Fighting for Maternal Healthcare in Arkansas

Summary

Podcast Summary: Uncared For – "Fighting for Maternal Healthcare in Arkansas"

Host: Soojin Pak (Lemonada Media)
Date: September 3, 2025

---

Overview

This episode of Uncared For dives deep into the maternal healthcare crisis in Arkansas—one of only two U.S. states (alongside Wisconsin) that haven't extended Medicaid coverage for postpartum women from two months to a full year. Through the story of Maya Gabarra, a Black mother of twins born extremely premature, the episode exposes the brutal gaps in the safety net, the bureaucratic hurdles, and the very real human costs of a fragmented healthcare system.

---

Key Discussion Points & Insights

1. A Traumatic Birth Experience

• Maya’s Early Delivery (02:03–12:51)
  • Maya recounts giving birth to twins at just 25 weeks. Her initial memory is seeing her sons in the NICU:

    "They just looked like little aliens...tiny and translucent." (01:49, Maya)

  • She describes feeling both awe and terror, uncertain if her babies would survive.

    "I was afraid to think about the future. I felt like I would be leaving there without children at that point." (09:49, Maya)

• Physical and Emotional Toll
  • Maya highlights how afterbirth care was lacking:

    "I felt more cared for before I had them. After, it felt like I was a non-factor...they were just trying to get me out." (13:16, Maya)

---

2. Postpartum Health Complications and Loss of Coverage

• Ongoing Physical Health Issues (14:55–19:59)

  • Following delivery, Maya experienced unbearable pain due to a gallbladder attack, linked to her pregnancy and preexisting conditions.
  • She required gallbladder removal surgery.

• Sudden Medicaid Loss (19:59–23:28)

  • While preparing for surgery, Maya discovers at the pharmacy that her Medicaid coverage is canceled:

    "I'm seeing that it's charging me full cost. And I'm like, what is happening? Wait, what?" (19:59, Maya)

  • She describes confusion, lack of notice, and being shifted to a new plan with more restrictions and paperwork.

---

3. The Bureaucratic Nightmare and Systemic Barriers

• Insurance Red Tape (21:24–25:55)

  • Maya confronts the labyrinth of referrals and in-network doctor limitations. Many providers don't treat adult women, and scheduled surgeries were delayed by months.

    "I just dropped everything and cried. I was so frustrated." (22:23, Maya)

  • Arkansas’ benefit application includes a 300-question form with invasive requirements—like submitting information on the children’s father, which for Maya posed safety concerns.

• Mental & Chronic Health Sacrificed (25:55–28:06)

  • After losing Medicaid in July 2024, Maya goes untreated for mental health, rheumatoid arthritis, and autoimmune issues:

    "I've been going untreated for all of it...for my mental health, for the rheumatoid arthritis, for the Sjogren's..." (26:14, Maya)

---

4. Caring for Medically Complex Children

• An Exhausting Daily Grind (27:00–39:00)

  • Maya's twins have severe health challenges: one is ventilator-dependent, the other has a feeding tube. Their care is a 24/7 operation, with frequent hospitalizations and specialist appointments.
  • Maya can't work outside the home—and private insurance premiums are unaffordable.

• Resilience & Sacrifice

  • On what keeps her going:

    "They do, they do. I love them so much. My love for them keeps me going every day...they motivate me to get up and go every day and to...focus on myself so that I can just be a better mom and a better human." (37:48, Maya)

  • She stresses the necessity of caring for herself to be there for her children, despite untreated health issues and high blood pressure.

---

5. Advocacy, Legislative Failure, and Call for Change

• Legislative Hopes Dashed (31:44–35:08)

  • In April, an Arkansas House-passed bill to extend Medicaid postpartum coverage died in the Senate committee. Testimony from women like Danielle Wright highlighted the stakes:

    "Recovering from an emergency C-section...as a single mother and seeking mental health therapy for myself, I could not get help. Moms and families need support during this time..." (32:14, Danielle Wright)

  • Maya’s message to legislators:

    "Shame on you...It's so easy to sit in an office and to make these decisions for other people's lives that you would never have to experience on your own...It is horrific and it is terrifying." (33:23, Maya)

• Systemic Impact

  • Nearly 40% of new mothers in Arkansas lose Medicaid coverage post-60-days, forced to navigate a “confusing system which will only get more complicated and bare bones.” (35:08, Soojin)
  • Recent Medicaid cuts and proposed work requirements will make access even harder for families like Maya's.

