STAND. COM. REP. NO.460

Honolulu, Hawaii

, 2003

RE: S.B. No. 956

S.D. 1

 

 

Honorable Robert Bunda

President of the Senate

Twenty-Second State Legislature

Regular Session of 2003

State of Hawaii

Sir:

Your Committees on Human Services and Health, to which was referred S.B. No. 956 entitled:

"A BILL FOR AN ACT RELATING TO PRESUMPTIVE MEDICAID ELIGIBILITY FOR PREGNANT WOMEN,"

beg leave to report as follows:

The purpose of this measure is to require the Department of Human Services to provide presumptive Medicaid or QUEST coverage to Medicaid-eligible pregnant women.

Testimony in support of this measure was submitted by the Healthy Mothers, Healthy Babies Coalition of Hawaii; March of Dimes, Hawaii Chapter; Good Beginnings Alliance; Hawaii Substance Abuse Coalition; Waianae Coast Comprehensive Health Center; and the Kalihi Palama Health Center. Testimony in support of the intent of this measure was submitted by HMSA. Testimony in opposition to this measure was submitted by the Department of Human Services (Department).

Your Committees find that early access to affordable prenatal care is critical to the health of both mother and baby. Through regular prenatal visits, potential problems can be detected and treated early and at significantly less cost. Left undetected or untreated, these potential problems can develop into serious complications with possible long-term impacts on both mother and baby, with the costs of treatment borne by Medicaid.

In Hawaii, Medicaid already pays the costs of 25% of all births, 38% of all births with complications costing $50,000 or more, and 75% of all births with complications costing $1 million or more. By contrast, prenatal care is relatively inexpensive, averaging just $1,800 for the entire pregnancy. Clearly, the State has an interest in ensuring that Medicaid-eligible pregnant women have early access to prenatal care.

Your Committees find that, despite a recently-enacted simplified Medicaid application form that was supposed to expedite the determination of Medicaid eligibility, health care providers continue to report that eligibility processing of Medicaid applications for some pregnant women can take four to six weeks or longer. This delay can result in a pregnant woman delaying seeking prenatal care, if she is told she will be billed, and she cannot afford to pay. Some providers may limit or delay recommended prenatal services, such as labwork, medications, and diagnostic tests, if a woman is not yet Medicaid-eligible. Some providers may simply refuse to see an uninsured pregnant woman.

Your Committees further find that the Department is currently working on a plan to expedite the processing of applications from pregnant women, not only from hospitals and community health centers, but also from independent providers in the community. The Department is also planning to conduct a campaign to raise awareness among health care providers about the expedited processing for Medicaid-eligible pregnant women. Because the Department does not yet have a firm timetable for plan completion and implementation of expedited processing for Medicaid-eligible pregnant women, however, your Committees are passing this measure out to facilitate further discussion.

Your Committees have amended this measure by:

(1) Amending section 1 by changing the word "perinatal" to "prenatal" for consistency;

(2) Amending section 2 by specifying the criteria that a pregnant woman must satisfy to be found presumptively eligible;

(3) Providing that infants of pregnant women presumptively covered by Medicaid or QUEST shall also be deemed presumptively eligible for coverage, and shall be processed for coverage under the State Children's Health Insurance Program;

(4) Clarifying that reimbursement payments to health care providers for prenatal care provided to a presumptively eligible pregnant woman shall be based on reimbursement standards for prenatal care established by the Department of Human Services;

(5) Directing the Department of Human Services to explore modifying the State Children's Health Insurance Program to permit coverage of pregnant women and their infants; and

(6) Making technical, nonsubstantive stylistic changes.

As affirmed by the records of votes of the members of your Committees on Human Services and Health that are attached to this report, your Committees are in accord with the intent and purpose of S.B. No. 956, as amended herein, and recommend that it pass Second Reading in the form attached hereto as S.B. No. 956, S.D. 1, and be referred to the Committee on Ways and Means.

Respectfully submitted on behalf of the members of the Committees on Human Services and Health,

____________________________

ROSALYN H. BAKER, Chair

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SUZANNE CHUN OAKLAND, Chair