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The First Steps Program: 1989-1997

Executive Summary

The First Steps Program has served low-income pregnant women in Washington State for ten years, since August 1989. By the end of 1997, more than 255,000 women had received services through this program, and Medicaid was funding 42% of all births to Washington residents. According to many indicators, Washington women have had better prenatal care and better birth outcomes since First Steps began than before its implementation. This report summarizes program services and outcomes through 1997, the most recent year for which data are available.

The goal of the First Steps program, authorized by the Maternity Care Access Act of 1989, was to provide "maternity care necessary to ensure healthy birth outcomes for low-income families." The legislation called for removal of unnecessary barriers to receiving prenatal care and provided for increased access to care and expanded Medicaid services for low-income pregnant women.

During the late 1980s, women across Washington State faced increasing difficulty in accessi/ms/rdang prenatal care. Increasing malpractice premiums and low Medicaid reimbursement had resulted in a shortage of obstetrical providers, and maternity care providers were increasingly reluctant to provide care to the growing number of Medicaid clients. Private practitioners, representatives of state agencies, public officials, and University of Washington faculty recognized this crisis in maternity care and formed the Access to Maternity Care Committee, sponsored by the Washington Chapter of the American College of Obstetricians and Gynecologists. This committee was instrumental in identify major causes of the maternity care crisis and in shaping the First Steps legislation.

The First Steps program included the following components:

• Expanded Medicaid eligibility to 185% of the federal poverty level for pregnant/ postpartum women and infants less than one year old

• Maternity Support Services during pregnancy and through two months postpartum

• Maternity Case Management for women at high risk for poor pregnancy outcomes during pregnancy and up to one year postpartum

• Increased reimbursement for maternity care providers

• Designation of maternity care distressed areas to encourage community planning and enhancement of health care delivery system for pregnant women and their infants

• A statewide public education campaign stressi/ms/rdang the importance of early prenatal care

Outcomes: Access Measures: In the years since First Steps started, access to prenatal care has improved. Provider willingness to accept Medicaid patients increased, and the greater demand for prenatal services was met by First Steps clinics, community and migrant health centers, and teaching hospitals, in addition to established obstetric practitioners. Between 1989 and 1994, the proportion of all Washington women with no prenatal care declined by 54%. For the poorest Medicaid women (those who received cash grants through AFDC, now TANF), the rate of inadequate prenatal care (third trimester entry or none) decreased more than 50% from 12% in early 1989 to 5.8% in late 1994.

Modified: Thursday November 17 2005

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