---

Notable Quotes & Memorable Moments

• On Living with Chronic Discomfort (07:06)

  "I have felt so much discomfort in my body for, like, as early as I can remember that, honestly, I have become exceedingly comfortable with being uncomfortable." (07:06, Maya)

• The Absurd Complexity of Insurance (21:24–22:23)

  "I needed a referral for everything...I was not used to that. It was a nightmare...I just dropped everything and cried." (21:24–22:23, Maya)

• On Legislators’ Responsibility (33:23–35:08)

  "Shame on you...where is your humanity?...As much as I want to explain my anger, I really want to express my fear and how terrorizing it is to navigate the system." (33:23, Maya)

• On Motivation and Motherhood (37:48–39:00)

  "My love for them keeps me going every day...I have the most special jobs...it's also rewarding on a level that I can't even describe." (37:48, Maya)

---

Key Timestamps

• 01:49 – Maya's first memories of her twins in the NICU
• 04:18 – Description of twins, pregnancy timeline
• 07:06 – Living with discomfort and missed early symptoms
• 09:49 – Fear and uncertainty during delivery
• 13:16 – Feeling "thrown away" after birth
• 19:59 – Realization of insurance loss at the pharmacy
• 22:23 – Describing the insurance and provider runaround
• 26:14 – Going untreated for chronic conditions
• 32:14 – Testimony about losing coverage (Danielle Wright)
• 33:23 – Maya’s direct message to legislators
• 37:48 – Maya on what motivates her amid adversity
• 40:05 – Reflection on what life could look like with proper care

---

Conclusion & Takeaways

The episode lays bare the stakes for maternal healthcare access in Arkansas, showing the cascading effects of bureaucratic neglect and policy inaction. Through Maya’s story, listeners witness how easy it is for parents to fall through the cracks and how these gaps are not just technical or political—they are profoundly human.

Host Soojin Pak’s closing thought:

“These aren't just policy debates, they're about real people who deserve better. This healthcare system and its many gaps isn't our only option. Our care is a choice we’re making as a country—and we can choose differently.” (41:00)

---

Get Involved

• If you live in Arkansas, pressure your legislators for postpartum Medicaid extension.
• Support organizations such as Arkansas Advocates for Children and Families for continued advocacy on maternal healthcare.

---

For more resources:

• Commonwealth Fund
• Word in Black
• Arkansas Advocates for Children and Families

---

This summary was created to deliver a comprehensive yet accessible account of the episode for listeners and advocates alike, capturing the urgency and humanity at the heart of maternal healthcare policy debates.

Transcript

[Soojin Pak]

This show is presented by the Commonwealth Fund, a nonprofit foundation whose mission is to promote a high performing, equitable health care system. The Commonwealth Fund supports research to improve healthcare policy and practice and has a long history of exploring what the US can learn from the best healthcare around the world to do better here at home, especially for people of color, people with low income, and those who are uninsured. To learn more, visit commonwealthfund.org work Are.

[Gretchen Rubin]

You looking for ways to make your everyday life happier, healthier, more productive, and more creative? I'm Gretchen Rubin, the number one bestselling author of the Happiness Project, bringing you fresh insights and practical solutions in the Happier with Gretchen Rubin podcast. My co host and happiness guinea pig is my sister, Elizabeth Craft. That's me, Elizabeth Craft, a TV writer and producer in Hollywood. Join us as we explore ideas and hacks about cultivating happiness and good habits. Check out Happier with Gretchen Rubin from Lemonada Media.

[Soojin Pak]

Lemonade Want to listen to your favorite Lemonada shows without the ads? Subscribe to Lemonada Premium on Apple podcasts for just 5.99. You'll get ad free episodes and exclusive bonus content from shows like this one, as well as Wiser Than Me with Julia Louis Dreyfus, Fail Better with David Duchovny, and so many more. It's a great way to support the work we do and treat yourself to a smoother, uninterrupted listening experience. Just head to any Lemonada show feed on Apple Podcasts and hit subscribe make life Suck Less with fewer ads with Lemonada Premium.

[Maya Gabarra]

They just look like little aliens. Yeah, yeah, it didn't even seem real. They were just so tall, tiny and translucent and you could just see right through them.

[Soojin Pak]

This is Maya's first memory of meeting her twin boys. It was the day after she gave birth to them. Maya was only 25 weeks. By any measure, that's terrifyingly early. She met her babies in the hospital's neonatal intensive care unit.

[Maya Gabarra]

And I can't really see them because they're all covered up except for maybe like little strips of their face. Like even their eyes are covered.

[Soojin Pak]

Each baby was in an isolette or an incubator underneath blue lights.

[Maya Gabarra]

I had never really seen a preemie before. I had preemies and so it was my first real experience. It was surreal. It was scary.

[Soojin Pak]

In that moment, Maya had no idea if her twin baby boys would survive past the nicu. She also didn't know that in just a few weeks while visiting her babies there, she'd be seized with a pain so strong she could bear barely speak. And soon after that, she'd lose her health insurance, setting off hurdle after hurdle to just get the care she needed. From Lemonada Media. This is uncared for. I'm your host, Soojan Pak. More women die in America due to complications from pregnancy or childbirth than in any other rich country. We explored this issue in depth in season one. Of all the high income nations in the world, the US Continues to have the highest rate of maternal deaths. To combat this, almost every state in the US has extended the time women can stay on Medicaid after Pregnancy ends from two months to 12 months. All states except two, Arkansas and Wisconsin. Maya Gabarra. Our guest today is a black woman living in Little Rock, Arkansas. She knows firsthand what it's like to have the system work against you when you're experiencing one of the hardest transitions in your life, having a baby, or in her case, having twins. Maya, you are the mother of twin boys. Tell me their names, how old they are, when they were born.

