HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1609 Pregnancy Support Services
SPONSOR(S): Stevenson
TIED BILLS: IDEN./SIM. BILLS: SB 1442
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
1) Healthcare Regulation Subcommittee 16 Y, 0 N Osborne McElroy
2) Health Care Appropriations Subcommittee 14 Y, 0 N Aderibigbe Clark
3) Health & Human Services Committee
SUMMARY ANALYSIS
Social determinants of health are the external factors of a person’s life that impact their health. These are the
conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a
wide range of health, functioning, and quality-of-life outcomes and risks. Housing is an important social
determinant of health.
The United States is in the midst of a housing affordability crisis. Income growth has not kept up with rising
housing costs, and the overall housing market has not responded adequately to the need for affordable
housing. The national crisis is being acutely felt in Florida, with low-income renters being especially vulnerable
to the rising cost of housing.
In 2022, there were 224,403 recorded births in Florida. Healthy pregnancies and childbirth are foundational to
healthy families and communities. Nonetheless, pregnancy remains an essential but often dangerous
experience with the potential for many avoidable complications. Maternal and infant health outcomes are an
important marker of the overall health of a society. Florida’s expecting mothers are not exempt from the state’s
affordable housing crisis. While the long-term effects of housing instability are detrimental to all who
experience it, the impact on pregnant women is especially acute. Homelessness during pregnancy poses
significant health risks for mothers and infants.
The bill creates that it is the Florida State Maternity Housing Grant Program within the Department of Health
(DOH). The bill states that it is the intent of the Legislature to provide housing resources to resident women
and families during the prenatal period, regardless of age or marital status, whose financial resources have
been determined inadequate to meet residential costs.
The bill outlines expenses which grant funds may be allocated toward, and directs DOH to make rules for the
implementation of the grant. The bill specifies that the total amount of grants awarded by DOH may not exceed
the funding appropriated for the grant program.
The bill grants DOH rulemaking authority to adopt rules necessary for the administration of the program.
The provisions of the bill are subject to an appropriation. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h1609c.HCA
DATE: 1/29/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Social Determinants of Health
Social determinants of health (SDOH) are the external factors of a person’s life that impact their health.
These are the conditions in the environments where people are born, live, learn, work, play, worship,
and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
There are five main categories of SDOH:1
Economic stability;
Education access and quality;
Health care access and quality;
Neighborhood and built environment; and
Social and community context.
SDOH influence a persons’ health in several ways. Some SDOH have causal relationships that are
clear and relatively direct; for example, the presence of mold, or poor air and water quality, are part of
the built environment that a person lives in and while consequences may be delayed, the causal
relationship is easily established.2 Living in such environmental conditions are often influenced by other
SDOH, such as economic stability and community context where the connections to health outcomes
are evident, but less easily conceptualized.3
Some aspects of health are especially sensitive to the environments that a person find themselves in.
Housing Insecurity
Housing is an important social determinant of health. The lack of housing, or poor-quality housing,
negatively affects a person’s health and well-being. Tangible housing defects resulting from damp and
mold, unregulated indoor temperatures, overcrowding, and safety factors have a clear impact on
physical and mental health. There are also pronounced psychosocial benefits to the concept of “home,”
which are tied to the social values of housing as reflecting stability, control, autonomy, status, and
empowerment. Such qualities have a significant impact on a person’s mental health and long-term
stability.4
The US is in the midst of a housing affordability crisis. 5 Income growth has not kept up with rising
housing costs, and the overall housing market has not responded adequately to the need for affordable
housing. The national crisis is being acutely felt in Florida, with one survey showing that 25 percent of
Floridians identifying “housing costs,” as the most important problem facing Florida today.6
1
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Social Determinants of Health.
Available at https://health.gov/healthypeople/priority-areas/social-determinants-health (last visited January 21, 2024).
2 Braubach, M., Jacobs, D.E., & Ormandy, D. Environmental b urden of disease associated with inadequate housing: a method guide to
the quantification of health effects of selected housing risks in the WHO European Region . (2011). World Health Organization. Regional
Office for Europe. https://iris.who.int/handle/10665/108587
3 Braveman, P., & Gottlieb, L. The social determinants of health: it's time to consider the causes of the causes. (2014) Public health
reports, 129:2, 19–31. https://doi.org/10.1177/00333549141291S206
4 Rolfe, S., Garnham, L., Godwin, J. et al. Housing as a social determinant of health and wellb eing: developing an empirically -informed
realist theoretical framework (2020). BMC Public Health 20, 1138. https://doi.org/10.1186/s12889 -020-09224-0
5 Desmond, M. Unaffordab le America: Poverty, Housing, and Eviction (2022). American Journal of Sociology. In The Affordable
Housing Reader (pp. 389-395). https://doi.org/10.4324/9780429299377-34
6 University of North Florida, Public Opinion Research Lab, Florida Republican Presidential Primary Polling (2023). Available at
https://www.unfporl.org/uploads/1/4/4/5/144559024/unf_mar_statewide_2023_ada.pdf (last visited January 21, 2024).
