Lawmakers: Fix pregnancy snafu

pregnant woman

Sixteen members of California’s congressional delegation are calling on Covered California to quickly fix a problem that has caused some pregnant women to be dropped from their health plans and enrolled in Medi-Cal without prior notice or consent.

Led by congressman Ami Bera and congresswoman Lois Capps, the lawmakers sent a letter Thursday to Diana Dooley, secretary of the state’s Health and Human Services Agency, and to Covered California, demanding action.

“No woman should have to worry about losing health care while pregnant,” they wrote.

As first reported by California Healthline on April 18, nearly 2,000 women with Covered California health plans who reported their pregnancies to the agency have been automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California.

As a result, some women lost their established doctors or missed prenatal appointments.

The problem, attributed by Covered California partly to a computer glitch, affects a very specific group of pregnant women — those whose household income falls between 138 percent and 213 percent of the federal poverty level, or roughly $22,100 to $34,100 for a family of two.

Covered California said a fix to its computer system is coming, but not until September.
“We are working to make sure pregnant women with Covered California coverage and incomes up to 213 percent of the federal poverty level know they have the choice of keeping their coverage or going into Medi-Cal,” said Amy Palmer, Covered California’s director of communications.

But in the letter, the lawmakers urged quick action to ensure no women experience interruptions in care.

“We remain concerned that until the problem is fixed in late 2016, women will continue to be unenrolled from their Covered California plans and lose access to their current medical providers. … We ask that you notify all women before any changes in their health coverage are made,” they wrote.

Palmer said Covered California has taken several steps to help reduce the number of women who are switched without their consent. At the same time, she confirmed that some women who report their pregnancy through the Covered California web site still will be moved automatically to Medi-Cal until the computer glitch is fixed.

“We updated our main web site to give consumers more information about reporting a change related to pregnancy, and we have given our service center representatives, insurance agents and enrollers the information they need to help consumers know about this choice before the consumer reports the change so that they can decide in advance whether to keep their coverage or move to Medi-Cal,” Palmer said. “In either case, they continue to have health coverage.”

A note on the Covered California website alerts consumers that the exchange “does not require members to report a pregnancy. If you are an existing Covered California member, it is not necessary or recommended to report a pregnancy unless you are interested in other coverage options for pregnant women such as Medi-Cal or the Medi-Cal Access Program.”

Lynn Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County, also suggested that women who bought health insurance policies from Covered California and want to keep them should not report their pregnancies to the agency. She has two clients whose plans were canceled without notice.

After reading the congressional letter, Kersey called on state leaders to “allocate sufficient resources to speed up the many urgent computer fixes needed for low-income Californians applying for coverage.”

— Emily Bazar, California Healthline

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