School of Public Health

Washington State Breaking Down the Insurance Barrier

March 2016

Washington State Department of Health

Rabeeha Ghaffar

Washington State’s Five Year Needs Assessment indicated a need to prioritize high risk pregnancy care, substance misuse screening, social/emotional well-being and improved access and quality to services for pregnant women. Our five-year plan focuses on the state priority of screening, referral and follow-up. Community-based screening, referral, and follow-up services address social, environmental and economic inequities by providing linkages to health and supportive services and removing barriers to access. The National Performance Measure (NPM) we have chosen for the women’s health domain is NPM 1: percent of women who had a preventive health visit in the past year.

The main objective and strategy related to NPM 1 is Objective 1: Enhance and maintain health systems to increase timely access to preventive care, screening and treatment; Strategy 1.1: Increase the proportion of women who have health insurance and get a preventive visit.

Access to preventive and prenatal care continues to be an issue for women in Washington State. Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 for the state show only a little over 50% of adult women had a preventive visit to their provider during the previous year. Women of child-bearing age who do not have special medical conditions generally see their reproductive health provider for family planning services, where providers are often not able to expand services to include full primary care. This leaves many women without a health home.

According to BFRSS (2011) about 23% of women ages 18-44 did not have health care coverage at the time of interview. In 2011, about 42% of women without health coverage reported they had a personal doctor, compared to 80% of women with coverage. In 2011, BRFSS also reported that about 51% of women without health coverage reported they needed to see a doctor in the previous year but could not because of cost, compared to 15% of women with coverage.

We will continue to contract with WithinReach to provide information on health insurance and provide assistance with online applications through the Family Health Hotline and ParentHelp123.org. Department of Health staff will consult and collaborate with Health Care Authority (HCA) Medicaid programs to increase the number of women on AppleHealth. We will also continue to work with the Washington State Hospital Association to improve quality of care through the Safe Deliveries Roadmap, a private/public collaboration to develop practice recommendations for pre-pregnancy, prenatal, labor and delivery and post-partum and infant care.

We will support HCA efforts to provide safety net for undocumented women who are not covered by ACA. MCH-supported staff will also work with the Office of Insurance Commissioner and HCA to ensure that coverage for preconception/pregnancy/preventive care services is maximized through health plans. We will support and assist HCA in identifying and implementing strategies to enroll members with primary care providers and medical homes to encourage access to comprehensive care before, during and after pregnancy. In these ways, we will leverage our strong partnerships to work towards improved quality of preventive care for women in the state of Washington.

Rabeeha Ghaffar is the Project Manager of the Maternal and Child Health Block Grant at the Washington State Department of Health. She was prevously the Wisconsin Occupational Health Program Manager and the Prevention Director of the Western Colorado AIDS Project. She is committed to health equity and cultural hmility, and currently serves on the Department's Diversity and Inclusion Council.

Email: Rabeeha.Ghaffar@doh.wa.gov