• ISSUE BRIEF

    Published on: September 16, 2014

Undocumented Immigrants in the United States: Access to Prenatal Care

This issue brief was draft­ed by Rachel Fabi with research assis­tance from Mohini Baner­jee, edit­ed by Michael K. Gus­mano and Nan­cy Berlinger, and designed by Mohini Baner­jee. Spe­cial thanks to expert review­ers Evan A. Ashk­in, MD, Asso­ciate Pro­fes­sor of Fam­i­ly Med­i­cine, Uni­ver­si­ty of North Car­oli­na at Chapel Hill; Kate Bice­go, Con­sumer Assis­tance Pro­gram Man­ager, Health Care For All, Boston, MA; Car­o­line Rath, physi­cian assis­tant, Gou­verneur Health­care Ser­vices, New York City; and Eva Tur­bin­er, Pres­i­dent and CEO, Zufall Health Cen­ter, Dover, NJ. Infor­ma­tion about pol­i­cy mech­a­nisms was com­piled using pub­licly avail­able doc­u­ments, includ­ing Med­ic­aid Provider Man­u­als for each state; see Ref­er­ences. All infor­ma­tion is cur­rent as of Sep­tem­ber 12, 2014.

Click Here for Slideset Ver­sion

On undoc­u­ment­ed immi­grants’ gen­er­al use of health care, see here. On rel­e­vant U.S. health pol­i­cy, see here. On rel­e­vant demo­graph­ics, see here.

Access to pre­na­tal care for wom­en who are undoc­u­ment­ed immi­grants varies wide­ly across the Unit­ed States due to dif­fer­ences in state poli­cies and dif­fer­ing state-lev­el inter­pre­ta­tions of fed­er­al poli­cies that fund health ser­vices for preg­nant wom­en. This issue brief pro­vides an overview of this access prob­lem and the con­se­quences of pol­i­cy-relat­ed uncer­tain­ty or vari­a­tion for undoc­u­ment­ed patients, their fam­i­lies, and the health care safe­ty-net.

Why is access to pre­na­tal care for undoc­u­ment­ed immi­grants impor­tant?

There is long-estab­lished med­ical con­sen­sus that pre­na­tal care is fun­da­men­tal to repro­duc­tive and infant health; how­ev­er, undoc­u­ment­ed immi­grants liv­ing in the U.S. are sig­nif­i­cant­ly less like­ly to have “ade­quate” pre­na­tal care, com­pared to oth­er immi­grants and to U.S. born cit­i­zens. [1–4] The rea­sons for this gap include lack of means to pay for pre­na­tal care, lack of access to sources of pre­na­tal care, and mis­trust of the health care sys­tem. [5] Oth­er bar­ri­ers to health care that undoc­u­ment­ed immi­grants face include dif­fi­cul­ties nav­i­gat­ing the health care sys­tem; lin­guis­tic, lit­er­a­cy, and oth­er chal­lenges in com­mu­ni­cat­ing about health care needs; inabil­i­ty to take time off from work; mis­in­for­ma­tion about the immi­gra­tion-relat­ed con­se­quences of using health care ser­vices; and per­ceived and actu­al risks of encoun­ter­ing immi­gra­tion author­i­ties or local law enforce­ment in the course of seek­ing health care.

The Emer­gen­cy Med­ical Treat­ment and Active Labor Act (EMTALA), which pre­vents hos­pi­tals from turn­ing away unin­sured patients in need of emer­gen­cy treat­ment, encom­pass­es labor and deliv­ery, and most “emer­gen­cy” health care ser­vices used by undoc­u­ment­ed immi­grants are relat­ed to child­birth. [6–8] State-lev­el Emer­gen­cy Med­ic­aid pro­grams provide some reim­burse­ment to hos­pi­tals for treat­ment pro­vid­ed under EMTALA. In some states, undoc­u­ment­ed immi­grants may account for as much as 99% of Emer­gen­cy Med­ic­aid expen­di­tures; approx­i­mate­ly 80% of the­se costs are relat­ed to child­birth or to com­pli­ca­tions of preg­nan­cy and labor. [8] Because access under EMTALA is restrict­ed to emer­gent con­di­tions, it is not a mech­a­nism for access to rou­tine pre­na­tal care that could pre­vent or mon­i­tor preg­nan­cy-relat­ed com­pli­ca­tions.

