REPORT OF COMMITTEE ON MATERNAL AND PERINATAL HEALTH
CM-MPH Report 1-A-07
Subject: Definition of "Child"
Presented by: Robert M. Wheeler, MD, Chair
Referred to: Reference Committee on Public Health
In 2002, the Centers for Medicare & Medicaid Services (CMS) changed the definition of "child" for purposes of eligibility for perinatal coverage under the Children's Health Insurance Program (CHIP Perinatal) to "an individual under the age of 19 including the period from conception to birth."
While the Committee on Maternal and Perinatal Health supports public programs that provide health care for pregnant women, the committee objects to this definition of "child." The committee endorses the definition of child as "an individual from the period of viable birth to age 19," which is consistent with standard medical terminology.
As a result of the federal definition of "child," CHIP/Perinatal in Texas provides prenatal care for the fetus only, not for the pregnant woman. The committee finds the concept of separating prenatal care for the fetus from care of the pregnant woman disturbing, as if the well-being of a child is unrelated to its mother's overall health during her pregnancy. If a pregnant woman breaks her leg, the program does not cover her medical care. More problematically, if she needs potentially life-saving treatment, such as radiation or chemotherapy, it most likely would not be covered because its effect on the embryo or fetus is unknown.
Physicians who participate in CHIP Perinatal are not only frustrated by limitations on the care they can provide their patient under the program but they may be exposed to medical liability in some circumstances.
The committee suspects the federal government's choice of definition for "child" is a political one. It appears to be a back-door way of defining in law an embryo and fetus as a "person" to achieve a political agenda. Clearly, a more practical way to ensure healthy babies would be simply to grant health coverage to pregnant women.
Recommendation : While the Texas Medical Association supports public programs that provide health care for pregnant women and fetuses, it objects to the definition of a child as "an individual under the age of 19 including the period of conception to birth." TMA endorses the definition of child as "an individual from the period of viable birth to age 19," which is consistent with standard medical terminology.
TMA House of Delegates: TexMed 2007