HOUSE OF REPRESENTATIVES

H.C.R. NO.

204

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 
   


HOUSE CONCURRENT

RESOLUTION

 

REQUESTING THE AUDITOR TO ASSESS THE IMPACT OF THE DEPARTMENT OF HUMAN SERVICES' POLICY OF EXPEDITED PROCESSING OF APPLICATIONS RECEIVED FROM PREGNANT WOMEN USING THE "MEDICAL ASSISTANCE APPLICATION FOR CHILDREN AND PREGNANT WOMEN ONLY" FORM ON EARLY ENTRY INTO PRENATAL CARE AND SUBSEQUENT BIRTH OUTCOMES.

 

WHEREAS, while not interchangeable, prematurity (infants born prior to 37 weeks gestation) and low birth weight (less than 5.5 pounds at birth) are often interrelated, as more than 66% of babies who are born with low birth weight are also premature, and more than 43% of babies who are born premature also have low birth weight; and

WHEREAS, the combination of premature birth and low birth weight was the leading cause of neonatal mortality in the U.S. in 2000, accounting for 23% of deaths in the first month of life; and

WHEREAS, premature birth is a leading challenge in pediatrics, accounting for substantial long-term disabilities such as mental retardation, cerebral palsy, vision and hearing problems, and chronic lung disease; and

WHEREAS, the rate of premature birth is rising both in Hawaii and nationally, with over 2,150, or one of every eight, infants (12.8%) born in Hawaii in 2001 born before 37 weeks gestation; and

WHEREAS, according to the Hawaii Health Information Corporation, initial hospital discharge costs for the more than 17,000 infants born in Hawaii in 2001 approached $70 million, and the costs associated with caring for the approximately 2,900 of these infants that were classified at birth as "sick" babies were estimated at $53 million; and

WHEREAS, according to the Hawaii Health Information Corporation, almost $43 million (81%) of the cost for caring for these "sick" babies was associated with low birth weight, and $18 million (42%) of that cost was paid by taxpayer dollars (Medicaid and QUEST); and

WHEREAS, known risks for the mother associated with premature birth include, among others, a history of premature birth and various behavioral or medical conditions, such as cigarette smoking or illegal drug use during pregnancy, certain maternal infections, diabetes, anemia, high blood pressure, and other chronic diseases; and

WHEREAS, the affects of these known risk factors may be ameliorated with early intervention by prenatal care providers; and

WHEREAS, infants born to mothers receiving late or no prenatal care are twice as likely to be born with low birth weight as infants born to women who receive early prenatal care; and

WHEREAS, early and continuous prenatal care for pregnant women is the nationally recommended best practices standard maintained by virtually all maternal and child health organizations; and

WHEREAS, lack of insurance and accessibility to health care early on in a pregnancy were among the most common barriers identified that pregnant women faced when seeking timely prenatal care in Hawaii, according to a January 2004 report of the Department of Health; and

WHEREAS, Chapter 346, Hawaii Revised Statues, requires the Department of Human Services to "administer the medical assistance programs for eligible public welfare and other medically needy individuals" and to "expand optional health care to low income persons," including pregnant women and infants; and

WHEREAS, efforts to enact legislation during the 2003 Legislative Session requiring the Department of Human Services to "presume that a pregnant woman applying for Medicaid or QUEST coverage for prenatal care or medically indicated services related to the pregnancy is eligible for coverage" led to a compromise whereby the Department of Human Services has implemented an expedited application process for pregnant women seeking health insurance coverage through Medicaid or QUEST; and

WHEREAS, health care providers serving pregnant women and community-based prenatal care advocacy groups in Hawaii remain concerned about the adequacy of this program to satisfactorily impact the problems for pregnant women seeking timely access to prenatal care under Medicaid or QUEST; now, therefore,

BE IT RESOLVED by the House of Representatives of the Twenty-Second Legislature of the State of Hawaii, Regular Session of 2004, the Senate concurring, that the Auditor is requested to evaluate the impact of the Department of Human Services' policy of expedited processing of applications received from pregnant women using the "Medical Assistance Application for Children and Pregnant Women Only" form on reducing the waiting period for Medicaid or QUEST enrollment and subsequent initiation of prenatal care; and

BE IT FURTHER RESOLVED that this evaluation is requested to include, but not be limited to:

(1) An assessment of this policy as currently implemented against the standard of presumptive eligibility with respect to timely access to and utilization of prenatal care;

(2) A quality assurance survey of both public- and privately-funded prenatal care providers to determine provider satisfaction with implementation of this policy; and

(3) An assessment of the impact of this expedited policy on the timely review and determination of eligibility of applications received by applicants that are not applying through the expedited process, e.g., those applicants who are not pregnant at the time of application; and

BE IT FURTHER RESOLVED that the Auditor is requested to report findings and recommendations, including proposed legislation, to the Legislature no later than twenty days before the convening of the Regular Session of 2005; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and the Director of Human Services.

 

 

 

OFFERED BY:

_____________________________

Report Title:

Auditor; Department of Human Service; Expedited application process for pregnant women seeking health insurance coverage through Medicaid or QUEST.