Lack of access to pre­na­tal care increas­es the risk of pre­ma­ture birth and low birth-weight, and may be a fac­tor in a range of poor health out­comes expe­ri­enced by undoc­u­ment­ed preg­nant wom­en and their babies, includ­ing high­er rates of labor and deliv­ery com­pli­ca­tions such as pre­cip­i­tous labor, exces­sive bleed­ing, breech pre­sen­ta­tion, cord pro­lapse, and fetal dis­tress. [9, 10] The­se risks and out­comes have con­se­quences for the via­bil­i­ty and health of new­borns, infant and child devel­op­ment, and the health of moth­ers, and for costs asso­ci­at­ed with treat­ing med­ical con­di­tions that could have be pre­vent­ed or man­aged before birth.

What pol­i­cy pro­vi­sions may offer access to pre­na­tal care for undoc­u­ment­ed immi­grants?

1. CHIP Unborn Child Option

As of Sep­tem­ber 2014, 16 states have imple­ment­ed a State Plan Amend­ment (SPA) to the Children’s Health Insur­ance Pro­gram (CHIP), which is joint­ly sup­port­ed by fed­er­al and state funds. An unborn child may be con­sid­ered a “tar­get­ed low-income child” who is eli­gi­ble for this pro­gram. [11] This pro­vi­sion would enable an undoc­u­ment­ed immi­grant to enroll her unborn child in the pro­gram so she can obtain cov­er­age for pre­na­tal care and labor and deliv­ery ser­vices, in the inter­est of pro­tect­ing the child’s future health. Under this pro­vi­sion, ser­vices such as pre­na­tal vit­a­mins and ultra­sounds may be cov­ered but ser­vices per­ceived as unre­lat­ed to preg­nan­cy may not be cov­ered.

2. Pre­sump­tive Eli­gi­bil­i­ty for Med­ic­aid (PE)

Pre­sump­tive eli­gi­bil­i­ty (PE) is a state-lev­el mech­a­nism that enables preg­nant wom­en to obtain imme­di­ate tem­po­rary Med­ic­aid cov­er­age with­out hav­ing to wait for a Med­ic­aid appli­ca­tion to be processed. As of Sep­tem­ber 12, 2014, PE was avail­able in 30 states, 13 of which explic­it­ly restrict access to wom­en with legal immi­gra­tion sta­tus. Physi­cians who are “qual­i­fied providers” of Med­ic­aid ser­vices and eli­gi­ble to deter­mine PE based on a patient’s self-report­ed income can provide Med­ic­aid-fund­ed care to any preg­nant wom­an whose self-report­ed income meets that state’s eli­gi­bil­i­ty thresh­old. Dur­ing the time-lim­it­ed PE peri­od, the wom­an is expect­ed but not required to sub­mit an appli­ca­tion for reg­u­lar Med­ic­aid cov­er­age. PE cov­er­age typ­i­cal­ly lasts two months, or until a deci­sion approv­ing the appli­cant for Med­ic­aid is made. The scope of ser­vices cov­ered under PE dif­fers by state; some states cov­er only ambu­la­to­ry pre­na­tal care, while oth­ers cov­er the full Med­ic­aid scope of ser­vices.

For infor­ma­tion on the Hos­pi­tal Pre­sump­tive Eli­gi­bil­i­ty pro­vi­sion of the Patient Pro­tec­tion and Afford­able Care Act (ACA), which enables qual­i­fied hos­pi­tals to deter­mine PE, see Ref­er­ences.

3. Oth­er Pol­i­cy Mech­a­nisms

Expand­ing eli­gi­bil­i­ty for safe­ty-net health insur­ance pro­grams to include cov­er­age for low-income preg­nant wom­en regard­less of immi­gra­tion sta­tus is anoth­er way that undoc­u­ment­ed wom­en in some juris­dic­tions can obtain cov­er­age for pre­na­tal care. Three states (New York, Mass­a­chu­setts, and New Jer­sey) offer pub­lic insur­ance for the dura­tion of a preg­nan­cy and for two months after deliv­ery. In New York, this cov­er­age is offered as an enti­tle­ment pro­gram through a state-fund­ed expan­sion of Med­ic­aid. In Mass­a­chu­setts, cov­er­age is pro­vid­ed through a state-fund­ed Med­ic­aid expan­sion, sup­ple­ment­ed by the CHIP Unborn Child Option (see above) to cov­er ambu­la­to­ry pre­na­tal care ser­vices. In New Jer­sey, Med­ic­aid cov­er­age for pre­na­tal care only is fund­ed through the state bud­get and offered through com­mu­ni­ty health cen­ters and hos­pi­tals sub­ject to the avail­abil­i­ty of grant funds.

