Assuring Access to Health Care for

Women and Children in Florida 

In 1990, the United States had one of the highest infant mortality rates (number of babies who die in the first year of life) in the industrialized world.  Florida ranked among the highest in the nation with over 1,900 infant deaths that year.  In June 1991, with the Healthy Start Program, Florida provided funding to expand Medicaid coverage for pregnant women, establish a network of community-based coalitions, and develop care coordination and other risk reduction services.  Florida was recognized for state-wide success in lowering adverse birth outcomes among women in the program.  Florida has reduced its infant mortality rate but now other factors threaten this progress.   Florida’s ranking in the National Kids Count annual assessment dropped three places, placing Florida in the bottom third of all states.  According to Kids Count, Florida ranks 29th in infant mortality rate, and 48th in children without health insurance.  Alarmingly, according to information from The Commonwealth Fund, a private foundation, out of all states Florida ranks dead last in access to care in the area of children’s health. 

In 2007, Florida had over 1,680 infant deaths and 20,767 low birth weight births.  Babies with a very low birth weight have a 25 percent chance of dying before age 1. These infants are at increased risk of long-term disability and impaired development.  Infant mortality is considered a sentinel indicator of the health of a community.  It is linked to poverty, education, housing, community and family violence, and access to basic health care.  Although many women may obtain prenatal care, our challenge in Florida is a woman’s health status prior to pregnancy which is related to an increase in fetal and infant deaths associated with prematurity.  This is also the indicator in which the greatest racial health disparities are occurring.  Appallingly, Florida’s Black infant death rate of 13.4 is more than double the White infant death rate of 5.2 for 2007.  Findings from research in Florida show risk factors related to maternal health and prematurity can be reduced with associated interventions.  For example, obtaining and maintaining well-woman care prior to conception would reduce risks of maternal infections and diseases that impact birth outcomes. 

Recommendations for a Healthier Florida 

     Utilize Preventative Care  * Provide Access to Healthcare Resources * Act to Reduce Health Disparities 

• Maintain Urgently Needed Services - Retain funding for Florida’s Healthy Start, MomCare, and Medicaid for Pregnant Women programs! Florida MUST maintain Healthy Start funding that is threatened by a Department of Health budget exercise to eliminate legislative funding gains of the past two years, resulting in a 22% loss and reverting to a static funding level of the prior decade. w MomCare funding of 14%, from a funding cut last year, MUST be restored. w A budget exercise by AHCA threatens to rollback Medicaid for pregnant women from 185% of poverty level to 150%. This would threaten coverage to the working poor and Florida could regress back to the level of high infant deaths of seventeen years ago! 

• Medicaid System Use - Streamline the current Medicaid application process for easier understanding and access. Changes in the Florida Department of Children and Families infrastructure greatly diminished the ability of the public to navigate a comprehensive route in the application process for Medicaid. w Ensure cautious Medicaid Reform by confirming that the evaluation of the Medicaid Reform pilot areas is complete and is reviewed prior to plans for expansion. Reports show that expansion is not advisable at this time. w Ensure continuous user-friendly access to the Florida KidCare program.

• Maintain Urgently Needed Resources - Continue support of low cost health department clinics for prenatal care, family planning (birth control education) and preventative primary care throughout Florida. Certain poor and uninsured residents are presently covered for only their childbirth delivery with Emergency Medicaid. Traditionally they have sought prenatal and other care at community clinics or “safety net providers” and have had good birth outcomes as a result. We support business-smart cost based reimbursement to these providers. Maintaining these valuable resources will benefit all Floridians. 

• Black Infant Health Practice Initiative & the Fetal and Infant Mortality Review (FIMR) Project - The Black Infant Health Practice Initiative is an excellent first step in reducing the high rates of racial disparities in infant mortality in Florida. This program is vital to reducing Black infant mortality rates and should be expanded to eight additional counties. And to continue this momentum we support reinforcing the FIMR infrastructure, in place since 1992, and expanding it to all Healthy Start Coalitions. (over)

It is estimated that 922,000 women of childbearing age in Florida have no health care insurance.  This may include non-citizens who are ineligible for Medicaid coverage, even though their infants will be U.S. citizens.  Many of the uninsured do not receive regular care, and consequently develop life-long health issues that can contribute to poor birth outcomes and other costly interventions.  While Healthy Start and Medicaid expansions have contributed to improvements in the care for women during pregnancy, gaps still exist in obtaining care prior to and after delivery.  The Kaiser Commission on Medicaid and the Uninsured reports that the “lack of insurance compromises the health of the uninsured because they receive less preventative care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than the insured”.

