Report Title:

Post-partum and Interconception Care; QUEST



Requires not less than 6 months post-partum and interconception care for women of childbearing age who are participants in the Hawaii QUEST health insurance program.  Defines "interconception care."  Requires department of human services to adopt rules.  Appropriation.



H.B. NO.














relating to women's health.





     SECTION 1.  The legislature finds that improving the health of women in the State can improve the quality of health for families and the community.  Nationwide, more than twenty million low-income women receive health coverage and long-term care through medicaid, the nation's public health insurance program for the low-income population.  Although medicaid is not typically considered a women's health program, sixty-nine per cent of its adult beneficiaries are women.  Medicaid provides a wide range of health services for women including primary care, pregnancy care, reproductive health care, care for chronic conditions and disabilities, assistance with medicare costs, and long-term care.  In general, compared to the total population, women participants in the medicaid program tend to be poor, minorities, and mothers.  In Hawaii, the medicaid program is implemented through the QUEST program.

     According to data on 52,932 women in Hawaii who gave birth to children from 2004 to 2006, compared with other women who have recently given birth but were covered under other health insurance, similar women under Hawaii's QUEST health insurance program were:

     (1)  Three times less likely to access prenatal care in the first trimester of pregnancy;

     (2)  Just as likely to have their infants receive their first well-baby check, but are twice as likely not to have received the recommended post-partum check for new mothers;

     (3)  One-and-a-half times more likely to have an unintended pregnancy;

     (4)  At three to four times and two to three times higher risk of being abused before becoming pregnant by their former and current spouses, respectively;

     (5)  At three to four times higher risk of experiencing intimate partner violence while pregnant;

     (6)  One-and-a-half times more likely to require dental services during pregnancy;

     (7)  Three times more likely to smoke during the last three months of pregnancy;

     (8)  Three to four times more likely to use illicit drugs during pregnancy;

     (9)  Twice as likely to experience post-partum depression;

    (10)  Twice as likely not to have initiated breastfeeding; and

    (11)  Ten per cent more likely to have a low birthweight or premature infant.

     The legislature also finds that pregnancies that recur within a short period of time place great stress on mothers and their infants.  Interconception care, or the full scope of preventive and primary care services for women between pregnancies, provides additional intensive interventions to women who have had a previous pregnancy that ended in an adverse outcome, which is an important predictor of future reproductive risk.

     The purpose of this Act is to extend post-partum and interconception care from eight weeks to six months for all women of childbearing age who participate in Hawaii's QUEST program.

     SECTION 2.  Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§346-    QUEST program; post-partum and interconception care; definition; rules.  (a)  Each female participant of childbearing age under the QUEST program shall be provided with not less than six months of post-partum and interconception care.

     (b)  For the purpose of this section, the term "interconception care" means the full scope of preventive and primary care services for women between pregnancies.

     (c)  The department shall adopt rules to implement the purposes of this section, including determining the age range of childbearing women."

     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 2008-2009 for providing not less than six months of post-partum and interconception care for women of childbearing age who participate in Hawaii's QUEST program.

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

     SECTION 4  New statutory material is underscored.

     SECTION 5.  This Act shall take effect upon its approval, except that section 3 shall take effect on July 1, 2008.