In some cities, undoc­u­ment­ed immi­grants are eli­gi­ble for cov­er­age for pre­na­tal care and oth­er health care ser­vices through local­ly-fund­ed pro­grams. In Wash­ing­ton D.C, for exam­ple, the D.C. Health­care Alliance pro­vides insur­ance cov­er­age for low-income city res­i­dents who do not have Med­ic­aid or oth­er insur­ance.

Beyond the­se pub­licly-fund­ed insur­ance mech­a­nisms, access to pre­na­tal care for undoc­u­ment­ed immi­grants may also be pro­vid­ed direct­ly by pub­lic health clin­ics and non­prof­it orga­ni­za­tions (such as Fed­er­al­ly Qual­i­fied Health Cen­ters) that offer health ser­vices for patients with­out insur­ance that are avail­able for free or at a slid­ing-scale fee based on a patient’s abil­i­ty to pay.

Ref­er­ences

1. Amer­i­can Acad­e­my of Pedi­atrics, Guide­li­nes for Peri­na­tal Care, 7th ed. 2012.
2. ACOG Com­mit­tee Opin­ion No. 425: health care for undoc­u­ment­ed immi­grants. Obstet Gynecol, 2009. 113(1): 251–4.
3. Cohen, G.J., The pre­na­tal vis­it. Pedi­atrics, 2009. 124(4): 1227–32.
4. Korinek, K. and K.R. Smith, Pre­na­tal care among immi­grant and racial-eth­nic minor­i­ty wom­en in a new immi­grant des­ti­na­tion: explor­ing the impact of immi­grant legal sta­tus. Soc Sci Med, 2011. 72(10): 1695–703.
5. Fris­bie, W.P., S. Echevar­ria, and R.A. Hum­mer, Pre­na­tal care uti­liza­tion among non-His­pan­ic Whites, African Amer­i­cans, and Mex­i­can Amer­i­cans. Matern Child Health J, 2001. 5(1): 21–33.
6. Fed­er­al Fund­ing for Unau­tho­rized Aliens’ Emer­gen­cy Med­ical Expens­es, in CRS Report For Con­gress. 2004.
7. Unit­ed States Con­gres­sion­al Bud­get Office, The Impact of Unau­tho­rized Immi­grants on the Bud­gets of State and Local Gov­ern­ments. 2007.
8. DuBard, C.A. and M.W. Mass­ing, Trends in emer­gen­cy Med­ic­aid expen­di­tures for recent and undoc­u­ment­ed immi­grants. Jama, 2007. 297(10):1085–92.
9. Lu, M.C., et al., Elim­i­na­tion of pub­lic fund­ing of pre­na­tal care for undoc­u­ment­ed immi­grants in Cal­i­for­nia: a cost/benefit analy­sis. Am J Obstet Gynecol, 2000. 182 (1 Pt 1): 233–9.
10. Reed, M.M., et al., Birth out­comes in Colorado’s undoc­u­ment­ed immi­grant pop­u­la­tion. BMC Pub­lic Health, 2005. 5: 100.
11. State Children’s Health Insur­ance Pro­gram; Elig­ili­ty for Pre­na­tal Care and Oth­er Health Ser­vices for Unborn Chil­dren, F. Reg­is­ter, Edi­tor. 2002: 61956–61974.

CHART–Prenatal Care: State-Lev­el Pol­i­cy Pro­vi­sions

SLIDESET–Access to Pre­na­tal Care Teach­ing Tool

State-Lev­el and Local-Lev­el Pro­grams

On immi­grants’ eli­gi­bil­i­ty pro­vi­sions for pub­lic ben­e­fits, includ­ing Med­ic­aid and CHIP, see Overview of Immi­grants’ Eli­gi­bil­i­ty for SNAP, TANF, Med­ic­aid, and CHIP, Office of the Assis­tant Sec­re­tary for Plan­ning and Eval­u­a­tion (March 2012): http://aspe.hhs.gov/hsp/11/ImmigrantAccess/Eligibility/ib.shtml (accessed on August 27, 2014).