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The precise cause of the shortage of affordable housing is complex and multi-faceted, but it is an issue
felt by would-be homebuyers and renters alike. In Florida, the median single-family home prices are
approaching the boom-era costs of the mid-2000s; between 2011 and 2022, the median home price
has risen 91 percent. Meanwhile, the situation in the rental market is dire for low-income renters. The
state has added hundreds of thousands of rental units in the last decade, but simultaneously lost
“affordable”7 rental units.8 Many low-income renters pay more than 40 percent of their income for
housing, and there are only 26 affordable and available rental units for every 100 households with an
extremely low income.9
As a result, more families and individuals are finding themselves in precarious housing situations. 10
Nationally, 5.52 million renter households reported being behind on their rent payment, with 1.87 million
fearing imminent eviction in August 2023.11
While the majority of people experiencing homelessness are men, women and families constitute the
fastest-growing segment of the homeless population.12 Black and Hispanic women, particularly single
mothers with children, are at the highest risk for housing insecurity. Women experiencing housing
insecurity report barriers to health care generally, and as such tend to lack access to adequate
contraceptive methods.13
Pregnancy Outcomes
In 2022, there were 224,403 recorded births in Florida.14 Healthy pregnancies and childbirth are
foundational to healthy families and communities. Nonetheless, pregnancy remains an essential but
often dangerous experience with the potential for many avoidable complications. 15 Maternal and infant
health outcomes are an important marker of the overall health of a society.
Maternal Health Outcomes
Maternal mortality refers to deaths occurring during pregnancy or within 42 days of the end of
pregnancy, regardless of the duration of the pregnancy, from any cause related to or aggravated by the
pregnancy, but not from accidental or incidental causes. 16 In 2021, more than 1,200 women died of
maternal causes in the United States compared with 861 in 2020 and 754 in 2019. 17 The national
maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births. 18 Racial and ethnic gaps exist
between non-Hispanic black, non-Hispanic white, and Hispanic women. The maternal mortality rate of
these groups is 69.9, 26.6, and 28.0 deaths per 100,000 live births, respectively.19
7
“Affordable” rental units mean those renting for $1,000 or less per month.
8 University of Florida, Shimberg Center for Housing Studies. Florida Affordab le Housing Trends (2022). Available at
http://www.shimberg.ufl.edu/publications/FL_presentation_121422.pdf (last visited January 22, 2024).
9 Id.
10 Greene, S., Richardson, T., Bryon, J., & Cho, R. Rise in homelessness averted amidst worsening housing needs in 2021. What does
this tell us ab out how to end homelessness in the U.S.? (2023). HUD User. Available at https://www.huduser.gov/portal/pdredge/pdr-
edge-frm-asst-sec-082223.html (last visited January 22, 2024).
11 Id.
12 Welch-Lazoritz, M.L., Whitbeck, L.B., & Armenta, B.E. Characteristics of mothers caring for children during episodes of
homelessness. (2015). Community Ment Health J. 51(8):913-920. doi: 10.1007/s10597-014-9794-8
13 Kozlowski, Z., Sanders, J.N., Panushka, K., Myers, K., Millar, M.M., & Gawron, L.M. "It's a Vicious Cycle": A Mixed Methods Study of
the Role of Family Planning in Housing Insecurity for Women (2022). Journal of Health Care for the Poor and Underserved 33(1), 104-
119. https://doi.org/10.1353/hpu.2022.0009
14 FL Health Charts, Birth Counts Query System . Available at https://www.flhealthcharts.gov/FLQUERY_New/Birth/Count (last visited
January 9, 2024).
15 Hernandez, L., Thompson, A., & Burch, D. Florida’s Pregnancy-Associated Mortality Review 2015 Update (2017). Florida Department
of Health. Available at http://www.floridahealth.gov/statistics-and-data/PAMR/pamr-2015-update.pdf (last visited January 22, 2024).
