05/05/1993 01:00 PM House FIN

  SB 91     An Act providing for  coverage of midwife services                 
            under   Medicaid;   reordering  the   priority  of                 
            optional  services  provided  by the  state  under                 
            Medicaid; and providing for an effective date.                     
                                                                               
            CS SS SB 91  was reported out of Committee  with a                 
            "do  pass"  recommendation and  with  three fiscal                 
            notes  by  the  Department of  Health  and  Social                 
            Services dated 3/22/93.                                            
  SENATE BILL 91                                                               
                                                                               
       "An  Act providing  for  coverage  of midwife  services                 
       under  Medicaid; reordering  the  priority of  optional                 
       services  provided  by the  state  under  Medicaid; and                 
       providing for an effective date."                                       
                                                                               
  ANNETTE KREITZER,  AIDE, SENATOR LOREN LEMAN,  commented the                 
  legislation would add certified direct entry midwives to the                 
  optional services covered by Medicaid.   At least 42% of the                 
  pregnant women in  Alaska are  eligible for  Medicaid.   The                 
  bill allows those women to use midwifery services instead of                 
  mandating that they  use clinics  or hospitals for  birthing                 
  services.    In expanding  the  options for  using midwifery                 
  services for  births, the  State will  stretch its  Medicaid                 
  dollars.                                                                     
                                                                               
  Representative  Hanley questioned the savings expected to be                 
  incurred.   Representative Therriault acknowledged  that the                 
  shift in midwife care would be for women who otherwise would                 
  go to the hospital  which would create greater costs  to the                 
  State than those opting for home delivery.                                   
                                                                               
  DAVID  WILLIAMS, PLANNER,  DIVISION  OF MEDICAL  ASSISTANCE,                 
  DEPARTMENT OF HEALTH AND SOCIAL SERVICES, commented that one                 
  hundred twenty-five Medicaid eligible women  would be giving                 
  birth each  year.   Of the  eligible women,  sixty of  those                 
  would   be  shifted  away   from  hospital  physician  costs                 
  indicated by the fiscal  note.  He pointed out,  the service                 
                                                                               
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  appeals  to  many  women  who  reject  the  current  system.                 
  Representative  Therriault  asked  if  there  were  Medicaid                 
  eligible women who do not use hospital services because they                 
  do not want  the physician  care.  Mr.  Williams said  there                 
  are.                                                                         
                                                                               
  Mr. Williams  added, women  who choose  the midwife  service                 
  will save  costs because  of the  preventative and  up-front                 
  prenatal care  the  child receives.   Representative  Hanley                 
  reiterated concerns with long term costs.                                    
                                                                               
  Representative   Brown  asked   if  midwife   services  were                 
  considered to be optional or mandatory.  Mr. Williams stated                 
  that the  intent language  recommends that  all services  be                 
  kept active with the funding available, although the service                 
  is optional with the alternatives available.                                 
                                                                               
  Representative Parnell MOVED to report CS SS SB 91 (HES) out                 
  of Committee  with individual  recommendations and  with the                 
  accompanying fiscal notes.  There being NO OBJECTION, it was                 
  so ordered.                                                                  
                                                                               
  CS SS SB 91 (HES) was  reported out of Committee with a  "do                 
  pass"  recommendation  and with  three  fiscal notes  by the                 
  Department of Health and Social Services dated 3/22/93.