SENATE BILL REPORT

ESB 6106

BYSenator McDonald

Relating to social and health services.

Senate Committee on Ways & Means

Senate Staff:Randy Hodgins

                  April 22, 1989

House Committe on Health Care

AS PASSED SENATE, APRIL 19, 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 and that this is especially true for low-income women.  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 within funds provided and 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 the federal Omnibus Budget Reconciliation Act of 1986.

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 of priority:  drug addicted or affected pregnant women; 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 (HB 1793).

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.

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

A provision is added which specifies that Medicaid Title XIX funds shall 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 currently existing programs in the department.

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

Appropriation:    none

Revenue:    none

Fiscal Note:      available

HOUSE AMENDMENT:

The House amendment adds a provision which requires DSHS to provide maternity care services to low-income women who are not eligible to receive such services under the Title XIX Medicaid program.

A provision is deleted which specifies that Medicaid Title XIX funds shall 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 currently existing programs in the department.

In addition, the amendment deletes provisions which define "high risk" women in terms of the establishment of a case management system for such women who are having difficulty in the pregnancy, as well as provisions which provide for health care provider availability and liability insurance.

To the extent federal matching funds are available, the department is required to establish a loan repayment program to encourage maternity care providers to practice in medically underserved areas.