Illinois General Assembly - Full Text of SB1041
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Full Text of SB1041  102nd General Assembly


Rep. Mary E. Flowers

Filed: 10/28/2021





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



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



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1    mothers who gave birth in an American hospital in 2011 and
2    2012, 1 out of 4 mothers who identified as Black or
3    African-American expressed that they would "definitely
4    want" to have a future birth at home, compared to 8.4% of
5    white mothers. Black mothers express a demand for planned
6    home birth services at almost 3 times the rate of white
7    mothers. Yet, in the United States, non-Hispanic white
8    women who can afford to pay out-of-pocket for their labor
9    and delivery costs access planned home birth care at the
10    greatest rate. Similarly, an analysis of birth certificate
11    data from the Centers for Disease Control and Prevention
12    for the years 2016 through 2019 shows that non-Hispanic
13    white mothers are 7 times more likely than non-Hispanic
14    Black mothers to experience a planned home birth.
15        (5) According to calculations based on birth
16    certificate data from July 2019 in Cook County, there
17    would have to be 7 Black or African-American certified
18    professional midwives working in Cook County in order for
19    just 1% of Black mothers in Cook County to have access to
20    racially concordant midwifery care in a given month.
21        (6) For birthing persons of sufficient health who
22    desire to give birth outside of an institutional setting
23    without the assistance of epidural analgesia, planned home
24    birth under the care of a certified professional midwife
25    can be a dignifying and safe, evidence-based choice. In
26    contrast, regulatory impingement on Black families'



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1    ability to access that choice does not serve to enhance
2    maternal or neonatal safety, but instead reifies the
3    institutionalization of Black bodies by the State.
4        (7) In order to make safe, planned home births
5    accessible to Black families in Illinois, the State must
6    require Medicaid provider networks to include certified
7    professional midwives. According to natality data from the
8    Centers for Disease Control and Prevention, every year
9    from 2016 through 2019, 2 out of every 3 live births to
10    Black or African-American mothers living in Cook County
11    utilized Medicaid as the source of payment for delivery.
12    According to that same data, Medicaid paid for over 14,000
13    deliveries to Black or African-American mothers residing
14    in Cook County during the year 2019 alone.
15        (8) A population-level, retrospective cohort study
16    published in 2018 that used province-wide maternity,
17    medical billing, and demographic data from British
18    Columbia, Canada concluded that antenatal midwifery care
19    in British Columbia was associated with lower odds of
20    small-for-gestational-age birth, preterm birth, and low
21    birth weight for women of low socioeconomic position
22    compared with physician models of care. Results support
23    the development of policy to ensure antenatal midwifery
24    care is available and accessible for women of low
25    socioeconomic position.
26        (9) In its January 2018 report to the General



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1    Assembly, the Department of Healthcare and Family Services
2    reported that its infant and maternal care expenditures in
3    calendar year 2015 totaled $1,410,000,000. The Department
4    of Healthcare and Family Services said, "(t)he majority of
5    HFS birth costs are for births with poor outcomes. Costs
6    for Medicaid covered births are increasing annually while
7    the number of covered births is decreasing for the same
8    period". The Department of Healthcare and Family Services'
9    expenditures average $12,000 per birth during calendar
10    year 2015 for births that did not involve poor outcomes
11    such as low birth weight, very low birth weight, and
12    infant mortality. That $12,000 expenditure covered
13    prenatal, intrapartum, and postpartum maternal healthcare,
14    as well as infant care through the first year of life. The
15    next least expensive category of births averaged an
16    expenditure of $40,200. The most expensive category of
17    births refers to births resulting in very low birth weight
18    which cost the Department of Healthcare and Family
19    Services over $328,000 per birth.
20        (10) Expanding Medicaid coverage to include perinatal
21    and intrapartum care by certified professional midwives
22    will not contribute to increased taxpayer burden and, in
23    fact, will likely decrease the Department of Healthcare
24    and Family Services' expenditures on maternal care while
25    improving maternal health outcomes within the Black
26    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 advise the
4Department of Healthcare and Family Services on the
5development of a Medicaid voucher program that is eligible for
6federal dollars to expand consumer choice for Black mothers
7that includes planned home birth services and in-home
8perinatal and postpartum care services provided by racially
9concordant nationally accredited certified professional
10midwives who are licensed and registered in Illinois. On
11January 1, 2024, and each January 1 thereafter, the Task Force
12shall submit a report to the General Assembly that provides a
13status update on the program and annual impact measure
14reporting. The Department of Public Health, in consultation
15with the Department of Healthcare and Family Services, shall
16implement the program. The Department of Healthcare and Family
17Services and the Department of Public Health are authorized to
18adopt rules to implement this Section. The Department of
19Healthcare and Family Services must apply for a State Plan
20amendment no later than December 31, 2022.
21    Section 15. Maternity episode payment model. The program
22shall implement a maternity episode payment model that
23provides a single payment for all services across the
24prenatal, intrapartum, and postnatal period which covers the 9



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1months of pregnancy plus 12 weeks of postpartum. The core
2elements of the maternity care episode payment model shall
3include all of the following:
4        (1) Limited exclusion of selected high-cost health
5    conditions and further adjustments to limit service
6    provider risk such as risk adjustment and stop loss.
7        (2) Duration from the initial entry into prenatal care
8    through the postpartum and newborn periods.
9        (3) Single payment for all services across the
10    episode.
11    The Department of Public Health, in consultation with the
12Department of Healthcare and Family Services, shall make
13available to the Task Force all relevant data related to
14maternal care expenditures made under the State's Medical
15Assistance Program so that budget-neutral reimbursement rates
16can be established for bundled maternal care services spanning
17the prenatal, labor and delivery, and postpartum phases of a
18maternity episode.
19    Section 99. Effective date. This Act takes effect January
201, 2022.".