Med­ic­aid Provider Man­u­als for pre­sump­tive eli­gi­bil­i­ty in many states are avail­able on the web­site of Enroll Amer­i­ca, a non­prof­it, non­par­ti­san orga­ni­za­tion (March 2014): http://www.enrollamerica.org/toolkits/pe/states.html
(accessed on August 20, 2014). See also links below.

For a list of states that had Pre­sump­tive Eli­gi­bil­i­ty as of Jan­u­ary 2013, see the Kaiser Fam­i­ly Foun­da­tion state indi­ca­tor: http://kff.org/medicaid/state-indicator/presumptive-eligibility/ (accessed on August 27, 2014).
(The chart that accom­pa­nies this Issue Brief reflects sub­se­quent changes to this list cur­rent as of Sep­tem­ber 1, 2014)
See also: Get­ting into Gear for 2014: Find­ings from a 50-State Sur­vey of Eli­gi­bil­i­ty, Enroll­ment, Renewal, and Cost-Shar­ing Poli­cies in Med­ic­aid and CHIP, 2012–2013, Kaiser Com­mis­sion on Med­ic­aid and the Unin­sured (Jan­u­ary 2013): http://kaiserfamilyfoundation.files.wordpress.com/2013/05/8401.pdf (accessed on August 27, 2014)

On Hos­pi­tal Pre­sump­tive Eli­gi­bil­i­ty, see Imple­men­ta­tion of the Afford­able Care Act’s Hos­pi­tal Pre­sump­tive Eli­gi­bil­i­ty Option: Con­sid­er­a­tions for States, Cen­ter for Medicare and Med­ic­aid Ser­vices (Novem­ber 2013): http://www.medicaid.gov/State-Resource-Center/MAC-Learning-Collaboratives/Learning-Collaborative-State-Toolbox/Downloads/State-Network-CHCS-Implementation-of-the-Affordable-Care-Acts-Hospital-P.pdf (accessed on August 27, 2014); see also The New Hos­pi­tal Pre­sump­tive Eli­gi­bil­i­ty Oppor­tu­ni­ty. Enroll Amer­i­ca. March 10, 2014. http://www.enrollamerica.org/toolkits/pe/home.html (accessed on August 26, 2014).

State Med­ic­aid Provider Man­u­als and Relat­ed State-lev­el Doc­u­ments

Alaba­ma:

Alaba­ma Med­ic­aid Agen­cy. Provider Man­u­al – Mater­ni­ty Care – Chap­ter 24. July 2014.
http://medicaid.alabama.gov/documents/6.0_Providers/6.7_Manuals/6.7.8_Provider_Manuals_2014/6.7.8.3_July_2014/Jul14_24.pdf (accessed 20 August 2014).

Alaska:

Alaska Depart­ment of Health and Social Ser­vices. Med­ic­aid. 2012. http://dhss.alaska.gov/dpa/pages/medicaid/default.aspx (accessed 26 August 2014).

Ari­zona:

Ari­zona Health Care Cost Con­tain­ment Sys­tem. AHCCCS Health Plans. 2014. http://www.azahcccs.gov/applicants/healthplans/healthplans.aspx (accessed 26 August 2014)

Arkansas:

Arkansas Depart­ment of Human Ser­vices. Med­ical Ser­vices Pol­i­cy Man­u­al, Sec­tion B. Jan­u­ary 2014. https://ardhs.sharepointsite.net/DHSPolicy/DCOPublishedPolicy/Section%20B-200%20Families%20and%20Individuals%20Group%20(MAGI).pdf (accessed on August 20, 2014).

Cal­i­for­nia:

Access for Infants and Moth­ers (AIM). AIM Hand­book. April 2014. http://www.aim.ca.gov/Publications/AIM_Handbook_en.pdf (accessed on August 20, 2014).

Col­orado:

Col­orado Depart­ment of Health Care Pol­i­cy & Financ­ing. Med­ic­aid Provider Infor­ma­tion Billing Man­u­al. Feb­ru­ary 2014. 19–20. https://www.colorado.gov/pacific/sites/default/files/GENERAL_PROVIDER_INFORMATIO_0.PDF (accessed on August 20, 2014).

