WASHINGTON, DC (October 31, 2014) — A new report by Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University examines the challenge of maintaining enriched health care for pregnant women who are enrolled in Covered California and who are also eligible for Medi-Cal, which includes the Comprehensive Perinatal Services Program (CPSP). The CPSP, whose roots are in one of the nation's most successful programs ever developed for low-income pregnant women, makes enriched maternity care available to pregnant women facing elevated health, environmental and social risks on account of their economic status. In June, the California Legislature passed legislation designed to preserve access to enriched CPSP services—part of the Medi-Cal program—for low-income pregnant women enrolled in Covered California health plans. State officials have yet to move forward with implementation strategies.
"This is one of those situations in which the need for a solution is of crucial importance because of the health of pregnant women and their infants, but readily workable solutions exist. These solutions are consistent with standard plan management practices," said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, who led the study. "California's lawmakers could not have been clearer that access to high-quality health care funded through Medi-Cal's special program is to be preserved for high-risk pregnant women who are enrolled in qualified health plans, and for whom standard maternity care is not enough. Understanding the need for flexibility, the Legislature gave the agencies ample running room to devise a care coordination strategy. Now is the time to put a strategy in motion."
To understand the health care coordination and integration challenge, researchers compared maternity care under the two programs by examining a wide range of materials, ranging from Medi-Cal and Covered California laws and regulations to an array of operational program documents from both sources of health insurance. The Milken Institute SPH team also reviewed plan documents related to maternity care coverage offered through Covered California health plans. Researchers found that while Covered California offers standard-quality maternity care suitable for women with average health risks, the program has not been designed to address the needs of women at highest health and social risks due to their economic status. This finding, researchers noted, is not surprising, since while both are sources of good quality insurance coverage, Medi-Cal and Covered California play very different roles in the health care system.
Based on their findings, researchers offer two possible solutions – one to expand Covered California provider networks to include CPSP providers, with supplemental Medi-Cal payments, and the other, to guarantee access to out-of-network coverage for women who wish to use a CPSP provider. Both solutions are consistent with standard insurance practice approaches to health issues requiring additional and more comprehensive treatment from specially trained providers.