to an organized care delivery model for the highest need behavioral health and developmental disability populations. The model, the Provider-Led Arkansas Shared Savings Entity (PASSE), was implemented in February 2017 and provides care coordination services. The program began providing comprehensive services to members in January 2019. PASSEs are responsible for integrating physical and behavioral health as well as developmental disability services for assigned members. Members are assigned a care coordinator who is responsible for creating a person-centered service plan for them.  However, for those members who do not meet eligibility criteria, the MCH Children with Chronic Healthcare Conditions Program (CCHCP) serves as the safety-net provider for a subset of this population.

These changes have brought new opportunities and challenges to the ADH. For example, ADH added services such as Well Woman visits and expanded services in some areas of coverage but pulled back in others. Specifically, the Women’s Health Waiver, a 1115 waiver that provided for family planning services for women with incomes up to 200% of the federal poverty level, was cancelled. The ADH bills private insurers and actively works to negotiate with larger private insurance companies to be on their approved list of providers.

The MCH program and Medicaid work together on many projects: management of high risk pregnancies, teen pregnancy, promoting the use of long acting reversible contraceptives, providing colposcopies, and data sharing.  The formal agreement between Medicaid and MCH in the state is a memorandum of understanding (MOU) between the ADH and the ADHS. A new draft MOU was developed to emphasize the role of MCH has been attached. The document is awaiting final approval from ADH administration and will then be sent to ADHS and Medicaid. In addition, while there are few formal advisory committees at Medicaid that MCH sits on, FHB has established an internal MCH Domain Workgroup and has invited Medicaid to participate.

Healthcare Delivery System Network and Partnerships

While the ACA has improved the number of insured in the state, it has not increased the number of providers, of which there is a shortage. The number of physician practices in the state is inadequate to provide necessary medical services to the population. Physician and other healthcare provider shortages are common. The average caseload for a primary care physician is 1,522 patients. Arkansas ranks 43rd in the nations for number of primary care physicians (122.3 per 100,000 population). There are only 639 pediatricians and 340 obstetricians/gynecologists in the state. Arkansas ranks 49th in the number of dentists (42.1 per 100,000) to population.

MCH is still a gap filler in areas lacking providers and in areas where providers are not taking Medicaid patients or those with no funding. The irony is that with Arkansas Works, some providers can fill the offices with privately insured patients and do not have an incentive to take Medicaid or no-pay patients. Despite the availability of coverage, some of the population has not yet enrolled. One-third of the family planning patients served by the ADH in the local health units are without any funding. 

The 83 general hospitals in the state provide the bulk of in-patient care. The ADH works closely with these local providers to assure that standards of care are met. Apart from this regulatory relationship, ADH also partners with the Arkansas Hospital Association (AHA) on issues of common interest at the systems level, including the development of the breastfeeding toolkit for hospital use, the state’s Infant Mortality Collaborative Improvement and Innovation Network initiatives, and the Arkansas Perinatal Quality Review Committee.

The University of Arkansas for Medical Sciences (UAMS) is a centralized point of referral for all medically complicated patients and provides medical and health education for the entire state. Except for the communities of West Memphis and Helena on the eastern border that depend on the city of Memphis, Tennessee, all state communities relate to UAMS and Little Rock hospitals as major sources of highly specialized medical care. UAMS's Regional Programs provide Family Medicine residency training in communities around the state, which has improved the distribution of primary care physicians. Family physicians provide most of the state's medical care and are by far the most numerous specialty practitioners in Arkansas. Specialists in obstetrics, pediatrics, internal medicine, surgery, and others have practices in the more urban communities. While Arkansas is geographically of modest size compared to some other states, the distances from cities such as Fayetteville and Texarkana to Little Rock require 2-1/2 to four hours of travel time. For families with few resources, these distances represent significant barriers to access specialized care.

The MCH program continually works with our partners to meet the health needs of the state. Changes are often driven by the planning of the larger institutions and agencies. An example of this is our work with Arkansas Children’s Hospital (ACH). ADH not only partners with ACH to provide home visiting services statewide, but also on a number of other issues including teen suicide, injury prevention, Infant and Child Death Review (ICDR), infant hearing, and newborn screening. In March of 2018, a third satellite clinic of Arkansas Children’s Hospital (ACH) opened in Springdale. The clinic is in a rapidly growing area of the state and has allowed more CSHCN access to pediatric specialty care. As part of our partnership, MCH plays a significant role in ACH’s community health needs assessment and the Natural Wonder Partnership Council.

FHB is collaborating with Project Linking Actions for Unmet Needs in Children’s Health (LAUNCH) to pioneer new ways to promote young child wellness. A key objective of this partnership is to improve coordination and collaboration across disciplines at the local, state, and federal levels to address the developmental, behavioral, and mental needs of Arkansas’s children. The ADH has formalized a partnership with Project LAUNCH, which includes housing LAUNCH staff in the local health unit in Mississippi County.

Professional boards of medicine, nursing, and other disciplines are other state agencies that provide support to the healthcare system. These disciplines, along with dentistry, pharmacy, chiropractic, and hospital administration are all represented on the Arkansas Board of Health.