Panel urges fixing coverage gap for pregnant women

An advisory panel has urged Congress to make sure pregnant women do not fall through the cracks of Medicaid and subsidized private coverage under the healthcare reform law.

The Medicaid and CHIP Payment and Access Commission issued seven recommendations affecting low-income women and children in Medicaid or the Children's Health Insurance Program both in states that expand Medicaid to adults earning up to 138% of the federal poverty level and those that do not.

The Patient Protection and Affordable Care Act allows states to retain their current, limited Medicaid benefits for pregnant women, even if they extend comprehensive Medicaid benefits to other low-income adults. This has created a situation where women earning above 138% of poverty who would qualify for federal premium subsidies to help them buy private coverage under Obamacare no longer are eligible for the subsidies once they become pregnant. That's because the state Medicaid program may provide limited benefits to pregnant women earning up to 200% of poverty, and adults eligible for Medicaid do not qualify for premium subsidies.

MACPAC is urging that Congress require states to provide the same comprehensive benefits to pregnant women who are eligible for Medicaid on the basis of their pregnancy that are furnished to women whose Medicaid eligibility is based on their status as parents of dependent children.

The goal is to address situations where state Medicaid programs cover only pregnancy-related services for Medicaid-enrolled women, which patient advocates say jeopardizes women's health. A consumer alert sent to MACPAC this past summer detailed cases of pregnant women in California's Medi-Cal program who did not have coverage for treatment of broken bones, osteomyelitis, a brain tumor and heart disease. The alert was co-signed by the March of Dimes, Planned Parenthood and the American College of Obstetricians and Gynecologists.

As of September, seven states were reported to cover only pregnancy-related services for Medicaid-enrolled pregnant women: Alabama, California, Idaho, Indiana, Nevada, New Mexico and North Carolina.

MACPAC also recommended that the HHS and Treasury secretaries specify that pregnancy-related Medicaid coverage does not constitute minimum essential coverage, thus enabling low-income pregnant women to qualify for subsidized private coverage through the insurance exchanges.

Under current rules, women who have incomes of less than 200% of poverty and qualify for premium subsidies to buy private coverage on the exchanges lose that eligibility if they become pregnant. Then they may have to switch from a subsidized private plan to Medicaid for the duration of their pregnancy since Medicaid is defined as minimum essential coverage. Once they give birth, they can qualify again for a premium subsidy for a private plan.

The MACPAC recommendation “ensures that these pregnant women won't have to bounce back and forth between coverage,” said Jocelyn Guyer, a director at the Washington-based consultancy Manatt Health Solutions.

MACPAC also suggested eliminating waiting periods for CHIP and eliminating premium payments for children in families with incomes below 150% of poverty. There are eight states that charge premiums for families with incomes at that level: Alabama, Arizona, Delaware, Florida, Georgia, Idaho, Nevada and Utah. And 37 states have CHIP waiting periods, half of them with waiting periods exceeding 90 days.

“Research is clear that asking very low-income families to pay even a modest premium for coverage can be a significant barrier to enrollment and seeking healthcare,” said Elisabeth Wright Burak, senior program director at Georgetown University's Center for Children and Families, a policy and research center.

Follow Virgil Dickson on Twitter: @MHVDickson