May 12, 2014 — Some low-income women who have obtained private health plans through the Affordable Care Act's (PL 111-148) insurance marketplaces also will have access to additional coverage through their state's Medicaid program if they become pregnant, the AP/San Francisco Chronicle reports.
According to the AP/Chronicle, prior to the ACA, low- and middle-income women who were uninsured and pregnant had access to special, time-limited Medicaid coverage that lasted through the child's birth. Once the ACA took effect, uninsured people typically had to enroll either in Medicaid coverage or coverage purchased through the marketplaces, depending on their income levels.
However, the Treasury Department last summer clarified that states' Medicaid coverage for pregnant women did not meet the ACA's definition of "minimum essential coverage" because it was temporary and states could limit coverage of services. As a result, certain pregnant women are now able to access coverage through both their state's Medicaid system -- depending on income requirements -- as well as through private marketplace plans.
Some observers have raised concerns about implementation of the coverage options. The ruling was issued too late for states to incorporate it this year into their Medicaid and marketplace computer systems, which currently support enrollment in one program or the other. Officials also face the challenge of educating consumers about their options.
In addition, the cost of pregnancy care and childbirth can be significant but hard to predict. About half of pregnancies in the U.S. are unplanned. Many consumers focus on monthly premiums when they select plans and think less about out-of-pocket costs, the AP/Chronicle notes.
Cynthia Pellegrini, head of March of Dimes' office in Washington, D.C., said, "A lot of women, particularly in a situation like childbirth, could end up with significant out-of-pocket costs," but if "they are eligible for Medicaid, they could be protected from costs ranging from hundreds to thousands of dollars."
Dipti Singh, an attorney with the National Health Law Program, said the best choice will depend on a woman's particular circumstances. For example, low-income women might be better off remaining solely in Medicaid because many states have opted to provide comprehensive coverage for pregnant women, whereas women with marketplace plans might want to also enroll in Medicaid to limit their out-of-pocket expenses (AP/San Francisco Chronicle, 5/12).
Obama Administration Reminds New Parents of Enrollment Options
In related news, the federal government used Mother's Day to remind uninsured women that giving birth or adopting a child counts as a special enrollment circumstance under the ACA, meaning that they can enroll in a plan through the marketplaces even though the initial open enrollment period has ended, the AP/Washington Times reports.
Under the ACA, people who have recently given birth or adopted a child have 60 days from the date of birth or adoption to enroll in coverage. Coverage purchased through the marketplaces includes postpartum depression treatment, breast pumps, immunization and other preventive services (AP/Washington Times, 5/11).