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California lawmakers push insurers to cover prenatal screening tests universally

The lawmakers say by covering noninvasive prenatal testing for pregnant women, California's maternal health disparities will lessen.

A group of California lawmakers recently sent letters to Aetna and UnitedHealthcare urging them to fully cover noninvasive prenatal testing for all pregnant women in the state.

The two insurance companies temporarily covered noninvasive prenatal testing, or NIPT, for younger women during the pandemic, but the letters implore them to broaden the coverage beyond COVID-19.

Instead of offering coverage for NIPT like other insurers including Cigna, Blue Shield of California, and Optima Health, Aetna and UnitedHealthcare only cover screening tests that can cause pregnant women and their families additional costs, and referrals to specialists for further testing, according to the letters.

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WHY THIS MATTERS

NIPT is used to determine the risk that a fetus will be born with certain abnormalities, such as Down's syndrome.

It has been found to be the most accurate prenatal screening test and has a detection rate for Down's syndrome of more than 99%, with a false positive rate as low as 0.1%, according to a study from The New England Journal of Medicine. The same study found that traditional screening tests miss up to 21% of Down's syndrome cases.

The letter cites one reason that insurers should cover NIPT is to avoid "wrongful birth lawsuits," where parents claim negligence in informing the parents of the risk of having a genetically impaired child. The letter suggests that by offering more accurate tests, like NIPT, these lawsuits could be avoided because the likelihood of discovering the baby's genetic disorder is higher.

Although California's overall maternal mortality rate is less than the national average, significant racial and ethnic disparities exist across a variety of maternal quality measures, including prenatal visits, preterm births, and maternal and infant mortality rates, according to the 2019 California maternity care report.

The lawmakers who sent the letter believe providing equitable access to prenatal screening options regardless of insurance plan, socioeconomic level, race or ethnicity is crucial in reducing the state's maternal health disparities.

THE LARGER TREND

The American College of Obstetricians and Gynecologists recently updated its policy recommendations to say all patients should be offered NIPT regardless of age or risk factors.

Previously, the organization only recommended the use of NIPT in "high-risk" pregnancies, such as in individuals 35 years or older.

Besides offering NIPT to pregnant women, telehealth may be a strategy to close the maternal health gap. It can bring pregnant women the prenatal care they need even when they don't have access to a physician.

ON THE RECORD

"Healthcare coverage decisions are often determined by a variety of factors, including cost, medical necessity, standard of care, and availability of service," the lawmakers said in their letter. "An essential area of healthcare coverage for many, particularly young women, is maternity benefits and testing available to determine a healthy pregnancy. Poor insurance coverage for early genetic maternity testing can have devastating consequences on women and their pregnancies. Unlike several insurers like Cigna, Blue Shield of California, Optima Health and others, Aetna [and UnitedHealthcare have] still not fully endorsed noninvasive prenatal testing (NIPT) coverage for all pregnant women."

Twitter: @HackettMallory
Email the writer: mhackett@himss.org