A model for improving access to care for uninsured women diagnosed with chronic hepatitis B during pregnancy

The US Preventive Services Task Force strongly recommends screening for chronic hepatitis B (CHB) infection in pregnant women to prevent vertical transmission of the virus. Consequently, 95% of pregnant women are screened nationwide and 20,000+ women are diagnosed each year. Many of these women are uninsured and covered by Medicaid only during pregnancy. Among them are a disproportionate number of uninsured Asian-American women with much higher rates of CHB infection. Newborn children are given prophylaxis and are covered by SCHIP, but mothers lose their Medicaid benefits just 60 days postpartum. There is currently a need for both better evaluation of these women during pregnancy, while they are still insured, and for extension of Medicaid coverage to allow for proper long-term clinical management and prevention of the serious consequences of CHB infection. The Breast and Cervical Cancer Prevention and Treatment Act of 2000 allows states to provide medical assistance through Medicaid to eligible women screened through the National Breast and Cervical Cancer Early Detection Program. Similar legislation allowing for Medicaid coverage of uninsured CHB-infected women, newly identified by Perinatal Hepatitis B Prevention Programs, would be an ideal solution to this dilemma. An analysis of the feasibility of extending Medicaid benefits to uninsured women diagnosed by the DOH Perinatal Hepatitis B Prevention Program in NYC was conducted. Preliminary results indicate that providing them with an option for treatment can lead to significant reductions in morbidity and mortality and also successfully remedies the issue of discontinued coverage of newly diagnosed, uninsured CHB-infected women.