Although CMS requires the care to be directed at the unborn child, the SCHIP unborn child SPA option effectively enables states to provide prenatal care to pregnant women including those with incomes at or above the Medicaid income eligibility thresholds and for individuals who do not qualify for Medicaid (or SCHIP) for other reasons, such as immigration status or incarceration. Finally, for the family coverage option, pregnancy-related benefits are those offered by participating private health plans. Summary of State Variation in Pregnancy Coverage Under SCHIP

 Table 1 summarizes the variation in pregnancy coverage among states with §1115 waivers and those using the SCHIP unborn child SPA option. As of October 2007, 17 states offered pregnancy-related services using SCHIP funds. Of those, 12 states extended coverage through unborn child SCHIP SPAs and 6 states used the §1115 waiver authority (Rhode Island extends coverage to pregnant women through both authorities). Of the 12 states that offer pregnancy-related services to unborn children under the SCHIP SPAs, all but Tennessee extended coverage to the unborn children of undocumented aliens who otherwise would not have access to federally funded pregnancy-related services, except through emergency Medicaid. Three states indicated that the coverage offered to pregnant women and/or unborn children was comprehensive and not limited to pregnancy-related services. The reason CMS permits this is because the state has a global rate for their pregnancy services that includes the cost of prenatal care, labor and delivery, and 60 days of postpartum care. Finally, two states (one §1115 waiver state and one SCHIP SPA state) provided access to extended family planning services and supplies as a part of their postnatal care benefit.
The State Children's Health Insurance Program (SCHIP) does not include pregnancy status among its eligibility criteria and does not cover individuals over age 18. Under SCHIP, states can cover pregnant women aged 19 and older in one of three ways: (1) states may apply for waivers of program rules to extend coverage to adults such as pregnant women (§1115 waiver authority); (2) states may provide health benefits coverage, including prenatal care and delivery services, to unborn children through an SCHIP state plan amendment (SPA) as permitted through regulation (Federal Register, vol. 67, no. 191, Wednesday, October 2, 2002, Rules and Regulations); or (3) states may offer a "family coverage option" that allows them to provide coverage under a group health plan that may include maternity care to adult females in eligible families. Section 2105(c)(3) of the Social Security Act allows states to cover entire families including parents if the purchase of family coverage is cost-effective when compared with the cost of covering only the targeted low-income children in the families involved, and would not substitute for other health insurance coverage. E-mail correspondence (from June 7, 2007) with Kathleen Farrell, the CMS Director of the SCHIP program, indicates that New Jersey and Massachusetts are the only states with operational family coverage variance programs. As of October 2007, 17 states offered pregnancy-related services using SCHIP funds. Of those, 6 states used the §1115 waiver authority and 12 states extended coverage through unborn child SPAs (Rhode Island extends coverage to pregnant women through both authorities). This report summarizes the variation in pregnancy coverage and the financing streams associated with such coverage among these states. This report will be updated as state activity warrants.