Opinion ID: 2243340
Heading Depth: 1
Heading Rank: 1

Heading: The Statute in Issue

Text: New York's PCAP statute is best understood against the backdrop of related programs. Medicaid was created by Congress in 1965 to provide Federal reimbursement to participating States for a portion of the cost of all medically necessary services for qualified individuals. Medicaid eligibility is determined by financial need, ultimately assessed by reference to the Federal poverty level  currently annual income below $9,840 for a single pregnant woman. Federal Medicaid reimbursement is available for abortion only in cases of rape or incest, or to save the life of the mother ( see , Pub L 103-112, § 509). States may, however, at their own option and expense, offer services additional to those reimbursed under Medicaid, and New York has consistently included all medically necessary abortions in its State Medicaid program (Social Services Law § 365-a [2], [5] [b]; 18 NYCRR 505.2 [e]). In 1987, Congress created PCAP to afford Federal reimbursement to States providing prenatal care and related services for needy pregnant women with household incomes exceeding the Medicaid eligibility standard ( see , Omnibus Budget Reconciliation Act of 1987, Pub L 100-203, § 4101). Every State must offer PCAP to women with incomes at or below 133% of the poverty level, and may extend eligibility up to 185% of the poverty level, without regard to other resources these women may have ( see , 42 USC § 1396a [l] [2] [A]). Effective January 1, 1990, New York amended its Public Health and Social Services Laws to participate in PCAP, [2] offering the maximum coverage for which Federal reimbursement is authorized (L 1989, ch 584). [3] Thus, in New York, a single pregnant woman with annual income between $9,840 and $18,204 is eligible for PCAP, which covers enumerated pregnancy-related services: prenatal risk assessment, prenatal care visits, laboratory services, parental health education, referrals for pediatric care and nutrition services, mental health and related social services, transportation to and from appointments, labor and delivery, postpregnancy services such as family planning, inpatient care, dental services, emergency room services, home care and pharmaceuticals (Public Health Law § 2522 [1] [a]-[o]). PCAP does not provide funding for an abortion, or transportation to or from an abortion. [4] An eligible woman who elects to have an abortion, however, may receive all other covered pregnancy and postpregnancy services. PCAP coverage continues, without regard to a change in income, for 60 days after the month in which the pregnancy terminates, even if by abortion ( see , Public Health Law § 2521 [3]). While Medicaid eligibility generally depends upon verification of the application ( see , Social Services Law § 366-a [2]), a pregnant woman applying for PCAP is immediately presumed eligible upon a preliminary showing to a qualified provider that her household income falls below 185% of the poverty level ( see , Public Health Law § 2529 [2]). Similarly, Medicaid applicants are required to exhaust certain household resources for eligibility ( see , Social Services Law § 366 [2]), while PCAP applicants need only satisfy the income requirement ( see , Public Health Law § 2521 [3]; Social Services Law § 366 [4] [o] [2]). These differences are rooted in the exigencies attendant upon the need for prenatal care. As was made explicit at the time of New York's adoption of PCAP, the available benefits are tailored to the statutory objective of combatting the State's unacceptably high rate of low birthweight and infant mortality  reportedly higher than the national average  and increasing healthy births by ensuring adequate prenatal care to pregnant women who, although not indigent, are deemed less likely to spend their available resources to obtain good prenatal care ( see , Mem of State Exec Dept, 1989 McKinney's Session Laws of NY, at 2218). Studies have documented the correlation between infant mortality and neurological abnormalities on the one hand, and low birthweight and premature birth on the other  conditions ameliorated by proper care throughout pregnancy, which can be costly ( see, e.g. , House Report No. 99-727 to Pub L 99-509, at 99, reprinted in 1986 US Code Cong & Admin News 3689). PCAP unquestionably is highly effective in meeting its objective.