The Florida Association of Healthy Start Coalitions believes that funding, planning and strategy development should operate from a foundation of viewing pregnancy as a part of a continuum of health care needs through out the lifetime of the individual, versus a model of episodic care in response to “acute conditions”.  Maternal and child health services need to be linked to other existing resources.  Community clinics and provided services like primary care and family planning (education on birth control and baby spacing), services for sexually transmitted diseases and other maternal infection control, substance abuse prevention and treatment services should be integrated with maternal and child health programs. 

It is clear that where Florida has invested resources, we’ve seen results.  Investments in Neonatal and Perinatal Intensive Care Centers, KidCare, Healthy Start, and Medicaid expansions have improved care and paid off in the reduction of infant mortality and child morbidity.  We must continue to be sincerely committed to a process of ongoing assessment and improvement of Florida’s maternal and child health system to see positive results and ensure a healthier Florida.

 Sources:

 The Annie E. Casey Foundation Kids Count 2008 Data Book for 2005/2006.  Florida’s overall rank = 35/50 (1-50 = lowest to highest or worst). 

K. Shea, K. Davis, and E. Schor, U.S. Variations in Child Health System Performance: A State Scorecard, The Commonwealth Fund, May 2008.

Florida Department of Health, Office of Planning, Evaluation and Data Analysis Reports:  “Infant Mortality Rates per 1,000 births”, “Infant Deaths, Single-Year Counts 1990 (1,912) to 2007 (1,689)”, “Live Births Under 2500 Grams to All Mothers, Single-Year Counts 1990 (14,821) to 2007 (20,767).”

“Babies who are very low in birth weight (less than 1,500 grams, or 3 pounds 4 ounces) have a 25 percent chance of dying before age one.”  Child Trends DataBank:   Mathews, TJ, Menacker, F, and MacDorman, MF. (2002). “Infant mortality statistics from the 2000 period linked birth/infant death data set.” National Vital Statistics Reports. Vol. 50, Number 12.

Hopkins R, Miller C, and Thompson D: Perinatal Periods of Risk: An Assessment Approach to Understanding Fetal and Infant Deaths in Florida, 1995 - 1998, Florida Department of Health.

Medicaid Outcome Measures, Section 3 - “Findings by Selected Groups, Pregnant Women and Those Seeking Family Planning Services.”  Florida Health Care Journal, February 2002.  Florida Agency for Health Care Administration.

Florida Agency for Healthcare Administration Inspector General Report, October 2007, on Medicaid reform.

“Uncompensated Prenatal Care Among Non-U.S. Citizens, Florida, 1996 to 2005″, Florida Department of Health, July 2006.

Florida’s Uninsured Women of Childbearing Age (2003-2005 average) number 922,000; which is 26.9 percent, and at a national rank of 47 of 51 (worst). From the U.S. Census Bureau, 2006 Current Population Survey Annual Social and Economic Supplement. Data prepared for the March of Dimes.

CDC Recommendations to Improve Preconception Health and Health Care, as reported in Morbidity and Mortality Weekly Report, April 21, 2006.

National Governors Association (NGA) Center for Best Practices Issue Brief, “Healthy Babies: Efforts to Improve Birth Outcomes and Reduce High Risk Births,” June 28, 2004.

Executive Summary of “Sicker and Poorer: The Consequences of Being Uninsured”, Jack Hadley, PhD., The Kaiser Commission on Medicaid and the Uninsured (KCMU) 2003.

For more information please contact your local Healthy Start Coalition or

the Florida Association of Healthy Start Coalitions at 407-891-9199.  (November 2008)