Senator Eliot Shapleigh - El Paso, Texas

After the Legislature incorporated substantial hurdles into the Children's Health Insurance Program, a massive drop in the number of enrolled youngsters cost the state millions in federal matching funds that would have gone to Texas clinics and hospitals. This, in a state with the highest rate of children growing up without health insurance. But now, state officials have taken a turn in children's medical coverage so innovative it could serve as a model for the rest of the country.

As reported in the San Antonio Express-News, lawmakers expanded CHIP coverage in the previous legislative session to include babies who have not yet been born. Starting next year, low-income pregnant mothers who do not qualify for Medicaid can receive care related to their pregnancy or to the health needs of their unborn children. The expanded program specifically excludes mothers from CHIP coverage, but it provides for the child in-utero and during the first months of life for a total of one full year of health insurance coverage.

Upon birth, the mother can apply to extend her child's CHIP coverage, avoiding the critical gap in newborn care that now occurs. Under current CHIP rules, a child enrolled in the program must wait 90 days before receiving benefits.

Typically, there is a catch to public health largess in the Lone Star State. Critics charge — with good reason — that lawmakers changed the CHIP rules for all the wrong reasons. Under the legislation, known as the CHIP Perinate Program, the fetus is described as an "unborn child" or a "perinate." Lawmakers made the change after a Bush administration policy change defined "an unborn child" as a person eligible for medical coverage.

The move has been widely criticized as an effort by abortion opponents to establish a fetus as a person.

The change, however, provides a substantial prenatal benefit to pregnant women who make too much money to qualify for Medicaid. Providing CHIP coverage to babies prior to birth so that women can receive prenatal care also reduces the amount of uncompensated care that hospitals provide uninsured mothers.

The perinate program will also allow Texas to draw down more federal matching CHIP dollars.

Ideally, Texas should allow all qualified newborns to be automatically enrolled in CHIP instead of engaging in the mental gymnastics required to provide health coverage for "perinates." And lawmakers should act swiftly to remove barriers — including six-month rather than annual enrollment and higher premiums and co-payments — they enacted in 2003 that caused tens of thousands of poor children to be dropped from CHIP.