State to change pregnancy coverage plans

Stopgap prenatal care to be provided

The Jindal administration announced late Tuesday it would rescind a decision that would have left some poor women who become pregnant after Jan. 1 without prenatal care.

The state Department of Health and Hospitals planned for the women to get insurance coverage through the federal Affordable Care Act.

But the agency recently found a potential problem could crop up for women who do not sign up through the exchange by the open enrollment deadline, then became pregnant.

The pregnancy would not be a “qualifying event” for coverage.

“Federal policy messed us up,” state DHH Secretary Kathy Kliebert said Tuesday.

“Once we realized that, we decided we are going to go ahead and move forward on a policy that would include coverage of these women.”

DHH estimates there are 2,626 women for whom the changes would have been relevant, but who now will be covered through a state program.

Under the solution, Kliebert said the women would be covered through a part of Louisiana’s Children’s Health Insurance Program.

“We are going to be able to change our rules so we can cover these women at pregnancy,” Kliebert said. Once the women have the baby, they would be eligible for insurance through the federal health insurance exchange, she said.

The state has been working on improving prenatal care to get healthier babies, Kliebert said, adding the state could not allow any lapse in care.

The agency proposed to decrease the income level for state Medicaid program eligibility from 200 percent of the federal poverty level to 138 percent effective Jan. 1 in the pregnant women’s program.

Those pregnant before Jan. 1 would have continued to be covered by the state program.

The Louisiana Hospital Association had filed a formal objection to the change.

The LHA also objected to a decision to scrap another state program that expedites sign-up for Medicaid disability coverage.

Louisiana Hospital Association President John Matessino said the association’s membership has “great concern” over the two policy changes, which in one case would negatively affect access to prenatal care and in the other case could cause delays in getting care to those with disabilities.

“Both of these things, they are going to have to be addressed. They are going to leave a lot of people in the lurch,” Matessino said Tuesday.

Matessino said the LHA was concerned about the pregnant women’s coverage gap that would be created.

Eliminating coverage for pregnant women is counter to the prenatal and neonatal care quality-improvement initiatives that both hospitals and DHH have worked to implement, Matessino said.

Louisiana recently got an F in a national March of Dimes report for “poor birth outcomes” even though it had made some progress from the prior year.

Kliebert said the disability change under which the Social Security Administration will take over eligibility decisions will stay.

“We have been working diligently to make sure these people get enrolled by Jan. 1,” she said.

She also said there is an emergency eligibility route that can be used when people need extended stays or acute care.

Matessino said the end of the state program would create problems for individuals and health care providers.

He said the LHA is concerned about the length of time the SSA will take to make a determination “which can take up to 18 months and potentially longer.”

“These patients have complex medical needs, and it is important that ‘verifiable’ coverage is available to facilitate the necessary care in the appropriate setting,” Matessino said.

“Providers simply cannot absorb the provision of this expensive care over a lengthy amount of time without reimbursement.”