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Title: Centers for Disease Control and Prevention, National Summit on Preconception Care: Financing Preconc


1
Centers for Disease Control and
Prevention,National Summit on Preconception
CareFinancing Preconception Care
  • Sara Rosenbaum
  • Hirsh Professor and Chair
  • Department of Health Policy
  • The George Washington University
  • School of Public Health and Health Services
  • June 22, 2005

2
Women and Health Insurance
3
Womens Health Insurance Coverage,Ages 18 to
64, 2003
Total 91 Million Women Ages 18 to 64
Note Other includes Medicare, Champus, and other
sources of coverage. Source KFF analysis of the
March 2004 Current Population Survey, Census
Bureau.
4
Uninsured Women Who is at Risk?
Percentage of Women who are Uninsured, by
Race/Ethnicity, 2003
Distribution of Uninsured, 2003
Total 44.7 Million
Source Urban Institute and KCMU analysis of
March 2004 Current Population Survey.
5
Access Barriers, by Insurance Status
Percentage of women reporting
No visit to provider in past year
Delayed care because of cost
Delayed care because of lack of transportation
Not able to see specialist when needed
Did not fill prescription because of cost
Note Includes women ages 18 to 64.

Source KFF,
Kaiser Womens Health Survey, 2001.
6
Women and Medicaid
7
Health Insurance Coverage of Women of
Reproductive Age (15 to 44), 2003
Women of Reproductive Age Below Poverty (N 9.1
million)
All Women of Reproductive Age (N 61.7 million)
Note The federal poverty level was 15,260 for
a family of three in 2003. Source Gold, et al.
Medicaid A Critical Source of Support for Family
Planning in the United States, Kaiser Family
Foundation, 2005.
8
Profile of Women on Medicaid, 2003
Other
200 FPL
65 years
Hispanic
100 to 199 FPL
Households w/out children under 18
African-American
50 to 99 FPL
White
Households with children under 18
Note Includes women on Medicaid ages 18 to 64.


Other consists of
4 Asian/Pacific Islander, 1 American
Indian/Aleutian Eskimo, 2 multi-racial. The
federal poverty level was 15,260 for a family of
three in 2003. Source Kaiser Family Foundation
analysis of Urban Institute estimates based on
March 2004 Current Population Survey, Census
Bureau.
9
Health Status of Non-Elderly Women by Health
Insurance, 2003
Note Includes women ages 18 to 64. Source
Kaiser Family Foundation analysis of Urban
Institute estimates based on March 2004 Current
Population Survey, Census Bureau.
10
Medicaid Eligibility Pathways for Women of
Reproductive Age
  • Parent/caretaker
  • Pregnant
  • Child
  • Woman with a disability

11
Medicaid Mandatory Income Eligibility Levels, 2003
Adults
Children
  • Based on AFDC average for 1996, the minimum
    standard now used for Section 1931 eligibility
  • The Federal Poverty Level was 15,260 for a
    family of three in 2003.

