CHIP Coverage Option May Help Improve Prenatal Care for Immigrants

By implementing the CHIP coverage option for immigrants and their children, policymakers can help reduce maternal and infant mortality and ensure that pregnant individuals receive adequate prenatal care regardless of their immigration statuses, according to a report from Manatt Health.

Undocumented immigrants are less likely to have healthcare coverage compared to immigrants with legal status and US citizens due to laws that assess eligibility for public coverage based on citizenship, policies which some experts argue lead to health inequities. 

However, states have the option to provide pregnant individuals with healthcare services through the Children’s Health Insurance Program (CHIP) plan, no matter what their immigration status is. This coverage option offers care from conception to birth, including prenatal services, labor and delivery, and postpartum services

Only around one-third of states offer the CHIP coverage option for immigrants as of January 2021, leaving more than 60 percent of states able to pursue this path in order to improve care for pregnant immigrants and their children.

In their report, Manatt Health researchers highlighted the key benefits of this coverage option and why policymakers should consider adopting it.

First, states do not need a Section 1115 waiver to receive approval from the Centers for Medicare and Medicaid Services (CMS), which makes the process straightforward. States must only submit a CHIP state plan amendment to implement the coverage option, the report said.

States can also set their own eligibility standards for the coverage option, as the benefit is available to pregnant individuals who may not be eligible for Medicaid or CHIP. States can choose eligibility income levels that range between 138 percent and 322 percent of the federal poverty level.

Certain states, including California, set their income level eligibility above what is required for Medicaid and CHIP enrollees in order to expand coverage to more individuals.

In addition, states can decide if they want to offer continuous eligibility, which would ensure individuals receive coverage and care up until their delivery, even if their household sizes or incomes change. In this case, states must reevaluate the circumstances once the child is born to determine if they are still eligible for coverage.

If states choose to adopt the CHIP coverage option for immigrants, outreach and communication are key to eliminating enrollment obstacles. For example, immigrants may be wary about applying for healthcare coverage due to past experiences.

States can help reassure individuals by conducting targeted outreach efforts and communicating clear information about the CHIP coverage and the accompanying benefits.

Most of the states that offer the coverage option provide similar comprehensive benefits that Medicaid and CHIP provide. Under this model, states can decide if they want to require cost-sharing or not.

But states also have the ability to choose which services they want to cover to a certain extent.

The CHIP coverage option automatically includes prenatal, labor, and delivery services. States can include postpartum services if they use a bundled payment method, the report stated. States can also adjust the degree of postpartum care, having the choice to offer limited visits or full coverage during the entire postpartum period.

Instead of choosing the bundled payment option to offer postpartum care, CHIP also allows states to use CHIP Health Services Initiative (HSI) authority to provide regular and extended postpartum care. If states select this payment method, they will have to follow HSI limitations and will receive limited federal financial support from CHIP, researchers said.

Past studies have shown that the CHIP coverage option for immigrants and their children led to increased prenatal care utilization. The program has the potential to help states improve access to care and the quality of prenatal care for pregnant immigrants, the report concluded.