WASHINGTON – Maryland health officials said they are not rushing to adopt controversial new federal regulations that would let to them count fetuses as children who would be eligible for federal health insurance for kids.
Their reluctance has nothing to do with a philosophical stance on the definition of “unborn child,” which has riled pro-choice activists. State officials say they simply don’t have the money to extend coverage to any more people because of high enrollments and recent federal budget cuts.
“This only helps the state that hasn’t used all of its unspent funds,” said Debbie Chang, deputy secretary for health care financing in the state Department of Health and Mental Hygiene. “We’ve used all of ours. We don’t have the money.”
The Maryland Children’s Health Insurance Program has insured more than 100,000 low-income children since 1998. But federal funding nationally dropped 26 percent last week, with the start of the new fiscal year. And Maryland was also forced to return $38 million that had been transferred from other states.
“Even before the federal action over funding, we have been fully utilizing our . . . allotments. We have used the program fully and maximized the federal expenditures. The federal issue just makes the situation worse,” Chang said.
The U.S. Department of Health and Human Services said last week that, effective Nov. 1, it would let states decide whether to include fetuses in the definition of “low-income children” covered under the State Children’s Health Insurance Program.
Until now, states had to apply for a waiver to extend coverage to any group not specifically included in the program’s guidelines.
The change was intended to make all women, regardless of age, eligible for prenatal care, delivery and other birth services. Before the change, only a pregnant woman under age 19 was considered a “low-income child,” eligible for SCHIP coverage.
The program is intended to act as a safety net for those children who do not qualify for Medicaid, but whose parents cannot afford private insurance.
While pro-choice activists agree it is important to provide prenatal care to low-income women, they said there are other ways to do it besides revising the definition of “child.”
“We think it is important to provide prenatal care to women but this is not a way to accomplish that goal,” said Vicki Saporta, president of the National Abortion Federation.
“If administration truly cared, they would extend health care to women directly . . . either through waivers, new Medicaid eligibility requirements or increased funding,” Saporta said. “It is clear their goal is to set a precedent to undermine Roe v. Wade.”
But federal officials said changing the regulation is the most-efficient way to expand coverage. Congress has not scheduled action on bills that would give states the flexibility, they said in supporting documents, and waivers are slow and cumbersome.
Maryland has applied for a waiver that would grant the state additional “unspent” funds to cover pregnant women 19 and older, but the federal government has yet to grant approval, which Chang said probably due lack of money.
That waiver sought to expand SCHIP to include pregnant women 19 and over who earn 185 percent to 250 percent of the federal poverty level. Chang said she is still waiting for an answer.
In the meantime, Maryland’s CHIP is working with legislators to find more funding for the program. The question of including “unborn children” has been put aside for the moment.
“We want to keep doing the things we are doing, providing health care to those who need it. We don’t want a politicized issue like this to get in the way,” said J. B. Hansen, a DHMH spokesman.