Some low-income Louisiana women who become pregnant in 2014 may not be covered for prenatal care because of a disconnect between new state and federal health care policies.
The problem cropped up with interpretations of a federal rule governing the new federal Affordable Care Act.
State health officials planned to reduce state Medicaid eligibility from 200 percent of the federal poverty level to 133 percent for pregnant women since they would be covered through the federally subsidized insurance exchanges.
Women who are pregnant before Jan. 1, would continue with state Medicaid coverage through their pregnancy.
Now, the federal Centers for Medicare and Medicaid Services has thrown the state a curve.
If the women are not enrolled in a health plan at the time they get pregnant, there would be no prenatal coverage.
“Right now, we are reworking our policy because we definitely want them to get prenatal services,” said state Department of Health and Hospitals Secretary Kathy Kliebert. “We worked too hard on our birth outcomes to lose any ground there. We want to make sure that pregnant women are covered.”
The state has been making progress on improving the health of newborns because of mothers who receive good prenatal care are less likely to have babies that need intensive care at birth.
Under the change, an estimated 2,626 pregnant women would no longer be covered by Medicaid because they could get subsidized coverage through the insurance exchanges set up by the Affordable Care Act, according to state officials.
The women fall between the 200 percent of federal poverty level eligibility or $39,060 for a family of three and the proposed 133 percent or $25,975 for a family of three that would take effect in the state’s Medicaid program Jan. 1.
A new Centers for Medicare and Medicaid Services interpretation of the term “qualifying life event” would leave some of those women in the gap without prenatal care, Kliebert said.
The definition of a qualifying event to enroll in the new health insurance exchange outside of the open enrollment period removed the event of becoming pregnant. Now it states the event is the birth of the baby that qualifies a woman for coverage.
So becoming pregnant will not be a qualifying life event to trigger a special insurance exchange enrollment period for women, Kliebert said.
“It’s not the pregnancy. It’s the birth,” she said.
State health officials have been trying to discuss coverage option possibilities with the Centers for Medicare and Medicaid Services but it has been slow going because of the just ended federal government shutdown, she said.
Kliebert she feared a lot of women won’t sign up through the insurance exchange, then get pregnant and know they need coverage.
“It will be a continuing problem,” Kliebert said. “If somebody signs with an exchange it would not be an issue. If they don’t, you are always going to have a problem.”