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FIRST STEPS DATABASE

First Steps, Family Planning, and the Changing Economy

In 1989, DSHS and DOH implemented the First Steps program to meet the goals of the Maternity Care Access Act passed by the Legislature earlier the same year. First Steps has achieved remarkable success in many of the areas this legislation addressed. Access to prenatal care has improved, low birth weight has decreased, and infant mortality has decreased.

After First Steps increased eligibility for pregnant women up to 185% of the Federal Poverty Level (FPL), the number of births funded by Medicaid increased from 17,984 before First Steps (Fiscal Year 1988) to 34,257 (Fiscal Year 2001). Of the Medicaid-funded births, nearly 50% of the pregnancies were unintended at conception. As the number of pregnant women on Medicaid's caseload has grown- Medicaid provided funding for 44% of all deliveries in 2001- what was initially viewed as a program success now represents a substantial and growing expenditure for the Medical Assistance Administration (MAA). At more than $220 million per year, maternity care is one of MAA's largest expenses.

The State Legislature and program staff recognized years ago that limiting the growth in Medicaid-paid deliveries required increasing access to family planning services, educating communities about the benefits of planning pregnancies, and changing individual behavior. A number of programs were initiated over the past ten years to accomplish this:

• Since 1993, family planning assistance and information for all TANF clients and potential clients have been provided in Community Services Offices (CSOs) across the state.
• In 1993, family planning coverage was extended to a full year post-pregnancy for women who became Medicaid eligible because of pregnancy.
• Since 2000, pregnant women and new mothers have received counseling from Maternity Support Services providers about achieving their desired family size, and assistance in planning for and accessi/ms/rdang family planning services.
• In 2001, TAKE CHARGE, a federal waiver allowing Washington to cover pre-pregnancy family planning services for women and men with incomes up to and including 200% of the FPL, was implemented.

In combination, these family planning efforts were designed to reach as broad a target population as possible, within existing policies. Yet, while remaining flat during most of the 1990s, in the early 2000s, the Medicaid maternity-related caseload continued to climb. The rising caseload raised questions about the impact of TAKE CHARGE.

Impacting community values and personal/individual behavior regarding use of effective birth control measures is a complex undertaking. Success requires many strategies. Despite all these efforts to decrease the numbers of unintended pregnancies, dramatic changes in Washington's economic climate created a radically different environment for assessing the impact of TAKE CHARGE. Washington's family planning efforts are well positioned. Given the economic changes that have occurred over the past three years, it is likely that the pregnancy caseload growth would have been even greater, had these family planning efforts not been in place.

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Modified: Thursday November 17 2005

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