One of the Affordable Care Act changes made to health insurance applications was the elimination of questions about pre-existing conditions for medical underwriting. However, the Covered California application for health insurance includes the pre-existing question of pregnancy. How a woman answers the question can determine whether she is offered a private health insurance plan or Medi-Cal for pregnant women.
Why Does Covered California Need To Know If You Are Pregnant?
I have always felt uncomfortable asking the Covered California applicant if they or anyone in the household is pregnant. Basically, it is none of my business. It is additionally awkward asking a mother or father if their adult daughter is pregnant. Now that reproductive health care is under assault in our country, I’ve become even more sensitive to asking the question.
If a woman answers in the affirmative that she is pregnant, and the household income is between 138% and 213% of the federal poverty level (FPL), she will be determined eligible for pregnancy related Medi-Cal. According to the Department of Health Care Services website, women can opt for a private health plan with the Covered California subsidies. However, unless the Covered California application has changed, women in the 138% to 213% FPL are automatically determined for Medi-Cal and their case information sent their respective county Medi-Cal office.
If the woman’s household income is between 213% and 322% FPL they are eligible for the Medi-Cal Access Program (MCAP.) MCAP has a monthly cost of 1.5% of the household income. MCAP has no copayments, deductibles or coinsurance. A woman can’t have both a private health plan through Covered California and Medi-Cal pregnancy assistance. The Covered California eligibility also defaults to Medi-Cal eligibility for women in the 213% and 322% FPL income range.
There is nothing wrong with pregnancy related Medi-Cal coverage. Of course, a health plan without your doctors is not a health plan. A pregnant woman indicating she is pregnant on the Covered California application could lose her doctors if those doctors don’t accept Medi-Cal.
Before the Affordable Care Act, how you answered the pre-existing condition medical conditions would determine if you were offered an individual and family health plan. Covered California is not denying health insurance to women who indicate they are pregnant, but the system may deny them private health insurance with their preferred providers.
I have had women who wanted the pregnancy related Medi-Cal and it worked well for them. I had another woman call me because she was tracked into Medi-Cal because she answered Yes to being pregnant. The only way I could think of for her to return to Covered California health plan was to call Medi-Cal and tell them she was no longer pregnant.
Are You Misrepresenting The Facts If You Answer You Are Not Pregnant?
This raises a tricky question of misrepresentation on the Covered California application. If a woman, who is pregnant, willfully answers No to being pregnant on the Covered California application is that a misrepresentation of the facts subject penalties and possible loss of health insurance? It clearly states on the Covered California application that you are not knowingly supposed to make any misrepresentations.
Certain discriminatory aspects of health insurance are baked into the ACA. For instance, the health insurance premiums can vary by age with older adults paying more than younger people. Household income can help avoid Medi-Cal. If a woman earns enough money, over 322% FPL, then she is not subject to pregnancy related Medi-Cal at all.
Regardless, I’m sure Covered California has a legal opinion that emboldens them to ask the pregnancy pre-existing question on the application for health insurance. I would like to see the question go away entirely. I would be happy to read a statement to women that if they are pregnant, or become pregnant in the future, there are programs from Medi-Cal to help reduce the costs of pregnancy. Because, it is no one’s business if a woman is pregnant.