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White House Fact Sheet on Maternal and Child Health Care Proposals

April 18, 1989

The administration today forwarded to the Congress proposed legislation to make Federal programs better serve pregnant women, infants, and children. The legislation carries out commitments the President made in his February 9 address, "Building a Better America." The President's proposals also include funds for improving the delivery of health care services; this request does not require new legislation.

The legislation would expand significantly the population Medicaid serves, making Medicaid available to 1.9 million more women when they become pregnant. The legislation also takes steps to make Medicaid more effective by bringing more eligible women and infants into the program. The legislation is part of an overall approach to health care for the disadvantaged that calls for full funding for Medicaid, $37.6 billion for FY 1990, an increase of $3.3 billion or 9.6 percent over the FY 1989 level.

The President's Principles

The President is committed to improving health care for lower income Americans by focusing first on the populations most at risk: mothers and their babies. Expansions in the Medicaid program contemplated under current law will do much to meet these needs.

The most cost-effective means must be used to achieve our goals. Adequate prenatal care and immunization against childhood diseases are both the most effective and least costly means to good health early in life.

Greater personal responsibility for good health must be fostered. Mothers must be encouraged to seek prenatal care; to avoid the use of cigarettes, alcohol, and drugs; and to obtain good nutrition. The effects of the expanded Medicaid eligibility in the administration proposal will be undermined if mothers make unhealthy choices.

States and community groups have a vital role in improving child health care and must be given flexibility in using their resources to meet their own specific problems. The Federal Government should continue to provide support through State-administered programs such as Medicaid.

The President's Proposals

The legislation transmitted to the Congress today would:

increase by 374,000 the number of pregnant women and children eligible for Medicaid.

foster greater participation in Medicaid by eligible pregnant women by providing services to pregnant women who are presumed eligible for Medicaid before a formal eligibility determination is made, and requiring States to operate outreach programs in areas of high infant mortality.

entitle all children under age 6 who are receiving food stamps to Medicaid coverage for immunizations.

make the Federal match rate for State administrative expenses a uniform 50 percent by gradually reducing special administrative match rates ranging from 75 to 100 percent. The savings that result would allow the legislative eligibility changes proposed by the President to be implemented within the current programs' spending level.

The President has also proposed investing $20 million in both FY 1990 and FY 1991 for a new demonstration program. The demonstrations would implement improved coordination among three Federal programs: Medicaid; Maternal and Child Health; and the Women, Infants, and Children (WIC) nutrition programs. The results of the demonstrations are intended to serve as the basis for future reform of service delivery under these programs.

Infant Health in America

Progress in improving infant health is most often described in terms of infant mortality statistics. The United States has made significant progress since World War II in reducing infant mortality. Infant mortality has dropped from 29.2 deaths per thousand births in 1950 to 10.4 in 1986, the most recent year for which final data is available.

In recent years, the United States has not made as much progress as other countries. As a result, the United States has dropped from 19th in 1980 to 22d in 1985 among the nations of the world when ranked by infant mortality rates.

Infant mortality rates for black Americans have been and remain higher than those for whites. The black infant mortality rate stood at 43.9 deaths per 1,000 births in 1950; in 1985 it was 18.2 deaths. While this is a significant improvement, it remains nearly twice the 9.3 deaths per 1,000 births among white Americans.

Medicaid alone is not sufficient to assure proper medical care. In a survey of the poorest areas of New York City, where infant mortality is high, 68.5 percent of the mothers were Medicaid recipients, but 39 percent of the mothers received late or no prenatal care. In such areas, drug and alcohol abuse are often the greatest threat to maternal and infant health.

The goal of healthier babies depends on mothers making intelligent choices during pregnancy: avoiding smoking, drugs, and alcohol. The President's proposal to fund demonstrations that encourage better coordination of Federal programs will lead to more effective program designs and form the basis for future Federal program changes.

Medicaid and Infant Health: Current Law and the Administration's Proposals

Under current law, by July 1, 1990, every State Medicaid program must cover pregnant women and infants (up to age 1) with incomes not exceeding 100 percent of the Federal poverty line. States may elect to cover women and infants with incomes up to 185 percent of the poverty line.

Under the administration's proposal, States would be required, by April 1, 1990, to provide coverage to pregnant women and infants whose income does not exceed 130 percent of the poverty line. The option for coverage up to 185 percent of the poverty line would remain unchanged.

Under the President's proposals, a single pregnant woman with an income of up to $10,426 would be eligible; $13,078 for a household of two; $15,730 for a household of three; and $18,382 for a household of four.

Current law provides that States may grant presumptive Medicaid eligibility to pregnant women. Under this option, States designate qualified providers who, based on a preliminary assessment of the woman's income, may determine her to be eligible. These providers are facilities that have a high proportion of eligible women in their clientele and include community health centers, public health departments, and maternal and child health clinics. A woman who is presumptively eligible is entitled to ambulatory care for up to 45 days, during the first 14 of which she is expected to apply for Medicaid. Twenty States have adopted this option.

The administration proposes to require that all States offer presumptive Medicaid eligibility. This will increase the number of pregnant women who will receive coverage and obtain prenatal care early in their pregnancies. Any woman with a valid food stamp card would be presumptively eligible. The period of presumptive eligibility would be set at 60 days. States would be required to demonstrate efforts to make the presumptive eligibility process work in all areas of the State. In addition, the State would be required to demonstrate outreach and public education efforts in areas with high rates of infant mortality.

George Bush, White House Fact Sheet on Maternal and Child Health Care Proposals Online by Gerhard Peters and John T. Woolley, The American Presidency Project

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