Updated – Better Coordinating Coverage for Pregnant Women: Putting Families First

May 19, 2014

Covered California plans and nearly all individual and employer-based health insurance plans offer maternity care.  California covers care for pregnant women through Medi-Cal (up to 200% of FPL), Access for Infants and Mothers (AIM) (up to 300% of FPL) and now Covered California covers maternity care (with premium subsidies up to 400% of FPL). In the Medi-Cal program, California offers the Comprehensive Perinatal Services Program (CPSP), which provides health education, psychosocial counseling and nutrition counseling that help achieve better birth outcomes.

The Governor’s budget proposes to shift AIM from the Managed Risk Medical Insurance Board (MRMIB) into the Department of Health Care Services (DHCS) and to give pregnant women with pregnancy-only Medi-Cal eligibility and incomes up to 208% of FPL the option to use premium assistance and wrap around benefits to enroll in Covered California. This appears to us to make a great deal of sense both programmatically and fiscally, but it is just a beginning. We need to make sense of these overlapping programs. While there are many commonalities, there are the following key differences among the programs: coverage for different provider networks and plans, different reimbursements, different rules governing the timeliness of applications, different rules for the undocumented, different rules for subscriber contributions, different covered services and different program administrators. There is an opportunity to coordinate these programs to improve birth outcomes. Premium assistance may allow us to simplify these programs in the best interests of the expectant mothers, their children and their families.

Let’s make it easy for families to understand and navigate. We would suggest that DHCS administer the program for women with family incomes under 138% of FPL and that Covered California administer the program for women over 138% of FPL. This would merge a portion of AIM and a portion of Medi-Cal pregnancy-only coverage into Covered California. Covered California could use premium assistance and the available Medi-Cal and AIM funding to upgrade care and coverage for pregnant women with incomes up to 300% of FPL: 1) upgraded services during pregnancy, 2) reduced copays during pregnancy, 3) reduced premium contributions during pregnancy, 4) adding pregnancy to the list of special life circumstances where enrollment is authorized outside the annual open enrollment period, and 5) continuity of care.

Read the full report here.