Report Title:

Medicaid

Description:

Requires the department of human services to provide presumptive Medicaid or QUEST coverage to certain pregnant women. (SB2140 HD1)

THE SENATE

S.B. NO.

2140

TWENTY-FIRST LEGISLATURE, 2002

H.D. 1

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 one thousand two hundred pregnant women applied for QUEST coverage in the first three quarters of 2001, and of this number, approximately sixty-seven per cent (eight hundred five) were approved for QUEST, while approximately three hundred sixty-three (thirty per cent) pregnant women were denied or discontinued from QUEST. From 1998-2000, there were four hundred fifty to five hundred uninsured, self-paying women yearly who delivered babies in Hawaii, out of seventeen thousand four hundred forty 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 one thousand two hundred fifty 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 to $80 a visit, which is very cost effective compared to the costs of either extended mother or infant care in an acute care facility.

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 medicaid eligible.

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 state children's health insurance program 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. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2002-2003 for the department of human services to hire additional eligibility workers and clerks for each island to manage the additional caseload.

The sum appropriated shall be expended by the department of human services for the purposes of this Act.

SECTION 4. This Act shall take effect on July, 1, 2002.