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Covered California Fixes Gap in Coverage for Pregnant Women

Covered California has fixed an enrollment gap for middle-income uninsured pregnant women, allowing them to receive affordable benefits through the exchange.

California’s insurance exchange added the Medi-Cal Access Program to its streamlined application process this week. MCAP (formerly known as Access for Infants and Mothers) is a longstanding program that covers pregnant women with annual incomes over the 213% federal poverty level income limit for Medi-Cal and up to 322% of federal poverty level ($51,312). The federal government covers 89% of the cost of the MPAC program.

Advocates long sought addition of MCAP to the Covered California application process. The Affordable Care Act requires that pregnant women be screened for MCAP eligibility and informed of this option before enrolling in a more costly health plan via the state-based exchanges. Covered California did not have this option in its design until this week.

“We are glad that, from now on, women will be tracked into the program that is right for their income level,” said Lynn Kersey, executive director of Los Angeles-based Maternal and Child Health Access.

Unlike Covered California, which has a limited three-month enrollment period that starts Nov. 1, MCAP offers year-round enrollment. Premiums for MCAP are also far cheaper at 1.5% of income, or about $42 to $64 per month depending on income. MCAP also has no co-insurance, co-payments, deductibles or other fees. Pregnant women are more likely to qualify for MCAP than Covered California subsidies because MCAP counts pregnant women as two people, while the exchange counts pregnant women as one person, Kersey said.

Private health plans including Anthem Blue Cross and Kaiser Permanente contract with MCAP to provide coverage. Women can stay on MCAP until the second month after delivery, and their child can stay on the program for up to two years. Eligible women can drop Covered California coverage at any time during pregnancy in favor of MCAP, with no penalties.

“This is a very important health policy development,” said Lucy Quacinella, a San Francisco-based attorney who has worked on the issue. “The main way people have been hearing about insurance programs is through Covered California. But this program for pregnant women has been missing since October 2013, so enrollment is way down. We are cautiously optimistic that those numbers should go up with this change.”

Only about 5,000 women were enrolled in the MCAP program as of February 2015, according to the latest enrollment figures.

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