California has received approval from the Obama administration to extend full Medicaid coverage to low-income pregnant women, patching an odd glitch in the Affordable Care Act's coverage expansion.
Even though California extended full Medicaid coverage under the Affordable Care Act to all women in households earning up to 138% of the federal poverty level, women who are pregnant at the time they enroll are given a limited set of benefits because of a previous federal mandate requiring states to at least cover pregnancy-related services (but allowing them to cover less).
The Medicaid and CHIP Payment and Access Commission (MACPAC) has asked Congress to 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.
Several state Medicaid programs still have coverage options that are limited to pregnancy-related services, which patient advocates say jeopardizes women's health. A consumer alert sent to MACPAC in 2013 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 2013, at least eight states were reported to cover only pregnancy-related services for most Medicaid-enrolled pregnant women: Alabama, California, Idaho, Indiana, Louisiana, Nevada, New Mexico, and North Carolina, according to MACPAC.
California now has permission to eliminate this limited coverage option. The approval notice also authorizes California to require pregnant women with incomes up to 138% of the federal poverty level to enroll in a Medi-Cal managed-care plan.
The waiver language was part of SB 857, which was signed into law last summer by California Gov. Jerry Brown.
Indiana also got approval to offer full coverage to women in its limited Medicaid pregnancy-only option last year, and Idaho is in discussions with the CMS about doing so, according a spokeswoman for the state Medicaid agency.
Alabama, meanwhile, has no plans to seek such a waiver, a spokeswoman there said. Representatives from Louisiana, Nevada, New Mexico, and North Carolina did not immediately return requests for comment.