Con­necti­cut:

Con­necti­cut Depart­ment of Social Ser­vices. U.S. Cit­i­zen­ship: What you need to know for your ben­e­fits in Med­ic­aid, HUSKY A and HUSKY B. Feb­ru­ary 2010. http://www.ct.gov/dss/lib/dss/pdfs/0606citizenshiprevised02.10.pdf (accessed on August 20, 2014).

Delaware:

Delaware Depart­ment of Health and Social Ser­vices, Divi­sion of Med­ic­aid and Med­ical Assis­tance. 31 Del.C. §512: Delaware Med­ic­aid Mod­i­fied Adjust­ed Gross Income (MAGI) Eli­gi­bil­i­ty and Ben­e­fits State Plan Amend­ments MAGI-Based Eli­gi­bil­i­ty Groups. Decem­ber 2013. http://regulations.delaware.gov/register/december2013/final/17%20DE%20Reg%20612%2012–01-13.pdf and http://regulations.delaware.gov/register/december2013/final/Benefits.pdf (accessed on August 20, 2014).

Flori­da:

State of Flori­da Depart­ment of Chil­dren and Fam­i­lies. Pre­sump­tive Med­ic­aid Eli­gi­bil­i­ty for Preg­nant Wom­en. Jan­u­ary 2014. http://www.dcf.state.fl.us/admin/publications/cfops/165%20Economic%20Self-Sufficiency%20Services%20(CFOP%20165-XX)/CFOP%20165–09,%20Presumptive%20Medicaid%20Eligibility%20for%20Pregnant%20Women.pdf (accessed on August 20, 2014).

Geor­gia:

Geor­gia Depart­ment of Com­mu­ni­ty Health, Divi­sion of Med­ical Assis­tance Plans. Part II: Poli­cies and Pro­ce­dures Afford­able Care Act For Pre­sump­tive Eli­gi­bil­i­ty Preg­nant Wom­en Med­ic­aid. July 2014. https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/HANDBOOKS/PE%20ACA%20Pregnant%20Women%20Medicaid%2002–07-2014%20145016.pdf (accessed on August 20, 2014).

Hawaii:

State of Hawaii. My Ben­e­fits. 2014, http://mybenefits.hawaii.gov/. (accessed 26 August 2014).

Ida­ho:

Ida­ho Depart­ment of Health and Wel­fare. Pre­sump­tive Eli­gi­bil­i­ty for Med­ic­aid: Provider Train­ing. Jan­u­ary 2014. http://healthandwelfare.idaho.gov/Portals/0/Providers/PresumptiveMedicaid/PresumptiveEligibilityProvidersTraining.pdf (accessed on August 20, 2014).

Illi­nois:

State of Illi­nois All Kids. Moms & Babies Pro­grams for Preg­nant Wom­en. 2014. http://www.allkids.com/pregnant.html#momsbabies (accessed on August 20, 2014).

Indi­ana:

State of Indi­ana Fam­i­ly and Social Ser­vices Admin­is­tra­tion. Pre­sump­tive Eli­gi­bil­i­ty for Preg­nant Wom­en. 2014. http://member.indianamedicaid.com/media/15344/pe%20brochure_v2.pdf (accessed on August 20, 2014).

Iowa:

Iowa Depart­ment of Human Ser­vices. All Providers II Mem­ber Eli­gi­bil­i­ty. August 2014. https://dhs.iowa.gov/sites/default/files/All-II.pdf (accessed on August 20, 2014).

Kansas:

Kansas Depart­ment of Health and Envi­ron­ment. Kan­Care. 2012–2014. http://www.kancare.ks.gov/ (accessed 26 August 2014).

Ken­tucky:

Ken­tucky Cab­i­net for Health and Fam­i­ly Ser­vices. Pre­sump­tive Eli­gi­bil­i­ty (PE) for Preg­nant Wom­en. April 2014. http://chfs.ky.gov/dms/peservice.htm#eligible (accessed on August 20, 2014).

Louisiana:

Louisiana Depart­ment of Health and Hos­pi­tals. Louisiana Med­ic­aid Eli­gi­bil­i­ty Man­u­al (MEM). May 2014. http://new.dhh.louisiana.gov/assets/medicaid/MedicaidEligibilityPolicy/H-3050m.pdf (accessed on August 20, 2014).

