HOUSE BILL REPORT

HB 525

BYRepresentatives Brekke, Brooks, Braddock, Lewis, Moyer, Sprenkle, D. Sommers, Lux, Wang, Unsoeld, P. King, Ballard, L. Smith, Doty, Spanel, Pruitt, Leonard, Miller, Holland and Todd; by request of Department of Social and Health Services

Providing a prenatal care program.

House Committe on Health Care

Majority Report:     Do pass.  (9)

     Signed by Representatives Braddock, Chair; Day, Vice Chair; Bristow, Brooks, Bumgarner, Cantwell, Lux, D. Sommers and Sprenkle.

House Staff:Bill Hagens (786-7131)

AS REPORTED BY COMMITTEE ON HEALTH CARE FEBRUARY 25, 1987

BACKGROUND:

The purpose of this measure is to permit the Department of Social and Health Services (DSHS) to establish a comprehensive prenatal care program and to expand medicaid coverage for pregnant women and children.

The prenatal care program provides or arranges for obstetrical services for low income women in Washington state.  DSHS contracts with county health departments and local health agencies to help women seeking prenatal care enter the health delivery system.

The program was started in late 1983 because increasingly fewer women were obtaining or had access to prenatal and delivery care primarily due to lack of adequate medical coverage.  The DSHS medical assistance program provides coverage for families up to an average of 65 percent of the federal poverty level, depending on family size.  The prenatal care program's statewide income standard has been set at up to 185 percent of the federal poverty level (income of $1,117 per month for a family of two, plus $290 per month for each additional household member).

National data shows lack of prenatal care as the most significant factor of problemed births, including prematurity, infants of low birthweight, and infant deaths and disabilities.  There is a high correlation between low birthweight and infant mortality, and the lower the birthweight, the more likely neonatal intensive care will be required and the longer the stay for that care.  Additional health and developmental problems during childhood and adulthood often occur to the low birthweight infant.

In 1985, there were 3,700 babies born in Washington weighing less than 5.5 pounds, most of whom required expensive neonatal intensive care.  Costs in 1985 for newborn intensive care admissions at the University Hospital alone were nearly $12 million for 518 infants weighing less than 5.5 pounds at birth.  Approximately 42 percent of the charges were for government-sponsored clients.  The average reimbursement to contractors from the prenatal care program is $1,043 per client.

The trend of declining infant mortality has reversed over the last two years.  Infant mortality rates (deaths per 1,000 births) in Washington state went from 12.4 in 1980 to 9.5 in 1983; and increased to 10.2 in 1984 and 10.6 in 1985.  In 1985, there were 750 babies in this state who died before reaching age one.

SUMMARY:

Legislative intent is established as increasing participation of low income women in the prenatal care program.

Comprehensive prenatal care is defined to include, but is not limited to:

(1) Providing or arranging for prenatal, delivery and postpartum care;

(2) health, childbirth, and parenting education;

(3) psychosocial assessment, and when appropriate, referral to counseling; and

(4) nutrition assessment, and when appropriate, referral to food supplement and breastfeeding programs.

Eligibility standards up to 185 percent of the federal poverty level are established.  The Department of Social and Health Services (DSHS) is directed to contract with local health agencies to arrange to provide comprehensive prenatal care services.

DSHS is required to establish the program and a data system to monitor the rates of low birthweight and infant mortality and to evaluate effects of the provision of comprehensive prenatal care.

DSHS is provided with the option of providing medicaid coverage to pregnant women and children with income up to 100 percent of the poverty level, subject to available funds.  This option is offered the state as the result of provisions of the Omnibus Budget Reconciliation Act of 1986 (commonly known as SOBRA).

Fiscal Note:    Attached.

House Committee ‑ Testified For:     Patricia Wilkins, Department of Social and Health Services; Diane Yelish, Tacoma/Pierce County Health Department; Cynthia Shurtleff, March of Dimes; Darcy Norville, Evergreen Legal Services; Robert Cole, Washington State Association of Local Public Health Officials; Lois Bergerson, Prenatal Task Force of Thurston County; John LeVeque, Alliance for Children, Youth and Families; Robert Ball, Washington State Nurses Association and Ron Kero, Department of Social and Health Services.

House Committee - Testified Against: None Presented.

House Committee - Testimony For:     Prenatal health care is a proven prevention measure.

House Committee - Testimony Against: None Presented.