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Member Research and Reports

Member Research and Reports

GW Report Examines Health Care Challenges for Pregnant Women Enrolled in Covered California

A recent report by Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University examines the challenge of maintaining enriched health care for pregnant women who are enrolled in Covered California and who are also eligible for Medi-Cal, which includes the Comprehensive Perinatal Services Program (CPSP). The CPSP makes enriched maternity care available to pregnant women facing elevated health, environmental, and social risks as a result of their economic status. In June, the California Legislature passed legislation designed to preserve access to enriched CPSP services — part of the Medi-Cal program — for low-income pregnant women enrolled in Covered California health plans. State officials have yet to move forward with implementation strategies.

Researchers found that while Covered California offers standard-quality maternity care suitable for women with average health risks, the program has not been designed to address the needs of women at highest health and social risks due to their economic status. This finding, researchers noted, is not surprising, since while both are sources of good quality insurance coverage, Medi-Cal and Covered California play very different roles in the health care system.

Based on their findings, researchers offer two possible solutions – one to expand Covered California provider networks to include CPSP providers, with supplemental Medi-Cal payments, and the other, to guarantee access to out-of-network coverage for women who wish to use a CPSP provider. Both solutions are consistent with standard insurance practice approaches to health issues requiring additional and more comprehensive treatment from specially trained providers.

For more information, please view the full report.