[Maya Gabarra]

We have Amir and Bryson. They are, I believe at this point, 17 months. But 14 months adjusted. They were due May 12th. I had them February 2nd of 2024.

[Soojin Pak]

Right, so the adjusted is because they were born so early.

[Maya Gabarra]

Yes.

[Soojin Pak]

Yeah. And what are their personalities like?

[Maya Gabarra]

Um, Amir is. That's my baby. He has a really big personality. Even though he cannot, like express himself verbally, he loves his alone time. He loves for you to be there when he wants you to be there. But you definitely know when you have been dismiss. And Bryson is like the opposite. He's really vibrant. He's a really big people person. So I really have like one introverted baby and one extroverted baby. So. Yeah. Oh, good.

[Soojin Pak]

Yeah, you're gonna get the full spectrum. Yeah. Maya was 37 when she became pregnant with Amir and Bryson. She discovered she was pregnant while she had Covid.

[Maya Gabarra]

I just was really sick and I wasn't feeling well and I hadn't quite experience that level of like, discomfort before. And so I took a COVID test and I had Covid. And I was laying there in bed and I was just thinking, I've had Covid twice before, like years prior. And although it was bad, it wasn't as bad as what I was feeling. I was like, this is something that's exceptionally terrible. And so I had an old pregnancy test from like Dollar Tre in my bathroom from like, it was like 2 years old. And I was like, you know what, I'm just, I'm just going to take it. I'm just going to see. And so I went ahead and I took it about an hour later, and before I could even sit it on the counter, it said that I was pregnant. And I was floored because I could have only at that point, you know, had been three weeks, really. And it told me so fast, and it just really wasn't what I was expecting. And so it really shocked me.

[Soojin Pak]

Part of why Maya was so shocked is because she tried to have kids earlier in her life but never did. And being in her late 30s, figured that ship had sailed. At the time, she was navigating major depression that was treatment resistant. She also had rheumatoid arthritis, an autoimmune disorder, is autistic, and has adhd. Maya has lived with pain and discomfort for most of her life.

[Maya Gabarra]

I have felt so much discomfort in my body for, like, as early as I can remember that, honestly, I have become exceedingly comfortable with being uncomfortable.

[Soojin Pak]

Which is why when things started to go wrong with her pregnancy, when her liver enzyme levels kept elevating, she didn't.

[Maya Gabarra]

Initially notice because they kept asking me, like, are you sure you're okay? Are you sure you're okay? And now, like, looking back, there are, like, some things where I'm like, whoa. I didn't even realize that that was happening. Or I didn't realize that that was a sign or a symptom of, like, liver failure. I didn't know, like, what. So for me, this is so vain. But, like, me and my family, we're known for, like, just the women, really soft skin, you know, from, like, all over. Like, that's our thing. No, I was like a lizard. Like, extremely dry to the point where my body was cracking and peeling, and I couldn't drink enough water. I couldn't moisturize enough. I couldn't. And it was hurting. It was at the point where, like, I was physically uncomfortable and dry and scaly all over. And now I'm like, that is a symptom. But I didn't realize it at the time.

[Soojin Pak]

Some liver diseases are uniquely associated with pregnancy and can occur in up to 10% of all pregnancies. At about 23 weeks, with her liver. Liver enzymes continuing to rise, Maya started seeing the doctor twice a week.

[Maya Gabarra]

I went in, I guess it would have been at the beginning of my 25th week for just regular blood work. And before I can even get home, she told me to pack a bag and go to the hospital.

[Soojin Pak]

Maya checked herself into the hospital. There, her liver enzymes were doubling every day.

[Maya Gabarra]

It's like they're just getting progressively Worse. And it's happening really fast.

[Soojin Pak]

Doctors were monitoring her. They were monitoring the babies. Then early in the morning on her fifth day in the hospital, Maya was woken up by a group of doctors.

[Maya Gabarra]

And they came in, and I knew it was a big deal because it was about, like, six or seven of them. My doctor wasn't even, like, talking. She was just, like, there. And it was another woman there, like, telling me, oh, you've gotten to a dangerous level. The babies are coming out today. And I was just like, can we please wait a little longer? Like, please? And she was like, no, this is dangerous for you. Like, we have to get them out.

[Soojin Pak]

When they woke you up in the hospital to say, okay, this is it. What's going through your mind?

[Maya Gabarra]

Um, I was shocked. I was really scared. Like, I was too afraid to think about the future. I was really sad because I felt like I would be leaving there without children at that point. That's how I felt.

[Soojin Pak]

Right, that you were going to walk out of there without babies. Because, I mean, 25 weeks, by any.

