Medicaid Coverage for Pregnant and Postpartum Persons.
The Health Care Authority (HCA) administers the Medicaid program, which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria. Washington's Medicaid program, known as Apple Health, offers a complete medical benefits package to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant persons. Apple Health provides coverage to pregnant individuals with countable income at or below 193 percent of the federal poverty level. Once an individual is enrolled, the person remains continuously eligible for 12 months following the end of a pregnancy, regardless of any change in income during that period.
Maternity Support Services Program.
Under the state's Maternity Care Access Act, the HCA established First Steps to provide access to services for eligible clients and their infants. The Maternity Support Services Program is a component of First Steps and delivers enhanced preventive health and education services and brief interventions to eligible pregnant clients to improve and promote healthy birth outcomes. The services are provided as early in pregnancy as possible, based on the client's individual risks and needs. State regulations establish client eligibility, qualifications, and requirements for providers to participate, and documentation and reimbursement requirements.
By January 1, 2026, the Health Care Authority (HCA) must create a postdelivery and transitional care program (postdelivery program) that allows for extended postdelivery hospital care for individuals with substance use disorder at the time of delivery. In administering the postdelivery program, the HCA must seek any available federal participation through Medicaid or other federal funding sources. The HCA must:
Subject to appropriated funds, the HCA must update the Maternity Support Services Program (MSS Program) to address perinatal outcomes and increase equity and healthier birth outcomes. By January 1, 2026, the HCA must:
By November 1, 2024, the income standards for pregnant and postpartum persons eligible for Apple Health pregnancy and postpartum coverage is increased to a countable income equal to or below 210 percent of the federal poverty level.
The striking amendment delays the date that the Health Care Authority must create a postdelivery and transitional care program and update the maternity support services program by one year to January 1, 2026.
(In support) There is a lot of excitement for this bill because many have been working for years to expand Medicaid access for pregnant and postpartum individuals. While the state has made strides in this area, 80 percent of pregnancy related deaths are preventable and are often linked to behavioral health conditions. This coverage can significantly improve the health of parents and young children. This bill expands wraparound services to patients who need extra support to match the latest standards of care.
This bill takes three different approaches to improve health outcomes for babies and families to give them the best start possible.
Section 1 of the bill directs the Health Care Authority to establish a postdelivery hospital program. There is a compassion model used currently that provides a five-day postpartum floor hospital stay to provide comprehensive, compassionate, and respectful whole-person care. This model should be extended to offer whole-person care to all mothers to encourage and empower them to offer care to their families.
(Opposed) None.
Lee Che Leong, Northwest Health Law Advocates; Siri Larson Iverson, Midwives Association of Washington State; and Vania Rudolf, Washington Society of Addiction Medicine.
The bill contains a null and void clause requiring specific funding be provided in the omnibus appropriation act.
(In support) None.
(Opposed) None.