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Calif. Insurance Marketplace Leaves Coverage Gaps for Some High-Risk Pregnant Women

Calif. Insurance Marketplace Leaves Coverage Gaps for Some High-Risk Pregnant Women

November 4, 2014 — Covered California -- the state's health insurance marketplace -- does not provide sufficient maternity care coverage for high-risk pregnant women, according to a study by George Washington University's Milken Institute School of Public Health, Medical Daily reports.

Study Details

For the study, the researchers compared maternity coverage offered under plans sold through Covered California and Medi-Cal, California's Medicaid program. The study examined laws, regulations and documents related to the plans. For example, the researchers looked at the Comprehensive Perinatal Services Program, which is a part of Medi-Cal. Low-income women enrolled in Covered California plans eventually will be able to access CPSP coverage under legislation passed in June (Iyer, Medical Daily, 10/31).

Findings and Recommendations

The researchers found that while Covered California plans provide standard-quality care for women with average health risks, they are not equipped to address the needs of women who are considered high risk because of their economic status (GWU Milken Institute release, 10/31). The researchers made two recommendations: include CPSP providers in Covered California provider networks and allow supplemental Medi-Cal payments, and provide access to out-of-network coverage for women who want to use a CPSP provider.

Lead researcher Sara Rosenbaum said, "These solutions are consistent with standard plan management practices." She continued, "California's lawmakers could not have been clearer that access to high-quality health care funded through Medi-Cal's special program [CPSP] is to be preserved for high-risk pregnant women who are enrolled in qualified health plans, and for whom standard maternity care is not enough," adding, "Now is the time to put a strategy in motion" (Medical Daily, 10/31).