Legislature(1993 - 1994)
03/19/1993 01:35 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
The first order of business was SSSB 91 (MEDICAID COVERAGE OF MIDWIFE SERVICES), sponsored by Senator Leman. ANNETTE KREITZER, legislative staff to Senator Leman, explained the bill would add midwives to the category of optional providers to be covered under Medicaid. It would also realign the priority of payments under Medicaid so that midwives are the lowest priority when the funds are distributed. KAYE KANNE, Certified Direct-Entry Midwife, Chair, Certified Direct-Entry Midwifery Board, said the improvement in the outcome of pregnancies resulting from the greater use of well trained midwives has become increasingly evident. She discussed the benefits and the use of midwifery in other countries. Ms. Kanne said it is obvious from the good outcomes of infants delivered by midwives that we could reduce the numbers of new born infants requiring intensive care by increasing the number of midwives and expanding the services offered by them. She noted a 1989 study by the Health Insurance Association of America (HIAA) sights a number of ways that the U.S. can save money in health care. A midwife's fee typically covers more time spent with a woman during pregnancy and after the birth, and the fee is much lower than that of a physician's fee. Ms. Kanne said midwives rely much less on technical procedures but can access them if necessary. She continued to discuss the savings in dollars if midwives are used and urged passage of the legislation. Number 080 STACIE MENDEZ, mother of two, indicated her children were born under the Medicaid Program. She said she would have liked to have been able to choose the type of prenatal and infant care that would have better met her needs and those of her family. Care offered by midwives should be allowable to all low risk women and their families, Ms. Mendez concluded. KARREN SHINE-AUDETT, Certified Direct-Entry Midwife and Regional Director, Midwive's Association, said she feels there are many benefits, not only to the state but people on Medicaid, by passing SSSB 91. She said there are other states that have allowed midwives for Medicaid recipients and it has saved taxpayers millions of dollars. Midwives charge a fraction of the price that individuals on Medicaid are paying currently. Ms. Shine-Audett said there are women who were on Medicaid who wanted to have a home birth but didn't because midwives are not covered. There are also low income women who have gone into debt by paying out of their own pockets for midwives as they strongly believe that home births are the best care. Ms. Shine-Audett said she believes that statistics will improve immensely through the individual attention clients receive. We need to offer babies and their mothers the right to choose their care providers no matter where the compensation comes from. She said the key to preventing premature babies and unhealthy mothers is good nutrition and individual attention. She continued to give testimony in favor of the legislation and encouraged the members to support the bill. GRACE ELLIOTT-DEANGLES, testifying as a former Medicaid mother, said eight years ago when she was pregnant she chose midwife services. She paid for the services out of her pocket with money she made during the fishing season as a deck hand. Ms. Elliott-DeAngles said she moved to Juneau after the fishing season and became an AFDC recipient. A person receives very little money on AFDC, and it was very difficult for her to pay her bill. She explained that if you borrow money and you are on AFDC, you are penalized and the AFDC check is lowered. Ms. Elliott-DeAngles explained that a midwife will spend about an hour with a patient per visit. She said during her last pregnancy her doctor spent about six to eight minutes with her each visit. She urged the committee to pass the legislation. Number 171 SALLY BRYNE, Midwife, said women in Alaska who qualify for Medicaid need to be in a position to make their own decisions regarding their own health care. The medical establishment would like us to believe that the change from home to hospital is the reason for improved outcomes of pregnancies. Going into the hospital is not the cause of the improvements. Improved outcomes is a result of improved hygiene, economic status, nutrition, and access to prenatal care. She urged that Alaska become a state where quality prenatal care is available to all low income women and their families. Families will all benefit from the intensive individualized attention given to them by midwives. She thanked the committee for listening to her. CHARLOTTE O'SHIRLEY-DAVIS, testifying from Anchorage, said midwifery allows women to make choices for themselves. The essence of midwifery is flexibility. Medicaid reimbursement allows women more choices and flexibility in care. Ms. O'Shirley-Davis said midwives oversee women's choices and they assist them. There is also more whole family involvement. She urged that there be Medicaid reimbursement for midwifery. SHERRILL MALONE, Certified Direct-Entry Midwife, testified from Anchorage. She said she feels that any woman, in any walk of life, no matter what her financial status, should be able to choose where she would like to have her baby. Midwives give excellent care and are able to take more time with each women. They give the much needed nutritional counseling to alleviate a number of complications that could arise should the woman's nutrition be less than optimum, which in turn causes women to fall into a high risk category and necessitate more medical intervention, thus causing the cost of premium care to become greater. Ms. Malone said midwife fees usually cost less than half of what a doctor's hospital birth would cost. If midwives had the opportunity to bill Medicaid they would save