Senate Bill No. 375
(By Senator Wooton)
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[Introduced March 16, 1993; referred to the Committee
on Health and Human Resources; and then to the Committee
on Finance.]
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A BILL to amend and reenact section twelve, article five, chapter
nine of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, relating to medicaid generally; and
providing medicaid coverage for all children under the age
of eighteen.
Be it enacted by the Legislature of West Virginia:
That section twelve, article five, chapter nine of the code
of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-12. Medicaid program; maternity and infant care.
(a) The Legislature finds that high rates of infant
mortality and morbidity are costly to the state in terms of human
suffering and of expenditures for long-term institutionalization,
special education and medical care. It is well documented that
appropriate care during pregnancy and delivery can prevent manyof the expensive, disabling problems our children experience.
There exists a crisis in this state relating to the availability
of obstetrical services, particularly to patients in rural areas,
and to the cost patients must pay for obstetrical services. The
availability of obstetrical service for medicaid patients enables
these patients to receive quality medical care and to give birth
to healthier babies and, consequently, improve the health status
of the next generation.
The Legislature further recognizes that public and private
insurance mechanisms remain inadequate, and poor women and
children are among the most likely to be without insurance.
Generally, low-income, uninsured children receive half as much
health care as their insured counterparts. The state is now
investing millions to care for sick infants whose deaths and
disabilities could have been avoided.
It is the intent of the Legislature that the department of
human services participate in the medicaid program for indigent
children and pregnant women established by Congress under the
Consolidated Omnibus Budget Reconciliation Act (COBRA), Public
Law 99-272, the Sixth Omnibus Budget Reconciliation Act (SOBRA),
Public Law 99-504, and the Omnibus Budget Reconciliation Act
(OBRA), Public Law 100-203.
(b) The department of human services shall:
(1) Extend the medicaid coverage to pregnant women and their
newborn infants to one hundred fifty percent of the federal
poverty level, effective the first day of July, one thousand ninehundred eighty-eight and effective the first day of July, one
thousand nine hundred ninety-three, extend the medicaid coverage
to all children under eighteen years of age regardless of family
income or assets.
(2) As provided under COBRA, SOBRA, and OBRA, effective the
first day of July, one thousand nine hundred eighty-eight,
infants shall be included under the medicaid coverage with all
children eligible for medicaid coverage born on or after the
first day of October, one thousand nine hundred eighty-three,
whose family incomes are at or below one hundred percent of the
federal poverty level and continuing until such children reach
the age of eight years.
(3) Elect the federal options provided under COBRA, SOBRA,
and OBRA, impacting pregnant women and children below the poverty
level: Provided, however, That no provision in this article
shall restrict the department of human services in exercising new
options provided by or to be in compliance with new federal
legislation that further expands eligibility for children and
pregnant women.
(4) Enter into an inter-agency agreement with the department
of health whereby the department of health shall be responsible
for the implementation and program design for a maternal and
infant health care system to reduce infant mortality in West
Virginia. The health system design shall include quality
assurance measures, case management and patient outreach
activities. The department of human services shall assumeresponsibility for claims processing in accordance with
established fee schedules, and financial aspects of the program
necessary to receive available federal dollars and to meet
federal rules and regulations.
(5) The department of health shall transfer to the
department of human services through inter-agency agreement such
state funds as are necessary to implement this program to the
department of human services medical services account; and the
department of human services shall, through inter-program
transfer, provide such state funds as are necessary to implement
this program.
(6) Beginning the first day of July, one thousand nine
hundred eighty-eight, the state department of human services
shall increase to no less than six hundred dollars the
reimbursement rates under the medicaid program for prenatal care,
delivery and post-partum care.
(c) In order to be in compliance with the provisions of
OBRA, through rules and regulations the department shall ensure
that pregnant women and children whose incomes are above the Aid
to Families and Dependent Children (AFDC) payment level are not
required to apply for entitlements under the AFDC program as a
condition of eligibility for medicaid coverage. Further, the
department shall develop a short, simplified pregnancy/pediatric
application of no more than three pages, paralleling the
simplified OBRA standards.
(d) Any woman who establishes eligibility under this sectionshall continue to be treated as an eligible individual without
regard to any change in income of the family of which she is a
member until the end of the sixty-day period beginning on the
last day of her pregnancy.
(e) Nothing in this section shall be construed to give the
department of health any jurisdiction over the medicaid program
or its operations.
NOTE: The purpose of this bill is to provide medicaid
coverage to all children under eighteen years of age regardless
of family income or assets.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.