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Virginia Expands Health Coverage To Undocumented Pregnant Women

Doctor and patient
A doctor checks a patient's blood pressure. (Photo: Thirdman)

Undocumented pregnant women in Virginia are now eligible for health insurance coverage during their pregnancy and up to 60 days postpartum through the state’s Medicaid agency.

The new coverage went into effect this month as part of a federal waiver application and $4.9 million in state general funds approved by Virginia lawmakers this year. Women who make up to 205% of the federal poverty line are eligible for coverage.

It applies to DACA recipients, women with expired visas who’ve remained in the country and women who entered the U.S. without any legal status. Women who receive services face no risk of deportation, according to the Virginia Department of Medical Assistance Services.

DMAS estimates that between 4,000 and 5,000 women are eligible for the new coverage. That’s the number of women who’ve utilized emergency delivery services annually in recent years.

“The majority of these women previously were only eligible for emergency services,” said Sarah Hatton, deputy of administration for DMAS.

Hatton says since July 1, DMAS has worked with partner organizations to help around 300 women enroll. She adds DMAS has translated materials and bilingual staff available to answer questions.

“We know overall that immigrants are more likely to be uninsured than U.S.-born individuals,” said Samantha Artiga, director of racial equity and health policy at the Kaiser Family Foundation. “And this reflects both more limited access to private coverage, because they tend to work in jobs and industries that often do not offer health coverage to employees. At the same time, immigrants face restrictions on eligibility for public health coverage options through Medicaid, CHIP and the Marketplaces that exclude undocumented immigrants in particular.”

Sara Cariano, health policy specialist with the Virginia Poverty Law Center, has been advocating for this expansion for years.

“This is really huge for women who were literally just kept out of the health care system during their pregnancies at such an important time for both their health and the health of the child,” Cariano said. “There are very few options for these individuals [undocumented women] to access comprehensive coverage and care. This remains the case for all but these pregnant women in Virginia, and these women will again have little access once the 60-day postpartum period ends.”

Seventeen other states currently provide health coverage to undocumented pregnant women through pregnancy. Virginia is one of just a few states to extend coverage to undocumented women beyond pregnancy, according to KFF.

That’s because of a general federal prohibition on coverage after the child is born through the “unborn child option.”

“Once the baby is born, the woman is no longer eligible because the child is born,” said Jennifer Tolbert, director of state health reform for KFF.  “So that’s the prohibition on states providing coverage.”

Virginia got an exception to this rule from the federal government in order to extend coverage 60 days postpartum. The only other way for states to provide this coverage, Tolbert says, is to use state dollars and state dollars alone.

Connecticut uses state funding to pay for up to 12 months postpartum for undocumented pregnant women.

“A large percentage of maternal deaths occur after 60 days,” Cariano says. “And so we need to provide postpartum care to women through that whole postpartum period to really decrease maternal deaths and address the disparity in maternal deaths.”

Virginia’s Medicaid agency has submitted another federal waiver to extend postpartum coverage for women up to 12 months, but Cariano says this waiver application does not include undocumented pregnant women.

The waiver option was made available to states as part of the American Family Rescue Act, which Tolbert says will be available for five years starting April 1, 2022.

Individuals can apply for Medicaid online at CommonHelp. Application assisters are available at no cost to help with the process. Visitors to the CoverVA and the Spanish-language CubreVirginia websites can find listings of application assisters in their communities. Those who prefer to speak to someone by phone can call the Cover Virginia Call Center at 1-855-242-8282. Translation and interpretation services are available in all languages.


Megan Pauly covers education and health care issues in the greater Richmond region.