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State Children’s Health Insurance Program (SCHIP) coverage of fetuses: What does it mean for low-income and immigrant women?

Lourdes A. Rivera, JD, National Health Law Program, 2639 S. La Cienega Blvd., Los Angeles, CA 90034, 310-204-6010, rivera@healthlaw.org

Starting in 2002, the Centers for Medicare and Medicaid Services (CMS) allowed states to cover fetuses for prenatal care, labor and delivery services. Other services that are deemed to benefit only the mother, such as postpartum care and treatment of postnatal complications, generally are not covered. This was the first major step by the Bush administration to elevate the status of the fetus, with serious implications for women's reproductive rights.

In contrast, states can extend coverage to women under Medicaid or an SCHIP waiver. Medicaid can cover prenatal care and 60 days postpartum care, pregnancy-related services (including family planning) and services that address conditions that would complicate the pregnancy (e.g. diabetes). Moreover, Congress has been considering several bills to allow SCHIP to cover pregnant women without a waiver and provide a similar scope of benefits as under Medicaid.

In promulgating the SCHIP rule, CMS emphasized that fetuses of immigrants, including undocumented, are eligible. While Medicaid confidentiality rules protect immigration status information, CMS quickly noted that the welfare reform statute prohibits the federal government from restricting State or local governmental entities from sharing information with INS.

A handful of states have opted to provide coverage to fetuses under SCHIP (e.g., IL, MA, MI, MN, and RI). In this presentation, we will examine how select states are implementing this option, determine how immigrants are being treated, and explore what it means for CMS to allow coverage of fetuses instead of women. We will compare this national policy with others implicating low-income women’s childbearing.

Learning Objectives:

Keywords: Reproductive Health, Low-Income

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Improving Maternal and Perinatal Health in the Context of Reproductive Health

The 132nd Annual Meeting (November 6-10, 2004) of APHA