Updated on July 21, 2016
Before I gave birth, I made three calls: one to Oscar, my health-insurance company; one to the New York state exchange through which I receive my insurance, thanks to the Affordable Care Act; and one to Child Health Plus, New York’s “health insurance program for kids,” through which my toddler daughter receives her coverage and with which I wanted to enroll my son.
No problem, a representative of Oscar assured me. My infant would be covered under my plan for the first 48 hours.
No problem, a representative of the New York State of Health assured me. Call from the hospital and we’ll get your son enrolled.
No problem, a representative of Child Health Plus assured me. We’ll be able to enroll your son.
That was in March. On May 1, my infant son’s health insurance through Child Health Plus finally kicked in—six weeks after he was born.
New York’s Child Health Plus (CHP) program predates the Affordable Care Act but has been absorbed into it and is now available via various providers, such as Empire Blue Cross Blue Shield. In 2001, the Times called CHP “one of the country's most successful insurance programs for poor children.” As of this year, over 200,000 children are covered by CHP. Enrollment is straightforward and, compared to many employer-provided and Obamacare family plans, it is affordable. But it is not immediate. What no one told me is that CHP is not obligated by the state to backdate coverage of qualified newborn infants so as to guarantee them health insurance from their first day of life.
New York’s program for ensuring health insurance to its most vulnerable population, children, is not required to provide access when those children, and their parents, need it most. Medicaid is required to provide such access; so are family plans purchased through private insurers. (My own plan, however, was an individual plan.) Somehow, CHP is not. So, instead, CHP delays the initiation of coverage of babies for 30 or 45 days after birth, depending on whether the baby is born before or after the 15th of the month. As representative after representative told me on the phone, when I called, with increasing desperation, from the maternity ward, “That’s policy.”
The only potential remedy is for parents to know to ask for a review, during which they can plead for CHP to backdate coverage. I found that out later, from a more forthcoming representative for the New York State of Health, when I called for comment on this story as a reporter rather than as a mom. That rep added that customer service employees are discouraged from telling parents that the appeals process exists, and that even being granted a review is no guarantee of success. “I’m sorry,” he told me. Had he, as a dad, been treated that way, he said, he “would be infuriated.” And I am hardly the first person to run into this problem with Child Health Plus: “It’s not rare for parents to be up in arms,” he said.
I reached out directly to Child Health Plus for comment as well but did not receive a response.
Some of those up-in-arms parents seem to have made a difference. New York State recently passed legislation addressing the issue and, as of January 2017, parents of newborns will be able to backdate Child Health Plus coverage to begin immediately upon the birth of their children.*
Even as a reasonably well-educated person with hard-won knowledge of the limitations of America’s health-care system, I was unprepared for this level of dysfunction. For 40-some weeks, I had been pregnant on a plan purchased on an Obamacare exchange: first bronze and then, when the year changed and my delivery loomed, platinum. My pregnancy on that plan transformed me into a far savvier medical consumer, and a far more jaundiced one. Still, when my son was born, and I went through what I had been told would be the straightforward process of getting him signed up for insurance, I was stymied.
Not 12 hours after bringing a new human being into the world, before I had slept or showered or gone more than a few feet from my bed in the maternity ward, I was on the phone with the New York State of Health. I answered all of the rep’s questions, and she assured me she could sign my son up for Child Health Plus. Because he had been born after the 15th of March, his coverage would start in six weeks.
That can’t be possible, I said. Obviously he needs insurance now. We were in a hospital. He already had his first pediatrician’s appointment scheduled, and he would have to have several more before May 1, which would include vaccinations as well as whatever else the doctors considered necessary.
My own plan only covered my child as an extension of me for the first two days. After that, he would be on his own: less than seven pounds of entirely helpless baby in Gotham City. Surely I could pay whatever was necessary to backdate his insurance?
The representative, as well as the representative and the supervisor I asked to speak when I called Child Health Plus directly, all told me they were sorry but that there was nothing they could do. Backdating was not an option. They could not offer insurance for my newborn or solutions for how I should obtain coverage elsewhere.
Ironically, the official Child Health Plus page on the New York State Department of Health website seems to contradict its own policy. “The best beginning you can give your baby is good health care!” it says. “Your baby should start getting regular health care right after birth.” I look forward to the day when the program makes that possible.
In the end I wrangled an absurd solution: individual coverage for my newborn via my own insurer, Oscar. It didn’t come cheap. Though he only needed about 10 days of coverage in March, I had to pay my son’s premium for the full month, as well as for the month after that. And, though we’d only be using the plan for six weeks, it still came with a $2,000 out-of-pocket max. Total cost: $550—all of which had to be handed over right away. Child Health Plus, by contrast, charges families at my income level $60 per child. That was what I had budgeted for.
My pregnancy had already generated about $1,500 in out-of-pocket costs aside from the price of coverage itself, which, by the end, came to almost $650 a month just for me. As I wrote these latest unexpected checks, I wondered what would have happened if, like almost half of all Americans, I wasn’t able to lay my hands on an extra $550. I might have had to gamble on letting my infant go without any health insurance, regardless of whether the bills would eventually leave my family bankrupt.
It is unconscionable that a state program that purported to be “for kids” offered them no guarantee of protection. For years, CHP came with a pothole, the kind that could only be bypassed with ready money. It’s good news that starting in 2017, the situation will improve.
* This article originally neglected to mention the passage of a recent law that corrects the gap in coverage for newborns under Child Health Plus. We regret the error.