HOUSE BILL REPORT

E2SSB 6128

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Brief Summary of Engrossed Second Substitute Bill

(As Amended by Committee)

Requires the Health Care Authority (HCA) to submit a waiver request to the Centers for Medicare and Medicaid Services to allow for the state to receive federal financial participation for the Medicaid postpartum coverage for the period from 60 days post pregnancy to 12 months post pregnancy, and report to the Legislature on the status of the waiver request by January 1, 2021.
Upon the availability of federal financial participation, the HCA must expand health care coverage to 12 months post pregnancy for pregnant and postpartum persons with a countable income at or below 193 percent of the federal poverty level (FPL).

Majority Report: Do pass as amended. Signed by 31 members: Representatives Ormsby, Chair; Robinson, 1st Vice Chair; Bergquist, 2nd Vice Chair; Stokesbary, Ranking Minority Member; MacEwen, Assistant Ranking Minority Member; Rude, Assistant Ranking Minority Member; Caldier, Chopp, Cody, Corry, Dolan, Dye, Fitzgibbon, Hansen, Hoff, Hudgins, Kilduff, Macri, Mosbrucker, Pettigrew, Pollet, Ryu, Schmick, Senn, Springer, Steele, Sullivan, Sutherland, Tarleton, Tharinger and Ybarra.

Background:

Medicaid is a program administered jointly by the federal and state governments to provide health coverage to low-income individuals. Washington's Medicaid program is known as Apple Health, which offers eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women a complete medical benefits package.

Apple Health provides coverage to pregnant individuals with countable income at or below 193 percent of the federal poverty level (FPL), regardless of citizenship or immigration status. Once an individual is enrolled, they are covered regardless of any change in income through the end of the month, following the sixtieth day after the pregnancy end date.

The 2016 Legislature established the Maternal Mortality Review Panel (Panel) to review and identify factors associated with maternal deaths occurring in the state, and to make recommendations to improve healthcare for women. The Panel's 2019 report to the Legislature included a recommendation to ensure funding for and access to postpartum care and support for 12 months after the end of pregnancy.

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Summary of Amended Bill:

The Health Care Authority (HCA) must submit a waiver request to the Centers for Medicare and Medicaid Services to allow for the state to receive federal financial participation for the coverage period past 60 days to one year post pregnancy, and report to the Legislature on the status of the waiver request by January 1, 2021. Once federal financial participation is available, the HCA must provide health care coverage up to 12 months post pregnancy to pregnant and postpartum persons with a countable income at or below 193 percent of the FPL.

Amended Bill Compared to Engrossed Second Substitute Bill:

The state-only funded program that ramps up eligibility requirements from 138 percent of the FPL to 193 percent of the FPL over four years to provide 12 months of postpartum Medicaid coverage is removed.

Effective Date of Amended Bill: This bill takes effect 90 days after adjournment of the session in which the bill is passed, except for section 2, relating to post partum coverage, which takes effect upon state eligibility for certain additional federal financial participation.

Staff Summary of Public Testimony:

(In support) This bill extends Medicaid postpartum coverage from the current 60 days post pregnancy to 12 months post pregnancy. The bill includes the same eligibility standards for the coverage, but the standards are phased in over four years. A mother's health needs continue over the first year postpartum. This is a particularly vulnerable time as the mother is caring for her child and still recovering. At the two-month period, there are gaps in coverage for many mothers, which has a negative impact on access to care and health. The Panel identified extending coverage to 12 months after the end of pregnancy as one of their recommendations. The Panel also found that 30 percent of maternal deaths occur between 43 days and 365 days postpartum and that there are significant racial disparities in maternal deaths.

Many pregnant women who are uninsured or underinsured are provided supplemental Medicaid coverage. When this coverage drops off at two months postpartum it can be very expensive for the family. Postpartum anxiety is an underdiagnosed condition and many mothers do not realize that they have it until six months postpartum.

(Opposed) None.