Report Title:

Medicaid

Description:

Requires the department of human services to provide presumptive Medicaid or QUEST coverage to certain pregnant women.

THE SENATE

S.B. NO.

2140

TWENTY-FIRST LEGISLATURE, 2002

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

RELATING TO PRESUMPTIVE MEDICAID ELIGIBILITY FOR PREGNANT WOMEN.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The Legislature finds that it is in the State's best interests to ensure that pregnant women and their infants receive appropriate perinatal care in order to prevent developmental disabilities and reduce costs of care due to preventable poor perinatal outcomes. With increased health care coverage of pregnant women, babies will be born in better health and both mother and infant will require less medical care post-delivery.

It has been established nationally that early and continuous prenatal care for pregnant women is recommended as a standard of care by virtually all maternal and child health organizations. Data collected by the National Governors Association Center for Best Practices, Health Policy Studies Division found that as of October 2000, thirty states include presumptive eligibility for pregnant women in their Medicaid programs.

Prior to 1995, presumptive eligibility for prenatal care for pregnant women existed under the department of health's Medicaid Options for Mothers and Infants ("MOMI") Program. During this time, the State reported experiencing significant improvements in birth outcomes and cost-savings via reductions of poor birth outcomes for low-income women and their families.

With the advent of the State's QUEST program, in 1994, the MOMI Program was terminated, along with presumptive eligibility for prenatal care for Hawaii's pregnant women. While the department of human services has made efforts since that time to address systemic application processing delays for pregnant women, the QUEST application processing time currently averages from four to six weeks, and can be longer in some circumstances. During this application processing period, pregnant women do not know if they will be found eligible for QUEST. This may be a barrier to seeking timely prenatal care, especially for women who lack the income to pay prenatal care bills should they be found ineligible and be held personally responsible for the costs of care.

Over 1,200 pregnant women applied for QUEST coverage in the first three quarters of 2001, and of this number, approximately sixty-seven per cent (805) were approved for QUEST, while approximately 363 (thirty per cent) pregnant women were denied or discontinued from QUEST. From 1998-2000, there were 450-500 uninsured, self-paying women yearly who delivered babies in Hawaii, out of 17,440 annual live births.

Early and continuous prenatal care for pregnant women is the primary cost-effective method for preventing low birthweight and poor birth outcomes. Infants born to mothers receiving late or no prenatal care are estimated to be twice as likely to be low birthweight as those born to mothers receiving early and regular prenatal care. Low birthweight has been determined nationally as one of the top three most expensive reasons for hospital stays in the United States, with higher infant birthweights correlated with lower resulting health care costs for infants post-delivery.

Approximately seven and one-half per cent of all Hawaii babies are born with low birthweight (less than five pounds). In Hawaii, during 1998-2000, approximately 1,250 infants a year were born weighing less than five pounds. Over $70,000,000 was spent in Hawaii in the year 2000 alone in newborn infant care post-delivery. One in four babies born in Hawaii between 1998-2000 were QUEST-insured babies; however, QUEST currently pays for the care of approximately one-third of all babies with hospital charges of over $50,000.

The current cost for prenatal visits in Hawaii now average between $65 - $80 a visit, which is very cost effective compared to the costs of either extended mother or infant care in an acute care facility.

The purpose of this Act is to rescind the waiver of presumptive eligibility and restore it to pregnant women and their infants applying for QUEST coverage in Hawaii.

SECTION 2. The department of human services shall provide presumptive Medicaid or QUEST coverage to pregnant women for prenatal and other medically indicated services, provided that applicants are able to show proof of:

(1) An annual income at or below the maximal allowable by federal law and under the section 1115 waiver; and

(2) Confirmation of a pregnancy test or health care examination indicating pregnancy.

All eligible women shall be provided immediate presumptive eligibility at the time of their Medicaid application, and shall be notified within forty-five days of their eligibility for continuing coverage under either Medicaid or QUEST.

Infants of women presumptively covered by QUEST shall also be deemed eligible for services, and shall be processed for SCHIP coverage. Prenatal care coverage for these women shall be reimbursed based on established best practice standards of the American College of Obstetrics and Gynecology for normal or at-risk pregnancy guidelines.

The department of human services shall explore modifying its SCHIP Program to permit coverage of pregnant women and their infants.

SECTION 3. This Act shall take effect upon its approval.

INTRODUCED BY:

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