[Maya Gabarra]

Measure, I know it was possible. You know, I've heard, like, success stories and stuff like that, but I also. I've seen the good, and I've seen the bad, you know? And so at that point, I felt like so many things had been going wrong for me that I just really felt like I was gonna be leaving there without babies.

[Soojin Pak]

God, that's so scary. So tell us how you delivered your babies and what that experience was like for you.

[Maya Gabarra]

So I delivered them via C section. And one thing that I found to be really. It's not funny, but literally, I'm in the middle of getting the epidural in the operating room. This is the first surgery I've ever had in my entire life. So I'm scared. And while there's a needle in my back, there's someone going, oh, yeah, do you want to get your tubes tied, or do you want an IUD and be still. And I'm just like, I don't know. And, like, so many things were going through my head that I said IUD because I was afraid that, like, what if I leave here with no children? I thought I didn't want kids, but now I'm really excited, and I'm scared, and, like, maybe I'll want to try again later. And just so I think that is almost, like, indicative of, like, the entire experience. So many people talking, so many questions, expecting to be present enough to, like, answer these questions, like, coherently while you're completely scared. And at this point, you're on meds, and you have no idea, like, what's actually happening.

[Soojin Pak]

Maya remembers the moment after they're born.

[Maya Gabarra]

I hear, like, my first one cry. I don't hear the second one cry. Like, freaks me out, but, like, the fact that I could hear one of them cry at all was just like, oh, my God, like, they're here.

[Soojin Pak]

Maya didn't see her babies until the next day in the nicu. That's the scene you heard at the beginning of the episode. Maya describing them as tiny and translucent with a sort of wonder that comes from meeting your kids for the first time. But Maya was also scared.

[Maya Gabarra]

All I heard from everybody was just like, what could possibly come down the line because they are so premature and so hearing basically all the things that could happen all the way up until, like, you know, death, which was a possibility. So holding all that and then, you know, having to leave.

[Soojin Pak]

Maya left the hospital three days after her babies were born.

[Maya Gabarra]

That's the hardest part. It's like leaving the hospital with no babies, and so they were still alive, but you're just kind of at home not knowing what to do. You know, I've had these kids, but I don't have them. And so I cried myself to sleep that night, for sure, at home. Yeah.

[Soojin Pak]

Overall, what sticks with you from that experience the most?

[Maya Gabarra]

I felt more, like, cared for before I had them, but then it felt like after I had them, I was just a non factor. Like, they were just trying to get me out, you know, I didn't really feel like anybody really cared at that point what was happening with me. It was like, okay, yeah, the babies are here. Bye. Like, that's really kind of how it felt. And when I hear sometimes the stories of, like, some moms in some hospitals and what, like, their aftercare was like, I was like, I didn't get any of that. Like, I didn't even. Like, no one came to, like, really talk to me. Talk to me about what was happening or how to process it.

[Soojin Pak]

Yeah.

[Maya Gabarra]

Thankfully, I had my own therapist to help me walk through the process, but really, they just kind of released me without even asking if I had anybody or any, like, real, you know, mental health support, even beyond the physical. So, yeah, it just kind of felt. I kind of felt thrown away. And that's what really sticks with me.

[Soojin Pak]

This feeling of being thrown away unsupported, uncared for, is all too common for new moms. It's often a very lonely time, though. She was feeling emotionally, unfortunately, unstable during those early days after giving birth. Physically, Maya thought she was okay. She was wrong.

[Maya Gabarra]

The way this intense pain radiated through my body was something I had never felt before, to the point where, like, I could hardly walk.

[Soojin Pak]

The health complications Maya had during pregnancy didn't go away. They got worse. That's after the break. Let's be real. Without the black press, who's covering how black Americans are really treated in the healthcare system? Mainstream media barely scratches the surface, but word in black goes deep because lives depend on it. They're reporting the truth about medical racism, black maternal mortality, breast cancer in black women, mental health stigma, all of it. Want to stay informed and empowered? Subscribe to their weekly health newsletter and get the stories that actually put black health first. Go to wordinblack.com that's wordinblack.com and sign up, because being informed is how we protect each other.

[Lemonada Media Announcer]

Want to listen to your favorite Lemonada shows without the ads? Subscribe to Lemonada Premium on Apple Podcasts. You'll get ad free episodes and exclusive bonus content from shows like Wiser Than Me with Julia Louis Dreyfus, Fail Better with David Duchovny, the Sarah Silverman podcast, and so many more. It's a great way to support the work we do and treat yourself to a smoother, uninterrupted listening experience. Just head to any Lemonada show feed on Apple podcasts and hit subscribe. Make life suck less with fewer ads with Lemonada Premium.

[Soojin Pak]

Maya's babies were born premature, with a slew of health conditions that demanded sustained, constant attention.

[Maya Gabarra]

One of my boys was in the NICU for 10 months, and the other one was in the NICU for a little over 13 months. He spent his first birthday there.

