S.B. NO.



S.D. 2


H.D. 1














SECTION 1. The legislature finds that women who are ineligible for post-partum health coverage struggle to get necessary care during the fourth trimester, the twelve weeks following childbirth. The legislature notes that these twelve weeks are a critical time as women are more likely to die of pregnancy-related conditions during this time than during pregnancy or childbirth. Drug overdoses, suicides, and pregnancy-related chronic illnesses including diabetes, heart disease, and high blood pressure contribute to a rise in deaths among women during pregnancy, childbirth, and the first twelve months after childbirth.

The legislature also finds that, according to the United States Centers for Disease Control and Prevention, adequate medical attention could prevent three out of five post-partum deaths. Further, medicaid pregnancy coverage, which pays for nearly half of all births in the United States, expires sixty days after childbirth, leaving many women without health insurance during this vulnerable time. Although women may reapply as a parent after this sixty-day time period, because the income limit for parents is lower, many women are unable to qualify for coverage as a parent. However, policymakers in at least six states, including California, Illinois, Missouri, New Jersey, South Carolina, and Tennessee, are working to extend medicaid coverage to a full year after childbirth. Health agencies in Georgia, Texas, Utah, and Washington are making similar efforts.

The legislature acknowledges that, according to the health care advocacy group Commonwealth Fund, maternal mortality rates, including deaths during and up to one year after pregnancy, are higher in the United States than in other developed nations. Additionally, while pregnancy-related death rates have dropped worldwide over the past thirty years, these rates have more than doubled in the United States. According to the United States Centers for Disease Control and Prevention, the number of deaths per one hundred thousand live births in the United States has risen from seven in 1987 to seventeen in 2016.

Accordingly, the purpose of this Act is to extend the state-funded medical assistance and medicaid insurance coverage provided to eligible pregnant women for up to twelve months post-pregnancy in certain circumstances.

SECTION 2. Section 346-70, Hawaii Revised Statutes, is amended to read as follows:

"[[]346-70[]] Medical assistance for other pregnant women. (a) The department may provide state-funded medical assistance to a pregnant woman age nineteen years of age or older whose countable family income does not exceed one hundred and eighty-five per cent of the federal poverty level for a family of applicable size, including the expected unborn children. The pregnant woman shall be:

(1) A legal immigrant who entered the United States on or after August 22, 1996; and

(2) Otherwise eligible for benefits under the State's medicaid program but is prohibited from participating in any medical assistance program under title XIX of the Social Security Act for a period of five years beginning on the date of her entry into the United States, due to restricted eligibility rules imposed by title XIX of the Social Security Act and the Personal Responsibility and Work [[]Opportunity[]] Reconciliation Act of 1996.

(b) Once determined eligible for medical assistance under this section, the pregnant woman shall continue to be eligible throughout her pregnancy and through the last day of the calendar month in which the sixty-day period following childbirth ends.

(c) Any woman who is enrolled in medicaid insurance coverage during her pregnancy shall be eligible for medical assistance under this section for a period ending twelve months following the end of pregnancy, using the same eligibility criteria that qualified her for pregnancy coverage.

(d) Any woman who is enrolled in medicaid insurance coverage during her pregnancy, or any newborn child of that woman, may be eligible for additional medical assistance under this section for any health‑related issues that arise from the mother's use of alcohol, tobacco, or opioids during the pregnancy.

[(c)] (e) Assets shall not be evaluated for eligibility purposes.

[(d)] (f) The director shall adopt rules pursuant to chapter 91 to determine eligibility for medical assistance."

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 2020-2021 for the purposes of this Act.

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

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect on July 1, 2050.



Report Title:

Department of Human Services; Pregnancy; State-Funded Medical Assistance; Medicaid Coverage; Appropriation



Extends the state-funded medical assistance provided to pregnant women for up to twelve months post-pregnancy in certain circumstances. Allows additional medicaid insurance coverage to women and their newborn children for health-related issues because of tobacco, alcohol, or opioid use during pregnancy. Appropriates funds. Effective 7/1/2050. (HD1)




The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.