the state many thousands of dollars. The transport records are low and any need for any other medical attention is very minimal. The passing of SSSB 91 would benefit all on both sides of the spectrum. Ms. Malone said she would appreciate the committee's support of SSSB 91. SENATOR SALO asked Ms. Malone what the training requirements are for direct-entry midwives in Alaska. Ms. Malone said for a person to become a midwife they must complete two years of apprenticeship and a midwifery course. She said the course is a written course that must be taken during the two years and covers the study of every area of the aspects of midwifery focusing on the prenatal period, nutrition, and any complications that may arise. The course ends in extensive testing by examination. Number 251 SHARON EVANS, Certified Direct-Entry Midwife and President of the Midwives Association of Alaska, said her association has kept statistics on the families that they have served over the last several years. The statistics have proved that pregnant women under a midwife's care have fewer low- weight babies, premature births, and neonatal mortality rates than the average for the State of Alaska and the nation. According to information received from the State of Alaska, Department of Vital Statistics, of the babies born at home under midwive's care, from 1989 to 1991, less than 1 percent of them were transferred to a hospital. Ms. Evans continued to give the committee members statistics relating to the information received from the state. Direct-Entry Midwives, licensed in the state, propose that if they are put on the list of Medicaid providers, the education and nutritional counseling that they give to low income women will help immensely to decrease the premature birth rate and the problems associated with low birth weight babies, thereby, dramatically reducing the cost of care to the State of Alaska. Ms. Evans urged the committee to please consider passing SSSB 91. DAVE WILLIAMS, Planner, Project CHOICE, Division of Medical Assistance, Department of Health and Social Services, said the committee has a position paper in support of the legislation. The department believes the bill is reasonable legislation and women should have this choice available to them. He said he would answer any questions the committee may have. Number 289 SALLY PESSAGE, testifying from Anchorage, said she has had two births and is currently pregnant. She explained that she saw a doctor while pregnant with her first child. Ms. Pessage said the care she received with a midwife was much better, far superior than a doctor's care, and there was more personal contact. Ms. Pessage informed the committee that she is currently on Medicaid. She indicated she will not be covered by Medicaid if the baby is born at home. Ms. Pessage said it is important to her, her unborn child, and her family that she goes through a home birth with her midwife. She asked that people on Medicaid be given the option of having a home birth. Number 308 CHAIRMAN RIEGER referred to the fiscal note and said a physician birth would cost $2,000 as opposed to a midwife birth at $1,480. He asked if those numbers seem right. SENATOR LEMAN said he has had three children and the $2,000 for the physician assisted birth seems to be a lot lower than what he paid. MR. WILLIAMS explained that the $2,000 is physician only and if a hospital were included it would be another $3,000. SENATOR LEMAN indicated he had a proposed amendment. He moved Amendment #1 which follows: Page 1, line 1, after "Act": Insert "prohibiting unfair discrimination against direct-entry midwives who perform services within the scope of their certification;" Page 1, after line 4: Insert a new bill section to read: "* Section 1. AS 21.36.090(d) is amended to read: (d) Except to the extent necessary to comply with AS 21.42.365, a person may not practice or permit unfair discrimination against a person who provides a service covered under a group disability policy that extends coverage on an expense incurred basis, or under a group service or indemnity type contract issued by a nonprofit corporation, if the service is within the scope of the provider's occupational license. In this subsection, "provider" means a state licensed physician, dentist, osteopath, optometrist, chiropractor, nurse midwife, advanced nurse practitioner, naturopath, physical therapist, occupational therapist, psychologist, psychological associate, [OR] licensed clinical social worker, or certified direct-entry midwife." CHAIRMAN RIEGER objected to Senator Leman's motion for the purpose of an explanation. SENATOR LEMAN said the amendment adds certified direct-entry midwives to the list of those protected from unfair discrimination. He said his understanding is that this was an oversight when legislation was passed during the Seventeenth Legislature. The insurance companies would have to provide payment for them to the same extent they do for others. Chairman Rieger asked if all the providers in the section are mandatory providers. He said if you are offering a health insurance policy you would have to cover all the things listed. MS. KREITZER said she doesn't believe that it is mandated that the insurance companies cover all the people listed, but means that they may not be discriminated against. Number 379 Chairman Rieger removed his objection to Amendment #1. There being no further objection to the motion, Amendment #1 was adopted. SENATOR SHARP asked how many other states allow midwives to be covered under Medicaid. SENATOR LEMAN said it is his understanding that there is one other state which does, New Mexico. Number 389 Senator Leman moved to pass SSSB 91, as amended, out of the HESS Committee with individual recommendations. Hearing no objection, the motion carried.
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