Maine:

Maine Depart­ment of Health and Human Ser­vices. Mainecare Eli­gi­bil­i­ty Man­u­al. June 2014. http://www.maine.gov/sos/cec/rules/10/144/ch332/144c332-sans-extras.doc (accessed on August 20, 2014).

Mary­land:

Mary­land Depart­ment of Health and Men­tal Hygiene. Mary­land Med­ical Assis­tance Pro­grams. Feb­ru­ary 2014, https://mmcp.dhmh.maryland.gov/SitePages/Home.aspx (accessed 26 August 2014).

Mass­a­chu­setts:

Mass­a­chu­setts Exec­u­tive Office of Health and Human Ser­vices. Mem­ber Book­let for Health Cov­er­age and Help Pay­ing Costs. March 2014. http://www.mass.gov/eohhs/docs/masshealth/membappforms/aca-1-english-mb.pdf (accessed on August 20, 2014).

Mass­a­chu­setts Exec­u­tive Office of Health and Human Ser­vices. MassHealth Reg­u­la­tions, 130 CMR 505.002(D). Jan­u­ary 2014.
http://www.lawlib.state.ma.us/source/mass/cmr/cmrtext/130CMR505.pdf (Accessed on August 27, 2014).

Michi­gan:

Michi­gan Depart­ment of Com­mu­ni­ty Health. Health Care Pro­grams Eli­gi­bil­i­ty. 2014. http://www.michigan.gov/mdch/0,4612,7–132-2943_4860-35199–,00.html (accessed on August 20, 2014).

Min­neso­ta:

Min­neso­ta Depart­ment of Human Ser­vices. Peo­ple Who Are Not U.S. Cit­i­zens. Decem­ber 2013. http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_144099# (accessed on August 20, 2014).

Mis­sis­sip­pi:

Mis­sis­sip­pi Divi­sion of Med­ic­aid. Med­ic­aid. 2014. http://www.medicaid.ms.gov/ (accessed on August 27, 2014).

Mis­souri:

Mis­souri Depart­ment of Social Ser­vices. TEMP Eli­gi­bil­i­ty Deter­mi­na­tion. 2008. http://manuals.momed.com/forms/temp_eligibility_determination.pdf (accessed on August 21, 2014).

See also : Lieb, D. Mis­souri gov­er­nor signs health care expan­sion. St. Louis Post-Dis­patch. July 10, 2014.
http://www.stltoday.com/news/special-reports/mohealth/updates/missouri-governor-signs-health-care-expansion/article_035eec6f-1bd0-5b9d-97b6-1d1363b127e4.html (accessed on August 21, 2014).

Mon­tana:

Mon­tana Depart­ment of Health and Human Ser­vices. Pre­sump­tive Eli­gi­bil­i­ty 2014 Qual­i­fied Enti­ty Ref­er­ence Guide. 2014. http://medicaidprovider.hhs.mt.gov/pdf/presumptive_eligibility/presumptiveEeigibilityreferenceguide%202014.pdf (accessed on August 21, 2014).

Nebraska:

Nebraska Depart­ment of Health and Human Ser­vices. New Adjunct Eli­gi­ble Pro­gram. July 2012. http://dhhs.ne.gov/publichealth/Documents/I-6-2012_New_Adjunct_Eligible_Program.pdf (accessed on August 21, 2014).

The Undoc­u­ment­ed and the Unborn. April 23, 2013. The New York Times. http://www.nytimes.com/2012/04/24/opinion/undocumented-immigrants-and-the-unborn.html (accessed on August 21, 2014).

Nevada:

Nevada Depart­ment of Health and Human Ser­vices. Divi­sion of Health Care Financ­ing and Pol­i­cy. https://dhcfp.nv.gov/index.htm (accessed 26 August 2014).

New Hamp­shire:

New Hamp­shire Depart­ment of Health and Human Ser­vices. Appli­ca­tion for Med­ic­aid Pre­sump­tive Eli­gi­bil­i­ty (PE). 2014. http://www.dhhs.nh.gov/dfa/presumptive/documents/dfa-821.pdf (accessed on August 21, 2014).

