CHIP Coverage is Important for Pregnant Women Too

While the importance of the Children’s Health Insurance Program (CHIP) for children has been widely documented, it is also important to remember that states can and many do use CHIP to provide coverage to low-and moderate-income pregnant women. With federal-funding for CHIP due to run out by the end of this federal fiscal year (September 2017), there are again discussions at the national level about the future of this coverage program. The following are some of the concerns state CHIP directors have shared with NASHP for pregnant women if funding for CHIP is not continued.

Pregnant women are at risk of losing coverage. Currently, nineteen states have opted to cover pregnant women using CHIP funds. A recent NASHP poll of these states found that approximately 320,000 pregnant women were enrolled in CHIP-funded coverage at some point during the last state fiscal year. CHIP eligibility for pregnant women, as it is for children, is targeted towards those with low- to moderate family income and ranges from 185% to approximately 300% of the federal poverty level. This eligibility and enrollment data is broken down by state CHIP program and displayed on our CHIP Eligibility for Pregnant Women Map. Without CHIP some of the currently covered pregnant women may have access to other sources of coverage, such as private insurance through exchanges or through employer-sponsored coverage, but it could be very costly and ultimately unaffordable. Others who are uninsured and become pregnant may not be able to access exchange coverage if they try to enroll outside of open enrollment periods. And finally some women may not meet exchange eligibility rules that bar certain immigration statuses from enrolling in coverage.

Exchange coverage might not be enough. With the implementation of the Affordable Care Act, pregnant women have new choices when it comes to coverage, such as access to private coverage through Health Insurance Marketplaces. Women face many decisions when navigating their coverage options and must weigh costs, access to existing providers, penalties for gaps in coverage and the possibility of transitioning to different coverage options post-pregnancy depending on their state. Although many women may qualify for tax credits and subsidies to make exchange plans more affordable, such coverage may still be too expensive for some low-income pregnant women. This is compared to CHIP, which is low or no cost for qualifying low-income pregnant women. NASHP recently explored the coverage options and decisions that pregnant women face in a set of infographics. These infographics also highlight policy implications for states to consider to improve coverage for pregnant women.

Ensuring access to critical pre-natal care. Since 2002 states have had the option to use CHIP funds to provide coverage for income-eligible pregnant women regardless of their immigration status through the “unborn child option.” Currently 15 states operate coverage programs under the CHIP unborn child option. The services provided through this option can be more limited than the typical CHIP benefit package and are intended to support the growth and development of the unborn child. Because the coverage is targeted to the unborn child, who will be a citizen of the United States, the pregnant woman’s immigration status is not a determining factor for eligibility.

In addition to paying for delivery costs, the CHIP unborn child coverage allows states the option to provide access to important pre-natal care so lower income women are more likely to have healthier pregnancies. Healthier pregnancies lead to lower-risk, lower cost deliveries and an increased likelihood of healthier babies. State officials are concerned that without this coverage, there would be increased uncompensated care costs to hospitals for both delivering and caring for infants from potentially higher risk births. Ensuring pre-natal care reduces the risk for poor birth outcomes, which not only affect medical costs, but future costs to schools.

In the coming months as federal policymakers and state and national stakeholders consider the future of CHIP, pregnant women and their unique, important health care needs should be included in these discussions.