Although California’s low-income health plan paid for prenatal care, until recently it sometimes didn’t cover other medical conditions that women faced during pregnancy. The exclusions included conditions, ranging from broken bones to cancer, that could influence the health of the baby.
That changed Aug. 1 when the state expanded Medi-Cal for pregnant women, allowing them the same health coverage that it had already extended to other low-income people since 2013. Low-income women with asthma, infections or other health problems no longer have to worry that treatment for those issues won’t be covered during pregnancy.
“It’s a basic equity issue to have pregnant women have the same full scope of benefits as their adult counterparts,” said Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty, which advocated for the change.
Women’s health advocates applaud the expansion of benefits, but say there are some access concerns that remain, such as whether pregnant women and doctors are aware of the new coverage and whether there will be enough providers to meet the demand.
Are there enough doctors?
The state Department of Health Care Services, which oversees Medi-Cal, expects that 18,000 to 20,000 pregnant women will enroll in Medi-Cal seeking the new benefits, an increase of about 50 percent in the coming months. Under the previous, more limited coverage, about 12,500 women were enrolled. The state agency believes there are enough providers to meet the increase in demand.
But exactly how many pregnant women enroll in the coverage and whether there will be enough doctors to treat them remains to be seen.
The Health Care Services department said in mid-November that it didn’t yet have data on the number of women who have enrolled in the program since Aug. 1. The agency expects to release those numbers sometime in December, spokesman Anthony Cava said.
Lynn Kersey, executive director of the Los Angeles-based nonprofit Maternal and Child Health Access, said she remains concerned that there may not be enough prenatal specialists for women with complicated pregnancies.
“Prenatal specialists can be difficult to find for high-risk pregnancies, abortion or pregnant women with a specific health problem, who need to see a cardiologist, for example,” she said.
Many doctors don’t take Medi-Cal patients, because the program reimburses them at a low-rate compared to private insurance. “I do have concerns there and I hope the state does it’s work to monitor the network and providers,” Kersey said.
Expanded coverage, open to more women
Low-income pregnant women are now eligible for Medi-Cal that covers prenatal care and any health problem included in regular Medi-Cal. Women with incomes up to $21,984, or 138 percent of the federal poverty level for a family of two, now qualify for the program. Pregnant women and their unborn child are included in the family-size calculations.
Pregnant women with incomes up to 213 percent of the federal poverty level, or $33,936 for a family of two, can get pregnancy Medi-Cal, which is designed to cover prenatal care, but not necessarily other health conditions. Advocates are working to expand the benefits for these women as well, Kersey said.
Because the health of the mother and baby are intertwined, Landsberg said she believes all medical issues should be covered.
“It’s critical for women to get prenatal care and also take care of other health conditions that some would say aren’t related to the pregnancy;” she said, “although, I would argue that anything related to the mother’s health is related to the pregnancy.”
Before August, women with Medi-Cal who were diagnosed with cancer or had accidents or injuries during pregnancy sometimes were forced to go without treatment or pay out of pocket.
A Los Angeles woman whose arm was injured from an I.V. in the hospital where she gave birth last year was left stranded by the limited-scope Medi-Cal plan, Kersey said. Worried they wouldn’t be reimbursed for her care, a physical therapist and an orthopedist both refused to see her.
“How much more pregnancy-related can you get?” Kersey said. “But still she couldn’t get treatment.”
Finally, the woman got help from Maternal and Child Health Access, which agreed to pay for a follow-up visit, where she also got some arm exercises to do at home.
While the expansion of benefits now would cover such visits, advocates and the state still need to make sure providers are aware of the change, so they don’t continue to turn away pregnant patients.
“There’s a lot of provider education and trial to go through, so that they feel confident that there’s not going to be things that are not covered or bills that are going to be rejected,” Kersey said. “Community clinics should be up to speed on this, but private providers are the bigger challenge.”
Pregnant women can apply for Medi-Cal coverage through the Covered California website.