The 2023 legislative session was Sen. Carri Hicks’ fourth year to file a bill that would pay baby-friendly hospitals in the state slightly higher Medicaid reimbursement rates in hopes of expanding access to quality maternal health care.
But that bill, along with the other nine bills aimed at improving maternal health in the state, failed this year. Most bills didn’t receive a hearing in the Senate Health and Human Services Committee this legislative session. Sen. Paul Rosino, R-Oklahoma City, who chairs that committee, told The Frontier he had no comment.
The bills included proposals requiring hospitals to make a “good-faith effort” to report all maternal deaths during pregnancy and up to a year after to the state medical examiner’s office, as well as requiring the state’s Medicaid program to cover donor human milk. Another failed proposal would have created a statewide telecare network to support women facing unexpected pregnancies.
“My main question is why?” said Hicks, D-Oklahoma City. “We had the opportunity to really highlight meaningful policy changes that would decrease our maternal and infant mortality rates. And instead, what we saw was kind of a mediocre response.”
Oklahoma’s maternal mortality rate from 2018 to 2020 was 25.2 deaths per 100,000 live births compared to the national average of 23.8 deaths per 100,000 live births, according to a 2022 report from the State Department of Health. The majority of those deaths are preventable. More than half of Oklahoma’s 77 counties are classified as maternity care deserts, according to the March of Dimes. Black women and Native American women in the state are two times more likely to die from complications during or shortly after childbirth, according to the 2022 report. The state has 43 birthing hospitals, mostly located in or near the major metro areas, according to the Oklahoma State Department of Health.
A handful of lawmakers have pushed for years for better reporting on maternal deaths and higher reimbursement rates for maternity care provided in areas with low or no access. Those bills have usually failed.
But lawmakers said earlier this year they believed there would be momentum this session to pass bills addressing Oklahoma’s maternal health care problems and expanding family supports after the state enacted a near-total ban on abortions last year.
“It shows that we say one thing, but our actions speak louder than our words,” said Becky Mannel, chair of the Coalition of Oklahoma Breastfeeding Advocates. “Our priorities are not in supporting maternal and child health outcomes.”
The state does already have some programs for new moms and babies through the State Department of Health. The agency provides funds to local county health departments to fill gaps in maternity services, expanding access to care. The agency has also asked lawmakers for an additional $2.9 million to create a pregnancy navigator program to connect women with resources and additional support. But a lack of providers has also been a barrier to programs in the past.
Earlier this year, the Oklahoma Health Care Authority got final approval for expanding postpartum coverage for Medicaid recipients from 60 days to 12 months, as well as expanding the income threshold for pregnant women to be eligible for coverage. The agency said it is also adding coverage of doula services in July.
After expanding the state’s Medicaid income limit for pregnant women, the number of women receiving pregnancy and postpartum coverage through the state increased by more than 40%, according to state data.
Those are positive changes, advocates said, but they only scratch the surface.
Even if a woman has insurance coverage, a lack of providers and a lack of transportation options can make getting to prenatal appointments difficult. Most parents aren’t guaranteed any paid time off when a child is born, and families struggle to find affordable childcare. Oklahoma has high rates of poverty, incarceration and adverse childhood experiences.
Lawmakers and state agencies are trying to address issues with child care, and the Legislature approved a policy allowing six weeks of paid maternity leave to teachers recently. Lawmakers are also eyeing paid maternity leave for all state employees during a special session.
“It’s not something that we’re going to be able to fix overnight, but there are several who are committed to trying to make it happen,” said Sen. Jessica Garvin, R-Duncan, who authored Senate Bill 594, which would have required the state to pay a higher rate for maternity care provided in maternal health care deserts.
The Health Care Authority said Oklahoma hospitals are already reimbursed at their maximum limit, according to federal rules, so the state can’t raise reimbursement rates to incentivize better access to care. But the state will finalize plans to hire third-party insurance providers to privatize SoonerCare, the state’s Medicaid program, in the coming months. The Health Care Authority said it expects new arrangements with hospitals and expanded incentive options as part of that process.
“We continue to explore how we can incentivize hospitals to provide enhanced maternal care,” the agency said in a statement.
Maternal health bills that didn’t go anywhere this year:
- Senate Bill 182 by Carri Hicks, D-Oklahoma City, would direct the state’s Medicaid program to cover breast pumps.
- Senate Bill 183 by Hicks would direct the state’s Medicaid program to have an enhanced reimbursement rate at hospitals deemed “baby friendly.”
- House Bill 2014 by Hicks and Rep. Trish Ranson, D-Stillwater, would require the Health Care Authority to provide postpartum insurance for 12 months after a woman gives birth. The Health Care Authority made that change without legal oversight, but this bill would have put the requirement into state law.
- Senate Bill 594 by Sen. Jessica Garvin, R-Duncan, would require the Oklahoma Health Care Authority to create an enhanced reimbursement rate for maternity care provided to Medicaid beneficiaries in areas with low or no access to care.
- Senate Bill 256 by Sen. David Bullard, R-Durant, would give $1.75 million to the State Department of Health to reimburse pregnancy resource centers that perform ultrasounds.
- Senate Bill 757 by Bullard would create a statewide telecare support network to provide community outreach and care coordination for women facing an unexpected pregnancy. The bill says the network cannot include groups that perform or assist with abortions or refer anyone to an entity that performs or recommends abortions. The program would be open to anyone with a child under age 2 or who is pregnant.
- House Bill 2511 by Rep. Ajay Pittman, D-Oklahoma City, and House Bill 2152 by Rep. Cynthia Roe, R-Lindsay, would require hospitals and licensed birth centers to make a “reasonable and good-faith effort” to report all deaths that happen during pregnancy or within one year of the termination of a pregnancy to the local coroner or medical examiner’s office. Senate Bill 399 by Sen. Jo Anna Dossett, D-Tulsa, also would have required reporting of maternal deaths.
- Senate Bill 245 by Sen. Julie Daniels, R-Bartlesville, would require the Health Care Authority to provide Medicaid coverage for medically necessary donor human milk derived products in an inpatient or outpatient setting for a kid who is under a year old that had low birth weight, was premature or had a heart condition.