Coverage of Pregnancy Services in CHIP, 2013
This map provides information on each of the 19 states, including the District of Columbia, that covered pregnancy services through CHIP in 2013.
States can provide services to pregnant women in CHIP in four ways, each with a different coverage authority: (1) a section 1115 waiver covering pregnant women; (2) the “unborn child” state plan option; (3) the state plan option to cover targeted low-income pregnant women; and (4) the state plan option to cover lawfully residing pregnant women. Each coverage authority offers states different design flexibilities, and states can operate programs under more than one coverage authority. Click here for more information on the flexibilities and restrictions of each coverage authority. For states with more than one coverage program for pregnancy services, each program is described.
Know of something we should add to this compilation? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment below the map, or email a NASHP staff member with your suggestion. You can reach Anita Cardwell at acardwell@oldsite.nashp.org.
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N/A = state did not respond to the question.
[1] Eligibility levels for CHIP coverage of pregnant women must begin at the level where Medicaid eligibility for pregnant women ends. Eligibility levels for the unborn child coverage program can begin at zero percent of the federal poverty level (FPL) and go up to the state’s upper CHIP eligibility level for children. Seehttps://www.statereforum.org/pregnant-women-eligibility.
[2] All enrollment data are for fiscal year 2013. Numbers of enrolled pregnant women are from Medicaid and CHIP Payment and Access Commission (MACPAC), Report to the Congress on Medicaid and CHIP (Washington, DC: MACPAC, March 2014). Unborn child enrollment data are from a MACPAC analysis of the Centers for Medicare and Medicaid Services CHIP Statistical Enrollment Data System (SEDS) as of March 4, 2014.
[3] Each program has different requirements regarding services included in benefit packages. States can provide a limited, pregnancy-only benefits package or more comprehensive services. States that provide pregnancy-only services may also provide coverage for additional categories of services that they choose. Unborn child coverage must be provided through a separate CHIP program. See the Overview of Available Coverage Authoritiesresource for more information.
[4] Funding source is only included if postpartum services are not typically covered as part of the coverage authority. States covering pregnant women under a state plan amendment (SPA) or section 1115 waiver can cover services during a woman’s postpartum period for 60 days. States with an unborn child coverage program may cover postpartum services using state-only funds or with federal matching funds only if part of a global payment with prenatal, labor, and delivery services.
[5] States are prohibited from charging cost sharing for preventive or pregnancy-related services in CHIP programs (Social Security Act, section 2103).
Map produced by Jennifer Dolatshahi and Anita Cardwell.
NASHP’s research on coverage of services for pregnant women in CHIP was funded by the March of Dimes. Support for the development of this map was provided by the David and Lucile Packard Foundation.
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Click on a state to see program information, including:
Coverage authority
States can use four coverage authorities to cover pregnancy services in CHIP, and can operate programs under more than one of those authorities.
Eligibility levels [1]
For more information on state eligibility levels,click here.
Enrollment [2]
Enrollment numbers are given by program, where available. All enrollment numbers are from fiscal year 2013.
Asset limit
Some states require an asset limit or test to determine eligibility.
Benefit package [3]
Each coverage authority has different rules around benefit package design. States may offer a limited, pregnancy-related services only package or a more comprehensive package of benefits.
Postpartum period and funding source [4]
Funding source is only included if postpartum services are not typically covered as part of the coverage authority. States covering pregnant women under a state plan amendment (SPA) or section 1115 waiver can cover services during a woman’s postpartum period for 60 days. States with an unborn child coverage program may cover postpartum services using state-only funds or with federal matching funds only if part of a global payment with prenatal, labor, and delivery services.
Visit limits and cost sharing [5]
No state can charge cost sharing for preventive or pregnancy-related services in their CHIP programs. States are able to impose minimal cost sharing on other categories of services and can impose limits on numbers of visits.
Provider network
Some states use the same provider network in pregnancy-related CHIP and pregnancy-related Medicaid while others rely on a different provider network in the CHIP program.
For more information on the flexibilities and restrictions of each coverage authority, see our Overview of Available Coverage Authorities resource.
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