CHA News Article

CMS Approves Medi-Cal Waiver Extending Full-Scope Coverage to Pregnant Women

The Centers for Medicare & Medicaid Services (CMS) has authorized the state to provide full scope Medi-Cal benefits to pregnant women during their pregnancy and for 60 days thereafter if their income is over 109 percent of — and is up to and including 138 percent of — the federal poverty level (FPL). The extended benefits result from CMS’ recent approval of the California Department of Health Care Service’s waiver amendment to California’s current section 1115 demonstration project. These beneficiaries will be required to enroll in a Medi-Cal managed care health plan in counties where a plan is available. Beneficiaries who are pregnant and in fee-for-service (FFS) prior to Aug. 1 may remain in FFS for the duration of their pregnancy and post-partum period to ensure continuity of care. Any pregnant woman voluntarily moving from FFS to managed care will be provided appropriate care coordination. The changes are effective July 31.