12
Women of Reproductive Age (15 to 44) Covered
Under Medicaid, 1994 to 2003
In March 2000, the Census Bureau made
significant changes to questions in the CPS,
resulting in more accurate estimates. Because of
these changes, insurance enrollment figures from
1999 and beyond are not directly comparable with
previous years. Source Source Gold, et al.
Medicaid A Critical Source of Support for Family
Planning in the United States, Kaiser Family
Foundation, 2005.
13
Early Prenatal Care by Type and Timing of
Insurance Coverage Low-income Women in
California, 1999
Percent of low-income women with early care
Source California Maternal and Infant Health
Assessment (MIHA), 1999. Note N1,558 women
with family incomes women who had "other" coverage or both Medi-Cal
and private coverage, who did not report
insurance type and/or timing, or who were unaware
of their pregnancies in the first
trimester. "Continuous" coverage is coverage that
began before pregnancy and continued throughout
pregnancy. "Early" prenatal care is defined as
care beginning in the first trimester.
14
Timing of Prenatal Insurance Coverage Women in
California, 1999
Percent of women
Source California Maternal and Infant Health
Assessment (MIHA), 1999. Note N3,343,
excluding women who had both Medi-Cal and private
coverage. "Continuous" coverage is coverage that
began before and continued throughout pregnancy.
15
Sources of Public Funding for Family Planning
Services, 2001
Note Federal Grants includes Title X (15), MCH
Block Grant (4), TANF (4), and Social Service
Block Grant (1). Source Sonfield, A. and Gold,
R.B., Public Funding for Contraceptive,
Sterilization and Abortion Services, FY
19802001, New York The Alan Guttmacher
Institute, 2005,
16
Medicaid Expenditures for Family Planning
Services and Supplies, Selected Fiscal Years
19802001
In thousands
Sources Sollom, T., Gold, R.B., and Saul, R.,
Public Funding for Contraceptive, Sterilization
and Abortion Services, 1994, Family Planning
Perspectives, July/August 1996, pp. 166173 and
Sonfield, A. and Gold, R.B., Public Funding for
Contraceptive, Sterilization and Abortion
Services, FY 19802001, New York The Alan
Guttmacher Institute, 2005, www.guttmacher.org/pub
s/fpfunding/index.html. .
17
Access Barriers Among Low-Income Women, by
Insurance Coverage
Notes Includes women ages 18 to 64 with incomes
below 200 of poverty.
The federal poverty level was 14,255 for a
family of three in 2001. Source Henry J. Kaiser
Family Foundation, Kaiser Womens Health Survey,
2001.
18
Medicaid Eligibility for Working Parents, July
2004
NH
VT
WA
ME
MT
ND
MN
OR
MA
NY
ID
WI
SD
MI
RI
WY
CT
PA
IA
NJ
NE
OH
IN
IL
NV
DE
UT
WV
CO
CA
VA
MD
MO
KS
KY
NC
DC
TN
OK
AR
SC
AZ
NM
AL
GA
MS
TX
LA
FL
AK
HI
50 - US Median 69 of poverty (10,836 annually)
100 (16 states DC)
SOURCE Cohen Ross and Cox. 2004. Beneath the
Surface Barriers Threaten to Slow Progress on
Expanding Health Coverage of Children and
Families.
19
Medicaid Eligibility for Parents Working Full
Time at Minimum Wage, July 2004
NH
VT
WA
ME
MT
ND
MN
OR
MA
NY
ID
WI
SD
MI
RI
WY
CT
PA
IA
NJ
NE
OH
IN
IL
NV
DE
UT
WV
CO
VA
CA
MD
MO
KS
KY
NC
DC
TN
OK
AR
SC
AZ
NM
AL
GA
MS
TX
LA
FL
AK
HI
Eligible (25 States and DC)
Not Eligible (25 States)
Note Annual income of parent working full time
at minimum wage is 10,712. Medicaid eligibility
based on working parent in a family of three for
2004. SOURCE Cohen Ross and Cox. 2004. Beneath
the Surface Barriers Threaten to Slow Progress
on Expanding Health Coverage of Children and
Families.
20
Key Medicaid Strategies
  • Eligibility
  • Pursue the 1931 option for parents
  • Find and enroll working low income women
    (streamline the process)
  • Optimizing Benefits and Coverage
  • EPSDT for women under 21
  • Bundled benefits family planning, FQHC, RHC
    services
  • Cost-sharing exemptions
  • Provider involvement
  • performance measures for womens health tied to
    payment incentives

21
Private Insurance/ Employee Health Benefits
  • Eliminating loopholes
  • Eliminate the PDA exemption for small firms with
    accompanying employer/employee credit
  • Narrowing pre-ex exclusion options
  • Mandates and Bully Pulpits
  • Healthy birth state benefit mandate with cost
    sharing limits and exemptions
  • Performance measurement specific to preconception
    care as bidding specification and insurer
    incentive
  • Consumer driven report cards and educational
    initiatives aimed at educating plan members
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