A Senate committee advanced a bill Thursday forbidding Medicaid payments for elective births before the 39th week of pregnancy if they aren’t medically necessary, but it delayed consideration of a bill requiring doctors to screen pregnant women for certain risk factors.
Senate Bill 495 would ban Medicaid from covering elective births prior to the 39th week of pregnancy. The bill defines an elective birth as one “not medically indicated for the health of the pregnant woman or the unborn child” but doesn’t specify how to determine what is medically indicated. No one testified for or against the bill.
The date of an elective delivery matters because babies tend to have the best outcomes after the 39th week of pregnancy, according to the American Congress of Obstetricians and Gynecologists.
A statewide efficiency report estimated Kansas could save up to $20 million over five years by reducing Medicaid funding for early elective births.
That figure appears dubious, however, because it was calculated using a broader definition of “elective” that may have included some early births that were medically necessary. The State Office of the Budget couldn’t estimate how much the state might save due to uncertainty about the number of early births that aren’t medically necessary.
The Kansas Healthcare Collaborative, Kansas Hospital Association and March of Dimes have been working to reduce the number of early elective deliveries in Kansas since mid-2012. The Kansas Healthcare Collaborative estimated the number of early elective births had fallen 70.5 percent from mid-2012 to the end of 2014, but about 4.4 percent of babies born in Kansas still arrived through early elective deliveries in 2014.
The Senate Public Health and Welfare Committee skipped over Senate Bill 497, which would require physicians or their staff to screen pregnant women for use of tobacco, alcohol or illegal drugs; depression; and whether they are victims of domestic violence. If a screening identified a problem, they would conduct a follow-up screening in the third trimester or shortly after birth. Women could opt out of the screening.
The Kansas Association for the Medically Underserved submitted testimony saying it opposed allowing women to opt out of the screenings, arguing that raising issues in a patient’s mind about her health behaviors could lead to better outcomes even if she declines to answer the questions. Salina Family Healthcare Center and GraceMed and HealthCore Clinic, both in Wichita, submitted testimony raising the same concerns.
Jessica Nasternak, director of legal and policy for the Kansas Coalition Against Sexual and Domestic Violence, said the coalition is neutral on SB 497 but that providers need more training on how to respond if a patient discloses she is a victim of domestic violence during a screening. Kansas For Life also offered neutral testimony, raising concerns that women could be pushed to have abortions if they learn their babies might be at an increased risk of a medical problem.