Chapter 018
2023 -- S 0032
Enacted 05/18/2023

A N   A C T
RELATING TO STATE AFFAIRS AND GOVERNMENT -- HEALTH CARE FOR CHILDREN AND PREGNANT WOMEN--EQUALITY IN ABORTION COVERAGE

Introduced By: Senators Valverde, Mack, Sosnowski, Acosta, Murray, Pearson, Miller, Euer, DiMario, and Lawson

Date Introduced: January 18, 2023

It is enacted by the General Assembly as follows:
     SECTION 1. Legislative findings. The general assembly hereby finds and declares that:
     (1) In enacting the Reproductive Privacy Act in 2019, the general assembly recognized the
importance of protecting a person's right to reproductive health care. However, exercising that right
can be illusory for people of limited financial means.
     (2) Funding restrictions on abortion coverage interfere with an individual's personal
decision-making, with their health and well-being, and with their constitutionally protected right to
a safe and legal medical procedure.
     (3) Restrictions on abortion coverage have a disproportionate impact on low-income
residents, immigrants, people of color, and young people who are already disadvantaged in their
access to the resources, information, and services necessary to prevent an unintended pregnancy or
to carry a health healthy pregnancy to term.
     (4) Numerous other states provide abortion coverage in their Medicaid programs and in
their state employee insurance plans.
     (5) The purpose of this legislation is to promote equity in access to reproductive health
care.
     SECTION 2. Section 42-12.3-3 of the General Laws in Chapter 42-12.3 entitled "Health
Care for Children and Pregnant Women" is hereby amended to read as follows:
     42-12.3-3. Medical assistance expansion for pregnant pregnancy women/RIte Start.
     (a) The secretary of the executive office of health and human services is authorized to
amend its Title XIX state plan pursuant to Title XIX of the Social Security Act to provide Medicaid
coverage and to amend its Title XXI state plan pursuant to Title XXI of the Social Security Act to
provide medical assistance coverage through expanded family income disregards for pregnant
women persons whose family income levels are between one hundred eighty-five percent (185%)
and two hundred fifty percent (250%) of the federal poverty level. The department is further
authorized to promulgate any regulations necessary and in accord with Title XIX [42 U.S.C. § 1396
et seq.] and Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security Act necessary in order to
implement said state plan amendment. The services provided shall be in accord with Title XIX [42
U.S.C. § 1396 et seq.] and Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security Act.
     (b) The secretary of health and human services is authorized and directed to establish a
payor of last resort program to cover prenatal, delivery and postpartum care. The program shall
cover the cost of maternity care for any woman person who lacks health insurance coverage for
maternity care and who is not eligible for medical assistance under Title XIX [42 U.S.C. § 1396 et
seq.] and Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security Act including, but not limited
to, a noncitizen pregnant woman person lawfully admitted for permanent residence on or after
August 22, 1996, without regard to the availability of federal financial participation, provided such
pregnant woman person satisfies all other eligibility requirements. The secretary shall promulgate
regulations to implement this program. Such regulations shall include specific eligibility criteria;
the scope of services to be covered; procedures for administration and service delivery; referrals
for non-covered services; outreach; and public education. Excluded services under this subsection
will include, but not be limited to, induced abortion except in cases of rape or incest or to save the
life of the pregnant individual.
     (c) The secretary of health and human services may enter into cooperative agreements with
the department of health and/or other state agencies to provide services to individuals eligible for
services under subsections (a) and (b) above.
     (d) The following services shall be provided through the program:
     (1) Ante-partum and postpartum care;
     (2) Delivery;
     (3) Cesarean section;
     (4) Newborn hospital care;
     (5) Inpatient transportation from one hospital to another when authorized by a medical
provider; and
     (6) Prescription medications and laboratory tests.
     (e) The secretary of health and human services shall provide enhanced services, as
appropriate, to pregnant women persons as defined in subsections (a) and (b), as well as to other
pregnant women persons eligible for medical assistance. These services shall include: care
coordination; nutrition and social service counseling; high-risk obstetrical care; childbirth and
parenting preparation programs; smoking cessation programs; outpatient counseling for drug-
alcohol use; interpreter services; mental health services; and home visitation. The provision of
enhanced services is subject to available appropriations. In the event that appropriations are not
adequate for the provision of these services, the executive office has the authority to limit the
amount, scope, and duration of these enhanced services.
     (f) The executive office of health and human services shall provide for extended family
planning services for up to twenty-four (24) months postpartum. These services shall be available
to women persons who have been determined eligible for RIte Start or for medical assistance under
Title XIX [42 U.S.C. § 1396 et seq.] or Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security
Act.
     (g) Effective October 1, 2022, individuals eligible for RIte Start pursuant to this section or
for medical assistance under Title XIX or Title XXI of the Social Security Act while pregnant
(including during a period of retroactive eligibility), are eligible for full Medicaid benefits through
the last day of the month in which their twelve-month (12) postpartum period ends. This benefit
will be provided to eligible Rhode Island residents without regard to the availability of federal
financial participation. The executive office of health and human services is directed to ensure that
federal financial participation is used to the maximum extent allowable to provide coverage
pursuant to this section, and that state-only funds will be used only if federal financial participation
is not available.
     (h) Any person eligible for services under subsections (a) and (b) of this section, or
otherwise eligible for medical assistance under title Title XIX [42 U.S.C. § 1396 et seq.] and title
Title XXI [42 U.S.C. § 1397aa et seq.] of the Social Security Act, shall also be entitled to services
for any termination of pregnancy permitted under § 23-4.13-2; provided, however, that no federal
funds shall be used to pay for such services, except as authorized under federal law.
     SECTION 3. Section 36-12-2.1 of the General Laws in Chapter 36-12 entitled "Insurance
Benefits" is hereby repealed.
     36-12-2.1. Health insurance benefits -- Coverage for abortions excluded.
     (a) The state of Rhode Island shall not include in any health insurance contracts, plans, or
policies covering employees, any provision which shall provide coverage for induced abortions
(except where the life of the mother would be endangered if the fetus were carried to term, or where
the pregnancy resulted from rape or incest). This section shall be applicable to all contracts, plans
or policies of:
     (1) All health insurers subject to title 27;
     (2) All group and blanket health insurers subject to title 27;
     (3) All nonprofit hospital, medical, surgical, dental, and health service corporations;
     (4) All health maintenance organizations; and
     (5) Any provision of medical, hospital, surgical, and funeral benefits and of coverage
against accidental death or injury when the benefits or coverage are incidental to or part of other
insurance authorized by the statutes of this state.
     (b) Provided, however, that the provisions of this section shall not apply to benefits
provided under existing collective bargaining agreements entered into prior to June 30, 1982.
     (c) Nothing contained herein shall be construed to pertain to insurance coverage for
complications as the result of an abortion.
     SECTION 4. This act shall take effect upon passage.
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