CMS Proposes Extending Coverage to Fetuses
The Bush administration has drafted a policy that would permit states to make fetuses eligible for medical coverage under their CHIP programs, the New York Times reports. The policy is laid out in an "undated" draft letter to state officials from Dennis Smith, who supervises the CHIP program at the Center for Medicare and Medicaid Services (formerly HCFA). The letter states that HHS Secretary Tommy Thompson will propose that "an unborn child" may qualify as eligible for the CHIP program. Smith writes, "This would mean that regardless of the age of the mother, eligibility for the unborn child may be established, thereby making services including prenatal care and delivery available." Currently, the CHIP program only covers pregnant women under the age of 18, though New Jersey and Rhode Island have received federal waivers to cover older pregnant women. And while Medicaid covers pregnant women of all ages, the federal government only requires states to cover women up to 133% of the federal poverty level (Pear, New York Times, 7/6). State CHIP programs, however, typically have income ceilings at 200% FPL (State Eligibility Table, Center for Budget and Policy Priorities, 7/6). The letter does not indicate how old a fetus must be to qualify for state coverage, and some officials "want to specify" that a fetus could qualify soon after conception (New York Times, 7/6). If adopted by the administration, states would not be required to change their CHIP policies but would be given the option to do so. States would also set income-eligibility requirements for fetuses, as they do for the rest of CHIP (McGinley, Wall Street Journal, 7/6). In the draft letter, Smith notes that the Bush administration will issue the policy in a "notice of proposed rule-making" in the Federal Register "in the near future," the Times reports.
HHS spokesperson William Pierce confirmed that Thompson is considering the policy change, saying, "This will increase access to prenatal care for pregnant women, the ultimate goal being healthier babies and healthier children." But abortion-rights supporters contend that the new policy would jeopardize the right to choose by giving fetuses some legal rights (New York Times, 7/6). In addition, other "coverage opportunities already are available under current law" to allow states to provide coverage to pregnant woman at higher levels of poverty, according to Cindy Mann, who worked on children's health coverage issues for the federal government during the Clinton administration (Wall Street Journal, 7/6). For example, under Medicaid states are permitted to cover women up to 185% FPL without needing a Medicaid waiver, and this level can be raised further under certain circumstances. As of November 2000, 37 states and the District of Columbia already covered woman beyond the 133% level (Medicaid's Role for Women, Kaiser Family Foundation, November 2000). Critics also call the fetus-coverage proposal "politically motivated" and say it would not increase coverage because it does not increase CHIP funding (Wall Street Journal, 7/6). But Pierce said that Thompson "wants to give states as much flexibility as possible to increase access to prenatal care." National Right to Life Committee Legislative Director Douglas Johnson added, "An unborn child ought to be recognized as a full-fledged member of the human family in law and public policy" (New York Times, 7/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.