New Jer­sey:

New Jer­sey Depart­ment of Human Ser­vices. Med­ic­aid Com­mu­ni­ca­tion No. 11–07: New Jer­sey Sup­ple­men­tal Pre­na­tal Care Pro­gram (NJSPCP). July 2011. http://www.state.nj.us/humanservices/dmahs/info/resources/medicaid/2011/11-07_New_Jersey_Supplemental_Prenatal_Care_Program_NJSPCP.pdf (accessed on August 21, 2014).

New Jer­sey Admin­is­tra­tive Code. 10:72–3.10: New Jer­sey Care Spe­cial Med­ic­aid Pro­grams Man­u­al. 18 August 2014.
https://web.lexisnexis.com/research/retrieve?_m=fa48f5c6040d70cb38009b6c3e923ada&csvc=toc2doc&cform=tocslim&_fmtstr=FULL&docnum=1&_startdoc=1&wchp=dGLzVzB-zSkAb&_md5=b1be9ccbb51b271b7fb8183803b176eb (accessed on August 26, 2014).

New Mex­i­co:

New Mex­i­co Admin­is­tra­tive Code. 8.291.400: Eli­gi­bil­i­ty Require­ments. 2014. http://www.nmcpr.state.nm.us/nmac/parts/title08/08.291.0400.htm (accessed on August 21, 2014).

New Mex­i­co Human Ser­vices Depart­ment. Pre­sump­tive Eli­gi­bil­i­ty (PE) Appli­cant Infor­ma­tion Form. May 2014. https://nmmedicaid.acs-inc.com/static/PDFs/PE%20Forms/MAD011.pdf (accessed on August 21, 2014).

New York:

New York State Depart­ment of Health. New York State Med­ic­aid Update, Pre­na­tal Care Spe­cial Edi­tion. Feb­ru­ary 2010. https://www.health.ny.gov/health_care/medicaid/program/update/2010/2010-02_special_edition.htm (accessed on August 21, 2014).

North Car­oli­na:

North Car­oli­na Depart­ment of Health and Human Ser­vices. Fam­i­ly and Children’s Med­ic­aid MA-3245 Pre­sump­tive Eli­gi­bil­i­ty for Preg­nant Wom­en. March 2012. http://info.dhhs.state.nc.us/olm/manuals/dma/fcm/man/ma3245-01.htm (accessed on August 21, 2014).

North Car­oli­na Depart­ment of Health and Human Ser­vices. Pre­sump­tive Eli­gi­bil­i­ty Deter­mi­na­tion Form for Preg­nan­cy-Relat­ed Care. July 2014. http://info.dhhs.state.nc.us/olm/forms/dma/dma-5032-ia.pdf (accessed on August 21, 2014).

North Dako­ta:

North Dako­ta Depart­ment of Human Ser­vices. North Dako­ta Med­ic­aid. 2010. http://www.nd.gov/dhs/services/medicalserv/medicaid/ (accessed 26 August 2014).

Ohio:

Ohio Depart­ment of Job and Fam­i­ly Ser­vices. 5160:1–2-50 Med­ic­aid: Pre­sump­tive Eli­gi­bil­i­ty for Preg­nant Wom­en. March 2014. http://emanuals.odjfs.state.oh.us/emanuals/GetDocument.do?docId=Document(storage%3DREPOSITORY%2CdocID%3D%24REP_ROOT%24%23node-id(1631364))&locSource=input&docLoc=%24REP_ROOT%24%23node-id(1631364)&version=8.0.0 (accessed on August 21, 2014).

Okla­homa:

Okla­homa Health Care Author­i­ty. What is Soon­er­Care?. http://www.okhca.org/individuals.aspx?id=52&menu=40&parts=11601_7453 (accessed 26 August 2014).

Ore­gon:

Ore­gon Health Author­i­ty. Oregon’s Med­ic­aid State Plan. http://www.oregon.gov/oha/healthplan/Pages/stateplan.aspx (accessed 26 August 2014).

Penn­syl­va­nia:

Penn­syl­va­nia Depart­ment of Pub­lic Wel­fare. Provider Instruc­tions Pre­sump­tive Eli­gi­bil­i­ty Appli­ca­tion. May 2006. http://www.dpw.state.pa.us/cs/groups/webcontent/documents/form/s_002592.pdf (accessed on August 21, 2014).

