The Hill

New Covered California Program Leaves Poor, High-Risk, Pregnant Women In The Lurch

Health insurance for pregnant women
A study examines the challenge of maintaining enriched health care for pregnant women who are enrolled in Covered California and also eligible for Medi-Cal. Photo courtesy of Shutterstock

In June this year, California passed legislation that allows the Comprehensive Perinatal Services Program (CPSP)—part of the Medi-Cal program—to be accessed by low-income group women who are currently enrolled in Covered California health plans. While the new legislation still needs to be implemented by the state’s lawmakers, a new study published by Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University raises concerns about the type of care pregnant women who are enrolled in Covered California and who are also eligible for Medi-Cal, will receive.

The CPSP was implemented in 1984 when it was found that a comprehensive approach in areas of nutrition, psychosocial and health education reduced both low birth weight rates and health care costs in women and infants. Since implementation, the program has seen unprecedented success in providing enriched maternity care to low-income pregnant women exposed to health, environmental, and social risks.

Covered California, on the other hand provides affordable health insurance to all legal Californians, but does not provide high quality maternity care coverage for high-risk pregnant women, the Milken Institute SPH claims.

"This is one of those situations in which the need for a solution is of crucial importance because of the health of pregnant women and their infants, but readily workable solutions exist. These solutions are consistent with standard plan management practices," said lead researcher Sara Rosenbaum, in a statement. "California's lawmakers could not have been clearer that access to high-quality health care funded through Medi-Cal's special program 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. Understanding the need for flexibility, the Legislature gave the agencies ample running room to devise a care coordination strategy. Now is the time to put a strategy in motion."

To understand how the new legislation would impact health care coordination and integration, the researchers compared the maternity care under Medi-Cal and Covered California. They examined a wide range of materials, including laws and regulations and a number of operational program documents from the two programs. The team found that Covered California differs from Medi-Cal in that it has not been designed to address the needs of women at highest health and social risks due to their economic status. 

In their paper, the Milken Institute SPH researchers propose two solutions:

  1. Covered California provider networks should include CPSP providers, with supplemental Medi-Cal payments
  2. Covered California should guarantee access to out-of-network coverage for women who wish to use a CPSP provider.
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