13 WTHR - Indianapolis News |FSSA seeking Medicaid expansion for pregnant women

FSSA seeking Medicaid expansion for pregnant women

Indianapolis - The state human services agency has reversed course and will seek federal approval for presumptive Medicaid eligibility for low-income pregnant women that would help them get prenatal care, agency chief Mitch Roob has told lawmakers.

The Family and Social Services Administration also might seek to expand enrollment in its State Children's Health Insurance Program to children in households earning up to three times the federal poverty level, Roob told the Legislature's Medicaid Oversight Commission this week.

Both expansions of the state's Medicaid program were included in the 2007 law that authorized Gov. Mitch Daniels' Healthy Indiana Plan, which provides medical savings accounts for low-income adults, but FSSA has been slow to adopt them.

In April, a manager in FSSA's Office of Medicaid Policy and Planning issued a memo saying the office had decided not to adopt presumptive eligibility for women in households earning up to two times the federal poverty level, as the law called for, because available data didn't show it would produce benefits.

However, Roob told lawmakers Wednesday that his Medicaid office would request federal approval for presumptive eligibility by the end of this month.

Rep. Suzanne Crouch, R-Evansville and a member of the commission, said Roob told her the state hopes to have the approval from the Centers for Medicare and Medicaid Services by the end of the year. She was among several lawmakers who objected to FSSA's earlier decision not to seek the Medicaid expansion.

"Certainly I'm satisfied with their deciding this is a priority and taking steps to address it," Crouch said Thursday.

Medicaid covers the births of more than half of the children born in Indiana each year, but whether mothers obtain critical prenatal care depends in large part on how easy is it for them to receive Medicaid coverage while pregnant. Presumptive eligibility makes it easier because Medicaid covers the cost of their examinations from the moment they first visit a doctor's office, rather than having to wait for FSSA to grant the approval weeks later.

The earlier mothers begin prenatal care, the healthier they and their children will be, said Larry Humbert, executive director of the Indiana Perinatal Network, a group of nurses, physicians, social workers, and others that seeks to improve the health of mothers and their babies.

"We've been very pleased by their response and their change of heart on this thing," said Humbert, whose group has met with representatives of the Medicaid office regularly on the issue since early June.

State vital statistics show 8 percent of the 87,088 children born in 2005 had low birth weights of 5 pounds, 8 ounces or less, and 21 percent received no prenatal care during their first trimester.

Humbert's group shared with the state officials data showing how doctors' offices in Illinois, Kentucky, Michigan and Wisconsin have become Medicaid enrollment centers for pregnant women, enabling presumptive eligibility in those states.

The federal poverty level is a sliding scale that's $14,000 for a family of two and $21,200 for a family of four.

Roob, in his appearance before the Medicaid Oversight Commission, was unsure whether CMS would grant approval to expand Indiana's SCHIP program to cover children in households earning up to three times the federal poverty level, as the 2007 law also called for.

CMS in May approved an expansion for Indiana to 2½ times the poverty level, and Roob said it will take effect Oct. 1.

Roob said he would meet soon with Kerry Weems, the acting administrator for CMS, to get a sense of whether the federal agency will allow the broader expansion. CMS previously has said it would not allow new SCHIP expansions beyond 2½ times the poverty level, but some states have sued CMS over the matter, and CMS last week backed down from a threat to penalize states who enroll children in families earning more than 2½ times the poverty level.

Sen. Vi Simpson, D-Ellettsville, asked Roob why Indiana hasn't been more aggressive with CMS, like other states.

"We have attempted to work collaboratively with them, and we think that's in the best interest of the children in this state," Roob said.

(Copyright 2008 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.)