FINAL BILL REPORT

HB 2244

                                 C 10 L 89 E1

BYRepresentatives Vekich, Anderson, Braddock, Hine, Dellwo, Jones, Fraser, K. Wilson, Nelson, Jacobsen, Sayan, R. King, Rust, Prentice, Wang, Cole, P. King, Zellinsky, R. Fisher, Appelwick, Pruitt, Cooper, H. Myers, Valle,  Leonard, Nutley, Spanel, Raiter, G. Fisher, Sprenkle, Morris and Rector

Providing for maternity care for low-income families.

House Committe on Health Care

Senate Committee on Ways & Means

SYNOPSIS AS ENACTED

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 spent on prenatal care, over $3 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 1, whose income is below 185 percent of the federal poverty level (FPL), and children up to age 8 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.  To provide adequate health care to low-income pregnant women and their young children, a maternity care access system is established.

Nothing in this act creates a vested right that cannot be repealed by the Legislature.  Definitions of "at risk person," "eligible person," "maternity care services," and "support services" are provided.

The Department of Social and Health Services (DSHS) 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 shall include a short and simplified application form, and the capability of determining eligibility within 15 days of application.

DSHS is required to refer eligible persons to persons, agencies or organizations with maternity care service practices that primarily emphasize healthy birth outcomes.

The Department of Social and Health Services is required to study the desirability and feasibility of implementing the presumptive eligibility provisions for pregnant women, recently made possible by federal Medicaid law.

The Department of Social and Health Services is required to establish a case management program for women who are at risk of having difficulty in the pregnancy.  Treatment for pregnant women who are substance abusive is provided through funding included in the Omnibus Drug Act (HB 1793).

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, 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.

To the extent federal matching funds are available, DSHS, or its successor, shall develop a health education loan repayment program to assist maternity care providers who agree to practice in underserved areas.

The Department of Social and Health Services is required to contract with an independent non-profit entity to evaluate the maternity care access program and report to the Legislature by December 1, 1990.

VOTES ON FINAL PASSAGE:

      House 77  18

      Senate    41     1 (Senate amended)

      House 83  12 (House concurred)

EFFECTIVE:August 9, 1989