Restoration of Medicaid Coverage for Pregnant Women in State Budget Needed
Access to Prenatal Care is Absolutely Necessary
The state budget bill also known as House Bill 64, includes a provision that will reduce Medicaid eligibility for pregnant women from 200% of FPL to 138% FPL. While we understand the strategy to move these women from Medicaid to the Marketplace, because of limitations set in place by the federal government, we do not believe now is the appropriate time for such a transition and advocate for restoration of the 200% eligibility limit.
Ohio uses the federal exchange for Marketplace enrollment. There is a single open enrollment period that spans three months, once a year. While there are opportunities to gain coverage outside those three months (Special Enrollment Periods or SEP), becoming pregnant does not trigger an SEP or access to Marketplace coverage. Therefore under HB 64, if a women between 139 and 200% FPL is either unable to gain Marketplace coverage or chooses to pay the federal mandate penalty instead of enrolling and then becomes pregnant, she cannot access health care coverage until the next Open Enrollment period. In this instance, both women and their unborn children are at risk. With Ohio’s abysmal infant mortality rates, maintaining eligibility as it is today at 200% FPL ensures Ohio women do not fall in this coverage gap and provides a path to access the prenatal care they need.
Premature Births - By the Numbers
The cost of maintaining the current coverage for pregnant women in Medicaid at up to 200% FPL is estimated at $15M for the upcoming biennium. HB 64 proposes to reduce eligibility to 138% FPL, a change which can ultimately lead to less access to prenatal care, and in turn, worse birth outcomes and increased infant mortality rates. Specifically:• According to Nationwide Children’s Hospital, NICU stays average $66,000 in Franklin County and can cost in excess of $2M.
• The U.S. Agency for Healthcare Research and Quality accounts that medical costs for the average very-low-birthweight infant are $79,000, compared with $1,000 for a normal newborn.
• National data has shown that the average cost in the short term of an extreme premature birth to be well over $100,000, and between $40,000 and $100,000 for early premature birth. Other data has shown that children born before 32 weeks have costs over $280k on average.
• Hospital Length of Stay: The March of Dimes reports that premature and low birth weight infants spend an average of 15 days in the hospital, compared to just 2 days for healthy, full-term infants.
Further, if Ohio scales back Medicaid coverage for pregnant women between 139 – 200% FPL it is important to note that once the child is born to a mom who falls in that coverage gap, Medicaid in all likelihood will cover the child’s immediate and long-term health care costs – whether good or bad. So even if we don’t pay for the health insurance coverage of Mom-to-be, we will cover the child once born and his or her birth outcomes.
Early entry into care is associated with better birth outcomes which we all want, and health insurance coverage is an important and essential tool in getting women into care as soon as possible. Improved birth outcomes translate into substantial cost savings, because the costs associated with preterm births are estimated to be 10 times greater than those for full-term births.
We have a cause and effect scenario. According to the ODM’s 2014 Report on Pregnant Women, Infants and Children, the average total cost during pregnancy of a woman enrolled in Medicaid in 2013 was $8,458. And the average cost of caring for premature or a low birth-weight baby for its first year of life is about $49,000. Simply put, if more women go without prenatal care, the more likely Medicaid will have to cover infants at a higher cost.
IN SHORT: The return on investment is clear. Maintaining Medicaid coverage for pregnant women to 200% FPL is cost-effective, provides a pathway forward for full-term pregnancies and positive birth outcomes, and will keep Ohio on track to improve our infant mortality rate.