16 U.S. Dep’t of Health and Human Services, The Surgeon General’s Call to Action to Improve Maternal Health (2020). Available at
https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf (last visited December 5, 2023).
17 Donna L. Hoyert, Ph.D., Division of Vital Statistics, National Center for Health Statistics, Maternal Mortality Rates in the United
States, 2021, (March 2023). Available at https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-
2021.pdf https://www.cdc.gov/reproductivehealth/maternal-mortality/index.html(last visited January 8, 2024).
18 Id.
19 Id.
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Although Florida’s maternal mortality rate is lower than the national rate, it has been increasing in
recent years. As of 2021, the maternal mortality rate in Florida is 28.7 deaths per 100,000 live births, an
increase from a low of 12.9 deaths per 100,000 live births in 2016. 20 Similar to the national trend, racial
and ethnic disparities exist in the maternal mortality rates in Florida as evidenced in the following chart:
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Florida Total 18.8 25.1 16.0 16.9 12.9 15.7 16.3 19.5 21.0 28.7
Non-Hispanic White 9.5 18.7 13.2 20.0 13.3 12.7 12.9 19.8 12.9 12.4
Non-Hispanic Black 60.5 37.9 29.3 25.1 25.0 35.3 32.0 38.9 50.0 75.1
Hispanic 1.7 25.4 8.1 6.3 4.6 7.5 10.6 8.9 16.3 21.8
Florida Total Non-Hispanic White Non-Hispanic Black Hispanic
For every maternal death, 100 women suffer a severe obstetric morbidity, a life-threatening diagnosis,
or undergo a lifesaving procedure during their delivery hospitalization. 21 Severe maternal morbidity
(SMM) includes unexpected outcomes of labor and delivery that result in significant short- or long-term
consequences to a woman’s health. SMM has been steadily increasing in recent years. 22
The consequences of the increasing SMM prevalence, in addition to the health effects for the woman,
are wide-ranging and include increased medical costs and longer hospitalization stays.23
From 2013 to 2022, there were 51,454 cases of SMM among delivery hospitalization in Florida. 24
Similar to maternal mortality rates, rates of SMM are higher in racial and ethnic minority women. 25
The following figure shows the trend over time for SMM rates in Florida per 1,000 delivery
hospitalizations:26
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
20 Presentation by Kenneth Scheppke, M.d., F.A.E.M.S., Deputy Sec’y for Health, DOH, before the Senate Committee on Health Polic y
0.0
(Nov. 14, 2023), available at https://www.flsenate.gov/Committees/Show/HP/MeetingPacket/5979/10504_MeetingPacket_5979_4.pdf
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
(last visited January 8, 2024).
21 Florida
Elizabeth A. Howell, MD, MPP, Total Disparities
Reducing 17.9 19.1 20.2
in Severe 17.0Morb
Maternal 18.0
idity17.2 18.0 20.4
and Mortality 23.8CLINICAL
(2018). 23.6 OBSTETRICS AND
GY NECOLOGY , 61(2). Available at
Non-Hispanic White 14.1 15.6 15.6 13.3 14.5 14.3 15.0 15.9 19.3 19.1
https://journals.lww.com/clinicalobgyn/abstract/2018/06000/reducing_disparities_in_severe_maternal_morbidity.22.aspx (last visited
January 8, 2024). Non-Hispanic Black 28.0 28.3 32.0 28.0 27.2 26.3 26.4 31.0 35.6 35.3
22 Id., and CDC, Severe Maternal Morb idity in the United States (2023). Available at
Hispanic 15.7 18.2 19.1 15.8 16.9 15.4 17.5 19.7 22.2 22.0
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html (last visited January 8, 2024).
23 CDC, Severe Maternal Morb idity in the United States (2023). Available at
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html (last visited January 8, 2024).
24 Presentation by Kenneth Scheppke, M.D., F.A.E.M.S., Deputy Sec’y for Health, DOH, before the Senate Committee on Health Polic y
(Nov. 14, 2023). Available at https://www.flsenate.gov/Committees/Show/HP/MeetingPacket/5979/10504_MeetingPacket_5979_4.pdf
(last visited January 8, 2024).
25 Supra, note 21.
26 Id.
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The consequences of maternal death and severe maternal morbidity are felt throughout a community.
High rates of maternal death are associated with infant and child mortality, loss of economic
opportunities, and cycles of poverty extending from the family into the broader community.27
Infant Health Outcomes
Infant mortality is the death of an infant before the first birthday. The infant mortality rate is the number<