The PJC’s Health Rights Project supports policies and practices that promote the overall health of Marylanders struggling to make ends meet, with the explicit goal of eliminating racial and ethnic disparities in health outcomes. 2022 is an important year for health care and public benefits. We are advocating alongside other health and anti-poverty advocates to pass legislation that would expand health coverage for communities that are historically underserved and would change public benefits programs to be responsive to the needs of low-income families struggling to make ends meet. These issues touch the lives of many of the PJC’s client communities, and we are hopeful that the Maryland House and Senate will pass these bills to improve the lives of low-income Marylanders. Here are some of the bills that our Health Rights Project is supporting this session.
Holding Maryland’s hospital accountable for providing charity care. The PJC and other health advocates are supporting HB 694 to address the failure of Maryland’s hospitals to meet their obligation to provide charity care to eligible patients. In 2021, when the legislature was considering the Medical Debt Protection Act (HB 595), the Maryland Health Services Cost Review Commission (HSCRC) released a study showing that hospitals collected roughly $60 million in 2017 and then again in 2018 from patients who were eligible for free care and thus, should not have been charged. HB 694 would require the HSCRC, in coordination with the Department of Human Services, the State designated exchange, the Office of the Comptroller, and the Maryland Hospital Association, to develop a process for identifying patients who paid for hospital services but may have qualified for free care and reimburse them. HB 694 covers patients who were wrongly charged between 2017-2021. We are urging the state House and Senate to pass this bill without any weakening amendments so that low-income hospital patients can be financially restored to where they were before they were wrongfully billed.
Transforming the Temporary Cash Assistance work program to meet the needs of low-income families. Temporary Cash Assistance (TCA) is an important resource for over 22,000 low-income families in Maryland and supports basic needs, such as housing and food. Though adult recipients of TCA are required to work, more than 25% of these families are working without pay. This issue disproportionately impacts TCA recipients who are Black and those who identify as women. The goal of TCA is to promote self-sufficiency, but unpaid work does not leave participants with the necessary skills or training to secure unsubsidized employment. Maryland’s existing TCA policies are rooted in the harmful and false narrative that labor must be compelled and that not all labor is worthy of payment. HB 1043/SB 828 seeks to disrupt this harmful narrative and bring meaningful changes to Maryland’s TCA program. We thank the Homeless Persons Representation Project and Catholic Charities of Baltimore for leading this important bill to address serious inequities in Maryland’s TCA program.
Closing gaps in Medicaid coverage for gender-affirming care. The PJC joins TransMaryland and other health advocates in expanding Medicaid coverage for comprehensive gender-affirming care through the Trans Health Equity Act of 2022 (HB 746/SB 682). Transgender Marylanders are navigating a tiered healthcare system where certain gender affirming care that would be covered by private insurance is not covered for Medicaid beneficiaries. Further, the existing list of gender-affirming care that is currently covered by Medicaid is outdated and does not cover comprehensive medically necessary and life-saving care. The lack of access to gender-affirming care impacts low-income transgender Marylanders by leaving them vulnerable not only to discrimination in various areas of life, but also to physical and mental health complications. HB 746/SB 682 aims to correct this glaring disparity by requiring Medicaid to expand the gender-affirming care that it covers, allowing Maryland to join more than 10 other states that provide more comprehensive care.
Expanding Medicaid to cover adult dental care. We thank the Maryland Dental Action Coalition for leading HB 6/SB 150, which would finally expand Maryland Medicaid to provide full adult dental coverage. Socioeconomic status should not be a barrier to attaining good oral health, but sadly this is the reality for many low-income Marylanders. Currently, Maryland provides dental coverage to adults under 65 who are dually eligible for Medicaid and Medicare. This leaves most adult beneficiaries without full dental coverage and places Maryland behind more than 30 other states that provide limited or comprehensive adult dental coverage to beneficiaries. When preventative dental care is not available, Medicaid beneficiaries must turn to emergency rooms to treat and manage pain from chronic dental issues. To eliminate dental health disparities and promote the overall wellness of Marylanders, the State must invest in the oral health of low-income adults now.
Ensuring pregnant and postpartum Medicaid beneficiaries have access to doula care. The PJC joins other maternal health advocates in urging the passage of HB 669/SB 503, which would require the Maryland Medical Assistance Program (Medicaid) to continue covering doula services for pregnant and postpartum beneficiaries. Doulas are non-medical birth workers who provide emotional and physical support, information and advocacy to birthing people and families during the prenatal, birth and postpartum period. Research supports that doula care provides a wide range of benefits to birthing parents and their babies, including lower cesarean rates, higher breastfeeding initiation rates, and shorter labors. Though Maryland’s Medicaid program began covering doula care in January 2022, the program is only slated to receive funding for four years. HB 669/SB 503 would codify the regulations for the Maryland Medicaid Doula Program, making doula care a permanent feature of Maryland’s Medicaid program. This would allow Maryland to join the growing number of states that have recognized that doula care can improve pregnancy outcomes for low-income birthing people and birthing people of color.
Expanding health insurance coverage for immigrant communities. We thank CASA de Maryland for leading the charge on the Healthy Babies Equity Act (HB 1080). The COVID-19 pandemic exposed and worsened existing health disparities and inequities in healthcare access. One of the most glaring disparities is the lack of health insurance coverage available to immigrants depending on their immigration status. Under current federal and state law, non-citizens who have resided in the United States legally for less than five years are not eligible for prenatal and postpartum care coverage through Medicaid. These laws have the impact of forcing low-income non-citizens who cannot afford prenatal care out-of-pocket to wait until birth to identify potentially life-threatening issues to the health of the birthing parent and baby. Access to quality healthcare should not hinge on immigration status. We are hopeful that Maryland’s legislators will vote to remove these harmful barriers and open pathways towards health insurance coverage for all pregnant and postpartum Marylanders.
Attorney Ashley Black leads the PJC’s health rights advocacy.