SENATE BILL REPORT

SHB 1963

BYHouse Committee on Health Care (originally sponsored by Representatives Vekich, Brooks, Braddock, Morris, Bristow, Day, Sprenkle, Spanel, Wolfe, Rector, K. Wilson, D. Sommers, Cantwell, Jones, Wang, Todd, Prentice, Winsley, P. King, Heavey, Walk, Cooper, Jacobsen, R. King, Brough, Basich, Dellwo, Zellinsky, Kremen, Phillips, Pruitt, Nelson, Hine, G. Fisher, Rust, Rasmussen, Leonard, H. Myers, Fraser and Miller)

Establishing the maternity care access act.

House Committe on Health Care

Rereferred House Committee on Appropriations

Senate Committee on Ways & Means

Senate Hearing Date(s):April 13, 1989

Majority Report:  Do pass as amended.

      Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bluechel, Cantu, Hayner, Johnson, Lee, Newhouse, Owen, Saling, Smith, Warnke.

Senate Staff:Randy Hodgins (786-7715)

                  April 13, 1989

AS REPORTED BY COMMITTEE ON WAYS & MEANS, APRIL 13, 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.

Low birth weight deliveries (5.5 lbs or 2500 grams) is the major factor in infant death and illness.  Adequate maternity care is 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 costs during the first year of an infant's life.

In addition to adequate medical care, availability of support services is an important factor in having healthy babies.  These support services include the following:  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.  To provide adequate health care to low-income pregnant women and their young children, a maternity care access system is established.

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 process shall include a short and simplified application form, and the capability of determining eligibility within 15 days of application.

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 the federal Omnibus Budget Reconciliation Act of 1986.

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).

Within funds appropriated, maternity care provider reimbursement levels are established at appropriate levels.

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.

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 nonprofit entity to evaluate the maternity care access program and report to the Legislature by December 1, 1990.

Appropriation:    none

Revenue:    none

Fiscal Note:      available

SUMMARY OF PROPOSED SENATE AMENDMENTS: 

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 may develop a program that addresses maternity health care providers' liability insurance problems.

A provision is added which specifies that Medicaid Title XIX funds may not be used for terminations of pregnancy services for women on the prenatal program, but that such women are eligible for these services from other programs in the department.

DSHS is required to establish a case management system for women who are at "high risk" of having difficulty in the pregnancy.  High risk women are defined in the following order or priority:  pregnant women who are drug addicted; pregnant or parenting teens; minority women who live in poverty; and homeless pregnant women.

Provisions are deleted which provide maternity care services to eligible pregnant women from 186 percent to 200 percent of the federal poverty level, and which would establish a loan repayment program to encourage maternity care providers to practice in medically underserved areas.

The measure is made contingent upon funding in the state budget.

Senate Committee - Testified: No one