Closer Look: Medicaid birth coverage fact of life

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Gov. Pat Quinn

Among the facts of life when trying to balance the Illinois budget is this: Medicaid plays a huge role in paying for childbirth in Illinois. It’s not going to change any time soon and illustrates why lawmakers may have so much difficulty reining in spending this year.

As Gov. Pat Quinn noted in his budget address last month, more than 50 percent of all Illinois births are paid for by the state and federal health care program for the poor and disabled. In part, that’s because Illinois has fairly liberal income eligibility levels for pregnant women compared to other states.

“It is vitally important that we restructure Medicaid, so it’s always there for our neighbors who need it.” Quinn said, underlining the value of the program.

Negotiators say everything must be considered if they are to accomplish Quinn’s recommended $2.7 billion in cuts from projected Medicaid spending in Illinois, but some benefits will remain safe. Illinois’ generous eligibility for pregnant women is one of them.

Medicaid paid for 89,621 Illinois deliveries in 2009, the most recent year for which statistics are available. That was nearly 54 percent of all births, according to the Department of Healthcare and Family Services. The total cost was $890 million. Medicaid plays an even bigger role in births to teen mothers, paying for nearly 94 percent of teen deliveries in 2009.

Since 1989, the federal government has required states to cover pregnant women whose income is at or below 133 percent of the federal poverty level. That’s the equivalent of about $14,800 annually for a single-person household. That’s the minimum states must do.

Illinois goes beyond that, covering pregnant women who make up to 200 percent of federal poverty, or about $22,300 for a single person’s annual household income. Teens who are pregnant are covered up to 300 percent of federal poverty, or about $33,500 for a one-person household.

And a newer federal requirement has tied Illinois to those higher eligibility levels.

The federal health care overhaul, President Barack Obama’s landmark legislation, requires states to keep their Medicaid eligibility stable, barring Illinois and other states from saving money by lowering income ceilings for pregnant women and other groups.

The idea is that the federal government will pay for expanding Medicaid eligibility in 2014 and doesn’t want states to drop people from the program before then. For that reason alone, “eligibility for pregnant women is not on the table” for Medicaid cuts, said Illinois Dept. of Healthcare and Family Services spokesman Mike Claffey.

Nationally, Medicaid became the largest payer of maternity health services during the past two decades, according to a Kaiser Family Foundation report. Medicaid pays for more than four in 10 U.S. births. At the same time, births became the most expensive Medicaid-billed hospital stays, making up more than a quarter of the total hospital charges billed to Medicaid nationally.


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