This post is part of Health Advocate Blog series about the importance of the Children’s Health Insurance Program (CHIP) to the health care system.
Since its enactment in 1997, the Children’s Health Insurance Program (CHIP) has provided affordable coverage to uninsured, low-income children and adolescents up to the age of 19. Congress later expanded CHIP to include uninsured, low-income pregnant women.
Children and adolescents enrolled in CHIP receive robust benefits that meet the variety of needs they have as they mature. These benefits include preventive care, prescription medication, dental and vision care, inpatient and outpatient services, lab and x-ray services, and emergency services. In states that operate CHIP as part of their Medicaid programs, children receive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), a Medicaid program that requires states to provide children with access to any medically necessary services. Medicaid’s EPSDT is the “gold standard” for children’s health care, according to the American Academy of Pediatrics.
As important as CHIP is to providing basic and preventive services to all enrollees, it also plays a role in ensuring adolescents have access to needed reproductive health services. Broader access to comprehensive family planning services (including contraception) has reduced rates of unintended pregnancy for women of all ages, including adolescents and young adults. But disparities remain, particularly due to income and race. CHIP is one tool in reducing these disparities. CHIP programs generally provide routine gynecologic exams and obstetric care, STI/STD (sexually transmitted infections/sexually transmitted diseases) screening, age-appropriate sexuality education, family planning, pregnancy testing, and pregnancy care. CHIP also helps adolescents and young adults prevent unintended pregnancies and ensure healthy pregnancies and better delivery outcomes for those who become pregnant and choose to carry those pregnancies to term.
CHIP has also increased coverage for pregnant women. States can pursue this goal through Section 1115 waivers, state plan amendments, state plan options to cover lawfully residing pregnant immigrant women, and the unborn child option. Currently, 18 states and the District of Columbia have chosen to cover pregnant women under CHIP.
Services covered by CHIP for pregnant women vary state by state, but most recognize that quality prenatal care includes mental health services, dental benefits, emergency services, and postpartum coverage. All include coverage for prescription drugs. States expanding coverage to pregnant women must cover them up to at least 185 percent of the federal poverty level. In actuality, the majority of states cover pregnant women in CHIP at even higher income levels. And most states require no copays, premiums, or other cost-sharing for pregnant women. CHIP thus serves as a valuable safety net for pregnant women who earn too much to qualify for Medicaid but who may also have trouble affording marketplace coverage.
Direct coverage of pregnant women is certainly preferable, but states can also cover an unborn child to provide coverage to a pregnant woman by technically covering the fetus. States have used this option to expand coverage to immigrant women regardless of their immigration status. Benefits provided under this option must have some connection to the “health of the unborn child.” Thus, while the unborn child option can expand critical prenatal care services to certain immigrant women, it does not provide optimum coverage for pregnant women who may need services not directly related to the health of the fetus.
It is essential that Congress reauthorize CHIP early in September. Most states will exhaust their current federal CHIP funds by March 2018. And many states will have to start sending disenrollment notices if funding is not confirmed soon. If Congress is not able to reach a consensus on reauthorization, it risks jeopardizing health coverage for the more than nine million children and the hundreds of thousands of pregnant women who rely on the program each year for affordable coverage, including coverage of basic reproductive health services.
