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Special Enrollment Period

Despite the steps forward, some pregnant women still do not have access to pregnancy related care because they lack coverage or their health plan is exempt from the ACA’s EHB requirement. Some women in this scenario can enroll in Medicaid. Others, however, remain left in the same position as millions of women before the ACA – lacking access to covered maternity care when it really counts. This can result in dire health and financial consequences. To fix the problem, we recommend making pregnancy a qualifying life event that allows pregnant women to enroll in new health insurance coverage through the marketplace.

Many women who need health coverage will enroll in ACA marketplace health plans during the annual open enrollment period, but some will need to apply for coverage following certain life events. Currently, the Federal government considers the birth or adoption of a child to be among the events that qualify for a special enrollment period.  We believe it is critical to add pregnancy to this list.

With about half of all pregnancies unintended, we know that planning ahead for coverage is not always possible. We want the rules to extend more upstream than birth or adoption of a child because we know that prenatal care is extremely important to the health of the mother and child. We also know that pregnancy related care is time sensitive and coverage is critical. Additionally, aligning pregnancy as a triggering event for special enrollment in private plans will further align the policies of our state Exchange with the Oregon Medicaid practices.

OFRH requested DCBS to include a Special Enrollment Period for Women who become Pregnant for Oregonians. For more information, download the reports below.

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