Rhode Island:

Rhode Island KIDS COUNT. RIte Care Cov­er­age for Immi­grant Chil­dren and Fam­i­lies. Octo­ber 2010. http://www.rikidscount.org/matriarch/documents/Q%20and%20A%20For%20Helpers.pdf (accessed on August 21, 2014).

South Car­oli­na:

South Car­oli­na Depart­ment of Health and Human Ser­vices. Health Con­nec­tions Med­ic­aid. https://www.scdhhs.gov/ (accessed 26 August 2014).

South Dako­ta:

South Dako­ta Depart­ment of Social Ser­vices. Med­ical Ser­vices. 2011. http://dss.sd.gov/medicalservices/ (accessed 26 August 2014).

Ten­nessee:

Ten­nessee Depart­ment of Finance and Admin­is­tra­tion Divi­sion of Insur­ance Admin­is­tra­tion. Chap­ter 0620–05-01 Cov­er Kids Rules. June 2014. http://www.tn.gov/sos/rules/0620/0620–05/0620–05-01.20140615.pdf (accessed on August 21, 2014).

Tex­as:

Tex­as Health and Human Ser­vices Com­mis­sion. CHIP State Plan. March 2012. http://www.hhsc.state.tx.us/medicaid/about/state-plan/docs/CHIPStatePlan.pdf (accessed on August 27, 2014).

Tex­as Depart­ment of State Health Ser­vices. Title V MCH Fee For Ser­vice Pol­i­cy Man­u­al. Sep­tem­ber 2013. http://www.dshs.state.tx.us/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8589980232 (accessed on August 21, 2014).

Utah:

Utah Depart­ment of Health. Baby Your Baby Eli­gi­bil­i­ty Chart. 2014. http://www.babyyourbaby.org/financial-help/eligibility.php (accessed on August 21, 2014).

Ver­mont:

Green Moun­tain Care. Med­ic­aid. 2014, http://www.greenmountaincare.org/vermont-health-insurance-plans/medicaid (accessed 26 August 2014).

Vir­ginia:

Virginia’s Med­ic­aid Pro­gram. Depart­ment of Med­ical Assis­tance Ser­vices. 2009. http://www.dmas.virginia.gov/ (accessed 26 August 2014).

Wash­ing­ton:

Wash­ing­ton State Depart­ment of Social and Health Ser­vices. Preg­nan­cy and Women’s Health – Med­ical Pro­grams. Novem­ber 2013. http://www.dshs.wa.gov/manuals/eaz/sections/medicalassistance/PREGmedicalprogs.shtml (accessed on August 21, 2014).

Wash­ing­ton D.C.:

DC Depart­ment of Human Ser­vices. Chap­ter 4 – DC Health­care Alliance. (2011) http://dhs.dc.gov/page/chapter-4-dc-healthcare-alliance-program (accessed on August 21, 2014).

West Vir­ginia:

West Vir­ginia Depart­ment of Health and Human Resources. West Vir­ginia Bureau for Med­ical Ser­vices. 2011. http://www.dhhr.wv.gov/bms/Pages/default.aspx (accessed 26 August 2014).

Wis­con­sin:

Wis­con­sin Depart­ment of Health Ser­vices. Bad­ger­Care+ Pre­na­tal Ser­vices. Feb­ru­ary 2014. http://www.dhs.wisconsin.gov/publications/p1/p10026.pdf (accessed on August 21, 2014).

Wyoming:

Wyoming Depart­ment of Health. Pre­sump­tive Eli­gi­bil­i­ty (PE). 2013. http://www.health.wyo.gov/healthcarefin/medicaideligibility/PresumptiveEligibilityPE.html (accessed on August 21, 2014).

Rachel Fabi is a PhD stu­dent in the Depart­ment of Health Pol­i­cy and Man­age­ment, Johns Hop­kins Bloomberg School of Pub­lic Health, and in the Johns Hop­kins Berman Insti­tute of Bioethics. She is a 2014 intern on the Undoc­u­ment­ed Patients Project.

Suggested citation

Rachel Fabi, "Undocumented Immigrants in the United States: Access to Prenatal Care," Undocumented Patients web site (Garrison, NY: The Hastings Center), originally published: September 16, 2014. Available at http://undocumentedpatients.org/issuebrief/undocumented-immigrants-in-the-united-states-access-to-prenatal-care/