[Soojin Pak]

Wow. Wait, and your sons are how old right now?

[Maya Gabarra]

They are like 17 months.

[Soojin Pak]

So this is all. This is like, wait, it's all. The timeline is like hitting me now.

[Maya Gabarra]

Yeah. No, I literally. We've been in and out of the hospital. After I get off of here, I have to go pick up my other son because they're about to release him from the hospital. So it's still like a big.

[Soojin Pak]

It's still happening. Yeah, this is still happening. This is isn't like, oh, yeah. Remember when you're like, no, they're still in and out of the hospital pretty much.

[Maya Gabarra]

Wow.

[Soojin Pak]

Oh, I'm trying to hold some of that for you. I don't know if you can feel it. I'm trying. During these early days in the nicu, all Maya could think about were her sons. She was at the hospital every day, and mentally, she Was in fight mode.

[Maya Gabarra]

The same way everybody else's attention was on them. Like, so is mine. Where, like, I didn't even feel like I had time to, like, think about my stuff, you know?

[Soojin Pak]

She was so consumed with her twins. Maya didn't realize that a few weeks after delivering, something was seriously wrong with her.

[Maya Gabarra]

I thought I was fine. So after I had them, I thought I was fine. And so while they were still at the first hospital, I was laying down, and I just woke up with this intense back pain. I'm used to back pain. And so I just thought, who? I just need to stretch, you know, like, this is really bad. But the way that it radiated through my body was something I had never felt before, to the point where, like, I could hardly get up and walk to the nursing station. I'm trying to talk to tell them about what's happening, and I can't. All I can say is, like, help. Like, just help.

[Soojin Pak]

The hospital ran some tests. Maya was having a gallbladder attack. What does it mean when you're. When you have gallbladder issues like this? And then I'm assuming that that has to be related to the pregnancy or with your liver enzymes. Is that linked together?

[Maya Gabarra]

They did say it was linked. You know, they told me later, like, okay, yes, this is totally linked. And so we need to take your gallbladder out. Because it was at the point where, like, whatever I ate, whenever I tried to eat things, I had to be very careful about what I ate. But honestly, it almost didn't matter. My gallbladder was in such bad shape that, like, I really had to choose between, like, eating or, like, this intense pain.

[Soojin Pak]

The gallbladder helps us digest food. When gallstones develop and get bigger, they can cause blockages which are very painful. Maya needed to have her gallbladder removed, so doctors scheduled her to have surgery. It was around this time that Maya went to the pharmacy to pick up a prescription.

[Maya Gabarra]

And I'm seeing that it's charging me full cost. And I'm like, what is happening? Wait, what? Yeah.

[Soojin Pak]

The pharmacy told Maya that her insurance had been canceled.

[Maya Gabarra]

I was floored because I had a surgery scheduled.

[Soojin Pak]

Maya called the Medicaid office to find out what happened. And that's when she learned the Medicaid plan she'd been on throughout her entire pregnancy and for some weeks afterward had been terminated. Taken away. Just ended without Maya's knowing.

[Maya Gabarra]

They're saying, you're off of that plan now. And I was like, okay.

[Soojin Pak]

Maya says they told her she was switched to a different Medicaid plan.

[Maya Gabarra]

And I said, well, okay, that's great, but I don't know, like, what that means for me. And I have the surgery scheduled and I don't know what to do. And they were like, no one told you? And I said, no, no one told me. You didn't get anything in the mail? No, I didn't.

[Soojin Pak]

States are federally required to provide pregnancy related Medicaid coverage through 60 days after delivery. That's the minimum. But Arkansas often starts moving women out of the program even sooner than that. The state transferred Maya onto a new plan, one with a new network of doctors, one that needed referrals, one with a lot of paperwork and red tape.

[Maya Gabarra]

Their plan was completely different. And so I needed a referral for everything, and I was not used to that. And so because I needed a referral for everything and I had to be, of course, with an in network doctor, I had to go down the list, which was a nightmare. I'm like, can you give me a list of doctors that I can see? And then I'm going to call those doctors and they'll say, oh, we're a geriatric doctor. We don't see people under the age of, you know, whatever. And I'm, yeah, okay. And so I found like a list of people on my own that had to be at the hospital that I already had the surgery scheduled. Because at this point, I'm trying to salvage things, but no one could see me until like, way after I was even supposed to have surgery. So I believe my surgery was supposed to be like, I believe like March 26th or something like that.

[Soojin Pak]

The doctor she called couldn't do it until at least three months after the original date.

[Maya Gabarra]

This is not working. The back and forth was like trying to call Medicaid to get more numbers to call to. It was a nightmare. And I just like dropped everything and cried. I was so frustrated. And my mom had to like, pick up the pieces and help.

