Day 37 – Medicaid at 50: State Highlight: Nebraska

Over the coming weeks this blog will highlight a key feature of Medicaid and the individual states that administer Medicaid and CHIP leading up to the program’s 50th anniversary (July 30th). Hopefully, you’ll learn some interesting facts about Medicaid and each of the 51 state programs.

In 2002, HHS promulgated regulations that allowed unborn children to be covered by CHIP, even if their mothers are not eligible for coverage. In this way, uninsured women who were otherwise ineligible for Medicaid could access prenatal care (for example, women who are undocumented, teens whose parents aren’t Medicaid eligible, or women whose insurance didn’t cover maternity care [although the latter is no longer an issue thanks to the Affordable Care Act]). This policy, known as the “unborn child option”, updated policy from the 1996 Welfare Reform Act, which said that undocumented pregnant women were ineligible for federally-funded prenatal care.

In 2012, Nebraska took advantage of the unborn child option, passing LB 599. Nebraska had a long history of covering prenatal care for all women in need, but discontinued the program quite abruptly in 2010 due to technical compliance issues with CMS. As you can imagine, this was very disruptive to the ~1,600 women and babies affected (about half of whom were undocumented). Fortunately, Nebraska restored prenatal coverage through the CHIP pathway. Groups like the ACLU and Catholic Bishops Conference worked hard to ensure the passage of LB 599, which had to overcome an executive veto. This means that today, moms-to-be can get pregnancy-related coverage, including prescriptions, chronic disease management, oral health, mental health, and any postpartum care that is part of the delivery bundle. On top of that, ladies in the program are also eligible for WIC.

Nebraska is one of just 18 states who have implemented the unborn child option. We’ve already talked about how important prenatal care is for good birth outcomes, so from a health perspective, it’s absolutely the right thing to do. On top of that, the state is responsible for the health needs of its littlest citizens once they are born, so it makes sense from a cost perspective to give babies the best possible start in life. Hats off to the Cornhuskers!

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