Rep. Mary E. Flowers

Filed: 10/27/2021





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2    AMENDMENT NO. ______. Amend Senate Bill 1041 by replacing
3everything after the enacting clause with the following:
4    "Section 1. Short title. This Act may be cited as the
5Consumer Choice in Maternal Care for African-American Mothers
6Program Act.
7    Section 5. Findings. The General Assembly finds the
9        (1) In its 2018 Illinois Maternal Morbidity and
10    Mortality Report, the Department of Public Health reported
11    that Black women were 6 times as likely to die from a
12    pregnancy-related condition as white women, and that in
13    Illinois, 72% of pregnancy-related deaths and 93% of
14    violent pregnancy-associated deaths were deemed
15    preventable.
16        (2) The Department of Public Health also found that



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1    between 2016 and 2017, Black women had the highest rate of
2    severe maternal morbidity with a rate of 101.5 per 10,000
3    deliveries, which is almost 3 times as high as the rate for
4    white women.
5        (3) In 2019, the Chicago Department of Public Health
6    released a data report on Maternal Morbidity and Mortality
7    in Chicago and found that "(w)omen for whom Medicaid was
8    the delivery payment source are significantly more likely
9    than those who used private insurance to experience severe
10    maternal morbidity." The Chicago Department of Public
11    Health identified zip codes within the city that had the
12    highest rates of severe maternal morbidity in 2016 and
13    2017 (100.4-172.8 per 10,000 deliveries). These zip codes
14    included: 60653, 60637, 60649, 60621, 60612, 60624, and
15    60644. All of the zip codes were identified as
16    experiencing high economic hardship. According to the
17    Chicago Department of Public Health "(c)hronic diseases,
18    including obesity, hypertension, and diabetes can increase
19    the risk of a woman experiencing adverse outcomes during
20    pregnancy." However, "there were no significant
21    differences in pre-pregnancy BMI, hypertension, and
22    diabetes between women who experienced a
23    pregnancy-associated death and all women who delivered
24    babies in Chicago."
25        (4) In a national representative survey sample of
26    mothers who gave birth in an American hospital in 2011 and



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1    2012, 1 out of 4 mothers who identified as Black or
2    African-American expressed that they would "definitely
3    want" to have a future birth at home, compared to 8.4% of
4    white mothers. Black mothers express a demand for planned
5    home birth services at almost 3 times the rate of white
6    mothers. Yet, in the United States, non-Hispanic white
7    women who can afford to pay out-of-pocket for their labor
8    and delivery costs access planned home birth care at the
9    greatest rate. Similarly, an analysis of birth certificate
10    data from the Centers for Disease Control and Prevention
11    for the years 2016 through 2019 shows that non-Hispanic
12    white mothers are 7 times more likely than non-Hispanic
13    Black mothers to experience a planned home birth.
14        (5) According to calculations based on birth
15    certificate data from July 2019 in Cook County, there
16    would have to be 7 Black or African-American certified
17    professional midwives working in Cook County in order for
18    just 1% of Black mothers in Cook County to have access to
19    racially concordant midwifery care in a given month.
20        (6) For birthing persons of sufficient health who
21    desire to give birth outside of an institutional setting
22    without the assistance of epidural analgesia, planned home
23    birth under the care of a certified professional midwife
24    can be a dignifying and safe, evidence-based choice. In
25    contrast, regulatory impingement on Black families'
26    ability to access that choice does not serve to enhance



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1    maternal or neonatal safety, but instead reifies the
2    institutionalization of Black bodies by the State.
3        (7) In order to make safe, planned home births
4    accessible to Black families in Illinois, the State must
5    require Medicaid provider networks to include certified
6    professional midwives. According to natality data from the
7    Centers for Disease Control and Prevention, every year
8    from 2016 through 2019, 2 out of every 3 live births to
9    Black or African-American mothers living in Cook County
10    utilized Medicaid as the source of payment for delivery.
11    According to that same data, Medicaid paid for over 14,000
12    deliveries to Black or African-American mothers residing
13    in Cook County during the year 2019 alone.
14        (8) A population-level, retrospective cohort study
15    published in 2018 that used province-wide maternity,
16    medical billing, and demographic data from British
17    Columbia, Canada concluded that antenatal midwifery care
18    in British Columbia was associated with lower odds of
19    small-for-gestational-age birth, preterm birth, and low
20    birth weight for women of low socioeconomic position
21    compared with physician models of care. Results support
22    the development of policy to ensure antenatal midwifery
23    care is available and accessible for women of low
24    socioeconomic position.
25        (9) In its January 2018 report to the General
26    Assembly, the Department of Healthcare and Family Services



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1    reported that its infant and maternal care expenditures in
2    calendar year 2015 totaled $1,410,000,000. The Department
3    of Healthcare and Family Services said, "(t)he majority of
4    HFS birth costs are for births with poor outcomes. Costs
5    for Medicaid covered births are increasing annually while
6    the number of covered births is decreasing for the same
7    period". The Department of Healthcare and Family Services'
8    expenditures average $12,000 per birth during calendar
9    year 2015 for births that did not involve poor outcomes
10    such as low birth weight, very low birth weight, and
11    infant mortality. That $12,000 expenditure covered
12    prenatal, intrapartum, and postpartum maternal healthcare,
13    as well as infant care through the first year of life. The
14    next least expensive category of births averaged an
15    expenditure of $40,200. The most expensive category of
16    births refers to births resulting in very low birth weight
17    which cost the Department of Healthcare and Family
18    Services over $328,000 per birth.
19        (10) Expanding Medicaid coverage to include perinatal
20    and intrapartum care by certified professional midwives
21    will not contribute to increased taxpayer burden and, in
22    fact, will likely decrease the Department of Healthcare
23    and Family Services' expenditures on maternal care while
24    improving maternal health outcomes within the Black
25    community in Illinois.



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1    Section 10. Medicaid voucher program. The Task Force on
2Infant and Maternal Mortality Among African Americans shall
3partner with Holistic Birth Collective to develop rules and
4regulations for a Medicaid voucher program to expand consumer
5choice for Black mothers that includes planned home birth
6services and in-home perinatal and postpartum care services
7provided by racially concordant nationally accredited
8certified professional midwives who are licensed and
9registered in Illinois. On January 1, 2024, and each January 1
10thereafter, the Task Force shall submit a report to the
11General Assembly that provides a status update on the program
12and annual impact measure reporting. The Department of Public
13Health, in consultation with the Department of Healthcare and
14Family Services, shall implement the program.
15    Section 15. Maternity episode payment model. The program
16shall implement a maternity episode payment model that
17provides a single payment for all services across the
18prenatal, intrapartum, and postnatal period which covers the 9
19months of pregnancy plus 12 weeks of postpartum. The core
20elements of the maternity care episode payment model shall
21include all of the following:
22        (1) Limited exclusion of selected high-cost health
23    conditions and further adjustments to limit service
24    provider risk such as risk adjustment and stop loss.
25        (2) Duration from the initial entry into prenatal care



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1    through the postpartum and newborn periods.
2        (3) Single payment for all services across the
3    episode.
4    The Department of Public Health, in consultation with the
5Department of Healthcare and Family Services, shall make
6available to the Task Force all relevant data related to
7maternal care expenditures made under the State's Medical
8Assistance Program so that budget-neutral reimbursement rates
9can be established for bundled maternal care services spanning
10the prenatal, labor and delivery, and postpartum phases of a
11maternity episode.
12    Section 99. Effective date. This Act takes effect January
131, 2022.".