[Soojin Pak]

With the help of her mom and some begging and crying over the phone, Maya was eventually able to find an in network doctor to give her a referral so she could get an MRI that was required before the surgery. All while experiencing intense gallbladder pain and caring for two kids in the hospital. There are so many moving pieces that are happening in your life, and life threatening moving pieces we're not talking about. I mean, you know, just small things that can even wait a day, a week, a month. What did this abrupt action, this shifting of insurance plans mean for you at this point in your life and for Your babies at this time, it put.

[Maya Gabarra]

Me under a lot more stress. It was very scary. There was so much red tape and everything was so difficult to navigate that I, like, honestly, I went into a shutdown and I just got so frustrated that I just didn't want to talk to anybody. I didn't want to do anything anymore. I didn't have anything left in me. And it was my mom being willing and able to step in to continue to help me that helped. And so luckily I was able to have those surgeries.

[Soojin Pak]

Thankfully, Maya had her mom so she could get the surgery she so desperately needed. But let's be real. Should it be this complicated to get the care you need? Though Maya is just one person, she's not alone in experiencing this. It's not uncommon for low income new moms in Arkansas to lose continuous access to health care in the weeks after having a kid. To be kept in the dark about that change and for that interruption to happen before the federally required 60 days are up. These aren't the only barriers to care poor women in Arkansas face. The state's process for women and children to access health care and other benefits is extremely complicated, confusing, and includes a 300 question form. 300 questions for single moms. Some of those questions ask for identifying information about the dad and require the applicant to comply with child support enforcement, something Maya did not want to do.

[Maya Gabarra]

Things with my children's father took like a turn for like the worst. And it was very clear that things were just not the safest for me to navigate.

[Soojin Pak]

Maya didn't want to list the dad's information on the state form and risk involving him in her and her son son's lives.

[Maya Gabarra]

I had to think about what that would mean for me, my safety and my children's safety versus my mental and physical health and like weigh that. And so I decided that it was just more important for us to be like, physically safe and I would have to figure out the rest on my own.

[Soojin Pak]

Maya lost her Medicaid coverage in July 2024. She hasn't had health insurance ever since. I mean, what. How do you. How do you care for yourself and your kids? Like, what other care have you lost or had to sort of sacrifice because you no longer have insurance?

[Maya Gabarra]

So I'm untreated for. Sorry. Yeah, I have been going untreated for all of it. So for my mental health, for the rheumatoid arthritis, for the Sjogren's, like, so for all of my autoimmune stuff, I have been going untreated. For my mental health, I have been going completely untreated. So.

[Soojin Pak]

Yeah, sorry, I'm just. That just makes me speechless. Even though Maya no longer has insurance through the state, her sons, thankfully, still do.

[Maya Gabarra]

They still get health care because they are medically complex and so.

[Soojin Pak]

So that the state will take care of the kids. Yes, but the mom. I mean, what do they have to do with kids that are medically complex?

[Maya Gabarra]

Yeah.

[Soojin Pak]

Maya's twins have a number of health conditions. Amir has a tracheotomy or trach, which is a hole directly into his neck that helps him breathe and is dependent on a ventilator. He also suffers from a number of other conditions, including a brain disorder, cerebral palsy, and chronic lung disease. Bryson depends on a gastrostomy tube or a G tube to get nutrition and also has chronic lung disease. Both experience developmental delays and are getting tested for other disorders. All the other ways to get health insurance are just not feasible for Maya.

[Maya Gabarra]

I would love to be able to just buy insurance, but we're talking about 5, 6, $700 a month that I just do not. And then on top of that, we're still talking about co pays and meds and all that.

[Soojin Pak]

So Maya can't afford to buy private insurance off the federal marketplace.

[Maya Gabarra]

And what I know people like, why don't you just go to work? I have a child who's on a ventilator 24 hours a day who needs to literally be cared for 24 hours a day. I do have some nurses, but I don't have them all the time, especially at night. And so I have to be able to care for him and I have to be able to look over him. Eyes have to be on him.

[Soojin Pak]

Yeah.

[Maya Gabarra]

So there is no sleep, pain. You know what I mean? It's just not feasible. And people. Oh, get a work from home job, you mean, where I have to not be around ventilators and alarms and machines all day? Plus another child who isn't. He's not as severe, but he's still on a G tube. He still has chronic lung disease and he still has therapies. I mean, we're talking about five, six times a week, plus doctor's appointments. We don't even want to talk about that. And so it's practically impossible for me to go and, like, get a job between my schedule. My son, the one on the ventilator, has been consistently in the hospital for at least a week every month for the last three months since he's been released.

[Soojin Pak]

Maya had hoped her son's health conditions would be at a more stable place by now so she could have more flexibility and find work. For now, though, she knows the safest place for her to be is home with her kids. We're going to take a quick break. When we come back, we'll find out what happened this past spring when the Arkansas state legislature heard a bill to extend postpartum Medicaid. I think it's our responsibility as a state to make sure that these women are covered for 12 months. With that, I'm closed. I'd ask for a good vote. Thank you. That's next.

[Maya Gabarra]

Foreign.

