The recent, sudden, surprising and alarming announcement by Nebraska’s Department of Health and Human Services that many unborn children will be disqualified from receiving prenatal services under the medical-assistance program needs a quick, life-affirming response. Apparently, it’s going to be up to the Legislature to get this done; to restore the status quo as it existed prior to the unfortunate turn of events.
For at least three decades, and until just recently, Nebraska policy recognized and treated unborn children as the true and ultimate recipients of prenatal services covered by Medicaid, the joint Federal-state program that insures the poor on a means-tested basis. The turn of events is that the Federal government, more specifically the Center for (Medicare and) Medicaid Services (CMS), discovered that Nebraska’s longstanding practice is not in accord with Medicaid rules. Medicaid policy does not recognize unborn children as unique and separate recipients of covered services.
The impact of the resulting order to end the unauthorized practice is affecting two general categories of unborn children. First are the unborn children of impoverished mothers whose presence in the U.S. is unauthorized under immigration laws. Due to their status, these pregnant women are themselves ineligible for all but emergency services and childbirth. DHHS estimates that Medicaid coverage will be terminated in approximately 1,000 such cases.
The second general category is likely to be considerably smaller in number. It consists of those being disqualified not because of their immigration status (they are U.S. citizens), but because not counting the unborn child in the family will drop the income ceiling that tests for eligibility. There also might be a few cases of lost eligibility due to other quirks in the policy, but overall the relevant, disconcerting number is 1,000-plus.
The state already has stopped enrolling new cases of pregnant women who are unable to document their authorized status. Beginning Feb. 1, notices were being sent to all pregnant recipients of Medicaid, advising them that if they themselves are not eligible then prenatal coverage will end as of March 1.
This is a bad situation; one needing correction sooner rather than later. Prenatal care is critically important for the health and well-being of the child post-birth. What’s more, no pregnant woman should feel pressure to abort her pregnancy due to concerns about accessibility to prenatal care or the lack of supportive public policy.
The good news is that there is a fairly uncomplicated way for restoring this important coverage. The solution is related to the Children’s Health Insurance Program Reauthorization Act (CHIPRA). Pursuant to this Federal law that governs a joint Federal-state children’s health insurance program—in Nebraska it’s known as Kids Connection—there is an unborn-child option; states can elect to cover unborn children as recipients in their own right, subject of course to means-testing household income.
Logic dictates that children in utero in this country are presumptive U.S. citizens, a status that will be affirmed at birth. CMS has acknowledged and allowed this basis for eligibility for covered prenatal services throughout the term of pregnancy.
Initially, DHHS officials balked at this idea for restoring prenatal coverage for the affected categories of unborn children. They held that because Nebraska originally chose to expand Medicaid rather than establishing a separate CHIP program, it would not be possible to “cherry pick” the unborn child option from CHIPRA. Fortunately, advocacy-group lawyers jumped in to assert that it would indeed be possible to combine the unborn-child option with Nebraska’s Medicaid-expansion, i.e., Kids Connection.
More recently, it appears that DHHS and Governor Heineman’s administration have acknowledged the unborn-child option under CHIPRA, in conjunction with Kids Connection, as a way to continue prenatal coverage for the unborn children of unauthorized immigrants. Nonetheless, there still seems to be reluctance to doing a Medicaid plan amendment in the absence of statutory authorization by the Legislature.
But another issue is also causing reluctance to act administratively on this urgent matter. It has to do with LB 403, which was passed last year by the Legislature as the state’s contribution to helping bail out the Federal government on illegal immigration.
Nebraska law under LB 403 is that public benefits cannot be paid or provided to any non-citizens who lack authorized immigration status. In the case of prenatal services, however, the true and ultimate recipient is not the unauthorized immigrant, but the unborn child, a presumptive citizen.
This is not an immigration issue; it’s a pro life issue. Anyone who tries to make this an immigration issue should be ignored, respectfully, of course.
If indeed an amendment to the statutes governing medical assistance is necessary in order to cooperatively ensure the necessary correction, then so be it; lawmakers should take the lead and get it done.
Likewise, if an amendment to the LB-403 law is necessary, either legally or politically to clear up the matter, then so be it, lawmakers should get that done as well. There is a lot at stake, both in the present and for the future.
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