SENATE BILL REPORT

SB 6080

BYSenators Smith and Vognild

Relating to maternity care of women and children.

Senate Committee on Children & Family Services

Senate Hearing Date(s):March 1, 1989

Majority Report:  That Substitute Senate Bill No. 6080 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.

      Signed by Senators Smith, Chairman; Craswell, Vice Chairman; Bailey, Stratton, Vognild.

Senate Staff:Jennifer Strus (786-7472)

                  March 1, 1989

Senate Committee on Ways & Means

Senate Hearing Date(s):March 20, 1989; March 21, 1989

Majority Report:  That Substitute Senate Bill No. 6080 as recommended by Committee on Children & Family Services be substituted therefor, and the substitute bill do pass.

      Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Fleming, Gaspard, Hayner, Johnson, Lee, Moore, Newhouse, Niemi, Owen, Saling, Smith, Talmadge, Warnke, Williams, Wojahn.

Senate Staff:Randy Hodgins (786-7438)

                  March 22, 1989

AS REPORTED BY COMMITTEE ON WAYS & MEANS, MARCH 21, 1989

BACKGROUND:

Access to maternity care (prenatal, delivery, and postpartum) has become increasingly difficult for low-income women.  Of the 70,000 births in Washington State during 1988, approximately 9,000 were delivered without consistent maternity care.  Washington State has a higher rate of infant mortality than the national average.  This is particularly important when the United States, as a whole, has one of the highest rates of infant mortality among industrialized nations.

Low birth weight deliveries (5.5 lbs or 2500 grams) are identified as the major factor in infant death and illness.  Adequate maternity care is identified as an effective tool in reducing low birth weight deliveries.  It is estimated that for every $1.00 spent on prenatal care, over $3.00 are saved in medical cost during the first year of an infant's life.

In addition to adequate medical care, availability of support services is identified as an important factor in having healthy babies.  These include:  education, nutrition counseling, transportation, child care, and other services.

Recent changes to federal Medicaid law permit a state to expand its federally matched program for low-income pregnant women and their children.  A state is now able to extend Medicaid coverage to pregnant women and children, under the age of one, whose income is below 185 percent of the federal poverty level (FPL), and children up to age eight below 100 percent FPL.

SUMMARY:

The Legislature finds that there is a high rate of infant death and illness in the state of Washington.  Further, this problem is closely related to the lack of adequate maternity care.  Access to prenatal care for low-income and high risk pregnant women in the state has declined significantly and has reached a crisis level.

The Department of Social and Health Services (DSHS), within funds appropriated for this purpose, is required to establish a maternity care access program with the following features:  providing maternity care to low income women, and health care to their children to the extent made possible by federal law and having in place, by December 1, 1989, a system that expedites the medical assistance eligibility process for pregnant women.  This process shall include a short and simplified application form, and the capability of determining eligibility within 15 days of application.

DSHS is required to study the desirability and feasibility of implementing the presumptive eligibility provisions for pregnant women, recently made possible by federal Omnibus Budget Reconciliation Act.

DSHS is required to establish a case management program for women who are at high risk of having difficulty in the pregnancy.  High risk women are defined in the following order of priority:  pregnant women who are drug addicted; pregnant or parenting teens; minority women who live in poverty; and homeless pregnant women.  Treatment for pregnant women who are substance abusive is provided through funding included in the Omnibus Drug Act (SB 5832).

Maternity care provider reimbursement levels are established at appropriate levels, consistent with available funds.

Areas of the state where the lack of access to maternity care is at a crisis proportion are designated as distressed areas. DSHS, in cooperation with the affected counties and a variety of community interests and within funds appropriated for this purpose, shall develop an alternative service plan to alleviate the shortage.  Criteria for designating a county or group of counties as a distressed area is provided in the act.  If necessary to ensure maternity care access, DSHS may contract with or directly employ health practitioners to provide maternity care.  In the latter case, DSHS may pay a related portion of the practitioner's liability insurance.

DSHS is permitted to increase health care provider's reimbursement levels under Title XIX to the extent funding is permitted for this purpose.  In addition, DSHS may develop a program that addresses maternity health care providers' liability insurance problems.

DSHS is required to contract with an independent nonprofit entity to evaluate the maternity care access program and report to the Legislature by December 1, 1990.

EFFECT OF PROPOSED SUBSTITUTE:

The intent section states that Washington State has a high rate of infant illness and death and that this is especially true for low-income women.

The department in its discretion is to outstation staff to make eligibility determinations.

The department is to establish a maternity care case management and support system that shall assist only high risk persons with obtaining medical assistance benefits and receiving maternity care services.

Appropriation:    none

Revenue:    none

Fiscal Note:      none requested

Senate Committee - Testified: CHILDREN & FAMILY SERVICES:  Dr. Maxie Hayes, Bureau of Parent & Child Health Services (pro); Ron Kero, Division of Medical Assistance (pro); Len Eddinger, Washington State Medical Association (pro); Dr. Roger Roseblatt (pro); Kay Koombs, Clark County (pro)

Senate Committee - Testified: WAYS & MEANS:  John Pinette, et. al, Prenatal Plus Partnership (pro); Elain Morgan, Kitsap Prenatal Care Program (pro); Willa A. Fisher, MD, Washington State Association of Local Public Health Officials (pro); Bob Lolcama, Department of Social and Health Services (pro); Bob Crittenden, Governor's Office (pro); Roger Rosenblatt, University of Washington Department of Family Medicine (pro); Barbara Bates, WSMA, WSOA, WAFP (pro); Yvonne Spies, Planned Parenthood Affiliates of Washington (pro); Rosanne Croft, Tacoma-Pierce County Health Department (pro); Nancy Chemy, Tacoma-Pierce County Health Department (pro); Patricia Brown, Community Health Centers of Snohomish County (pro); Pat Thibaudeau, Washington Women United (pro); Thomas Trumpeter, Washington State Primary Care Association, Prenatal Plus Partnership (pro)