[Joelle Brevel]

Hello, I'm Joelle Brevel, medical mythbuster and host of the Dose, a health policy podcast from the Commonwealth Fund. Each season I sit down with a leading health policy expert and medical professionals to have real conversations about the issues that keep them up at night. We talk about breakthroughs in their research and their new ideas to make our healthcare system work better for all Americans. This idea of equity needs to be taken up by everyone and wherever you are in your work, whatever sector that you're in, we need to have conversations about what tomorrow looks like. I hope you'll check out the Dose and enjoy listening to our interviews. You can find us at thedose show or by searching your podcast app for the Dose from the Commonwealth Fund.

[David Duchovny]

Hi everyone, I'm David Duchovny. Join me on my podcast Fail Better, where we use failure as a lens to reflect on the past and analyze the current moment. I speak with makers and performers like Rob Lowe's, Rosie o' Donnell and Kenya Barris, as well as thinkers like Kara Swisher and Nate Silver to understand how both personal setbacks and larger forces impact our world. Listen to Fail Better wherever you get your podcasts.

[Soojin Pak]

This past April, a bill to extend postpartum Medicaid in Arkansas to 12 months passed the Arkansas House. It was a glimmer of hope for the state, which as a reminder is the only state aside from Wisconsin that hasn't passed the full postpartum Medicaid extension. When the bill went to a Senate committee, several women testified, including Danielle Wright, who spoke about her own experience losing Medicaid coverage shortly after giving birth.

[Danielle Wright]

I personally experienced losing coverage after having my one year old son. We also temporarily temporarily also lost his coverage. This was extremely difficult because recovering from an emergency C section that was completely unplanned, caring for two other children as a single mother and seeking mental health therapy for myself, I could not get help. Moms and families need support during this time and this bill would make sure. Moms and other families just like me don't have to go through this or worse without postpartum care. Thank you so much for your time and your consideration, and I'm glad to be here today.

[Soojin Pak]

Thank you. But the bill, which is not supported by Arkansas Governor Sarah Huckabee Sanders, died in committee. All those in favor say aye and opposed. No Sabbath. Sorry the bill fails. What would you want to say to those legislators that killed the bill that did not pass this extension that is available virtually in every state in this country?

[Maya Gabarra]

The only thing that comes to mind is like, shame on you. Shame on you. Like the stories that I've heard, just not my own, you know, because even my own, I tell people, all things considered when I hear about some of the other stories, like, I'm one of the best case scenarios because I was still able to, like, have my search surgeries and things like that. And it's just, it's so easy to sit in an office and to make these kinds of decisions for other people's lives that you would never have to experience on your own. It's just like, where is your humanity? And you claim that, you know, you're doing your best for your constituents and for the people that voted for you in office or the people who didn't vote for you but you're responsible for and that you have our best interests at heart. Heart. And that you care about children and that you care about us. Where is the care? Because I do not see it, I do not feel it. I see no evidence of it. And all I see is people just caving into pressures at the expense of the people that they are supposed to be representing. And it is absolutely. As much as I want to explain, like my anger, I really want to express my fear and how like, terrorizing it is to navigate the system and to live here every day. It is horrific and it is terrifying. And you always are afraid of what they are going to snatch from you next.

[Soojin Pak]

Maya's fear is real. Nearly 40% of new mothers in Arkansas lose their Medicaid coverage after the 60 day postpartum period. They're left to jump through the hoops of a confusing system which will only get more complicated and bare bones with the Medicaid cuts passed this summer in the one big beautiful bill. These cuts are the biggest in Medicaid's history and will include three things like work requirements, which make the system even harder to access for people like Maya. In the meantime, Maya keeps up the difficult daily routine that her kids need. Can you Describe to me what a typical day looks like for you now. What support do you have? You know, what does it look like for you, Maya, today?

[Maya Gabarra]

Luckily, we have a day nurse Monday through Friday from 7 to 3, and so I have her to help take care of one of my sons. Chances are we have a doctor's appointment that I have to navigate just to get out the door. With my son on the ventilator and his equipment, that's about a half an hour to a 45 minute prep session to make sure that you have everything you need to get out of the door. Neither one of my kids eat by mouth, so we're talking about just a lot of feeding, pumps, equipment to maintain. And so I live on like around the clock schedule. And if I'm lucky enough to get night nursing, then I only have to focus on my one child. She comes three times a week, but the other times, like I'm on my own. I have to be up pretty much most of the night. Luckily, I have my mom. My mom helps me, so I feel really, really blessed with that. So she'll allow me maybe like three to four hours of sleep. And then by that time like I'm up by 2am and I have to up until like the, the nurse comes at 7am and so yeah, it's, it's a lot. And that's not even counting like the therapies. So.

[Soojin Pak]

Yeah, or you.

[Maya Gabarra]

Yeah, or me. Right, Me.

[Soojin Pak]

Yeah. I'm thinking about your day, I'm thinking about the little support that you have, but how much it takes to even just get you out the door for one of your appointments for your sons. What keeps you going right now?

[Maya Gabarra]

They do, they do. Like I love them so much. I really just believe my love for them keeps me going every day. Just this reminder that like, I'm not alone in this. So I think it even like combats like my natural like autistic responses. Sometimes when I want to shut down, it's like, nope, you can't because you are responsible for these two little lives. And that is so important to me. And I just feel like I have like the most special jobs. And yes, it is tired, yes, it is exhausting, yes, it's frustrating and all of that, but it's also like rewarding on a level that like I just can't even describe. Like they keep me going. But then at the same time, I never wanted to be the kind of mom who lives for her children only because I feel like there's too much pressure on a child. And so they Motivate me to, like, get up and go every day and to not just focus on them and. And to pour into them, but to focus on myself so that I can just be a better mom and a better human. Really? Yeah.

[Soojin Pak]

Yeah. Part of being a better mom, Maya says, is not giving into the stress. She needs to stay healthy and grounded for her sons because they rely on her.

[Maya Gabarra]

I'm having high blood pressure, you know, but I'm trying to manage it a little bit better, but it's still not managed. And so it scares me because I'm already an older, older parent, and the stress is already a lot, which is why I do so much to, like, try to take care of myself, to try to stay grounded, because I know that me with a flare or a stress response, I can't afford to let my body shut down because I have kids who are depending on me. So, like, as far as, like, I can't let the stress get to me. I literally can't. So. Yeah.

[Soojin Pak]

What do you think your life would have looked like if you had had Medicaid, at least for a full year after your twins were born, where you didn't have to worry about health insurance for yourself?

[Maya Gabarra]

I would have been able to do more. There's not much that I can do. Sometimes when my legs are hurting, when my joints are hurting, when. When I'm so swollen, you know, that there's really not much that I can do for anybody. And there have been times I've had to, like, navigate what can be rescheduled, what absolutely has to be done. And so I feel like I would be able to, like, fully invest in them if I had health care versus having to, like, navigate their needs and mine at the same time.

[Soojin Pak]

Just impossible choices. Impossible choices. My heart breaks for Maya, who is facing an impossible slew of health issues within a system that seems entirely indifferent to moms or children. I couldn't believe how she kept it together in our conversation despite the obstacles she's facing. But I know she has to to for the sake of her kids. Advocates in Arkansas are hopeful women there won't have to continue making impossible choices, even with the disappointing loss in the legislature. If anything, the loss makes them more fired up. And there have been some maternal health wins in the state, like increased OBGYN reimbursement rates and Medicaid coverage for doulas and breastfeeding support services. But what would make a huge, huge impact would be reliable health coverage for new moms so they can get regular checkups, maintain their own health, and better care for their families. Currently, 48 states plus DC have implemented the 12 month extension to postpartum Medicaid coverage. Arkansas and Wisconsin are the only two states that haven't. Medicaid expansion has been shifted to lead to fewer hospitalizations for women postpartum, and that kind of care can be life saving. If you live in Arkansas, you can call your legislators to push for postpartum Medicaid extension. You can also get involved with or donate to organizations like Arkansas Advocates for Children and Families, which plans to keep fighting for this issue. Throughout this season, we've been talking about fighting back, appealing denials, tackling medical bills and defending Medicaid because it benefits all of us. These aren't just policy debates, they're about real people who deserve better. This healthcare system and its many gaps isn't our only option. We have to remember our care is a choice we're making as a country and we can choose differently. There's more Uncared for with Lemonada Premium if you haven't subscribed to Lemonada Premium yet, now's the perfect time. Because guess what? You can listen completely ad free. Plus you'll unlock exclusive bonus content like tips from health experts and caregivers that you won't hear anywhere else. Subscribe now on Apple Podcasts or head to lemonadapremium.com to subscribe on any other app or listen ad free on Amazon Music with your prime membership. That's lemonadapremium.com Uncared for is a production of Lemonada Media. I'm your host Soojin Pak Muna Danish is our senior producer. Lisa Fu and Hannah Boomershine are our producers. Our mix is by Ivan Kurayev, Engineering support from Bobby Woody. Music is by Andrea Christensen. Daughter Jackie Danziger is our VP of Partnerships and production executive. Producers are Jessica Cordova Kramer and Stephanie Wittleswax. This season of Uncared for is presented by the Commonwealth Fund, a non profit foundation working toward a health care system where everyone, no matter who they are, where they live or how much money they make, can get the health care they need. Help others find our show by leaving us a rating and writing a review. You can follow me on Instagram at SujinPak and lemonadaemonadamedia across all social platforms. This show is presented by the Commonwealth Fund, a nonprofit foundation whose mission is to promote a high performing, equitable healthcare system. The Commonwealth Fund supports research to improve health care policy and practice and has a long history of exploring what the US can learn from the best health care around the world to do better here at home, especially for people of color, people with low income and those who are uninsured. To learn more, visit commonwealthfund. Org.