Maternal and Child Health Access v. Department of Health Care Services
On Dec. 16, 2008, the San Francisco Superior Court struck down a state law requiring that low-income working women must have resided in California for at least six months before becoming eligible to receive prenatal and other medical care services through California's Access for Infants and Mothers (AIM) insurance program.
Equal Protection and Freedom to Travel
We argued that excluding pregnant women from medical care simply because they are new California residents violated their rights under both the California and U.S. Constitutions. The residency requirement, we said, violated their right to equal protections under the law and impeded their fundamental freedom to travel between states.
The ACLU Foundation of Northern California, Lawyers' Committee for Civil Rights, Bay Area Legal Aid and Lucy Quacinella represented Maternal and Child Health Access, an advocacy group, in the case filed on April 24, 2008.
Conserving Resources no Justification for Discrimination
AIM provides low cost health insurance coverage to uninsured, working poor pregnant women who might otherwise not be able to afford health care because they earn too much to qualify for the Medi-Cal program but too little to purchase health insurance.
The six-month residency requirement for AIM had been in place since 1991. In 2007, the Legislature passed AB 1328, which would have deleted the requirement. The Governor vetoed the bill in Oct. 2007, claiming that removing the restriction would potentially increase General Fund expenditures. We argued that a state's legitimate interest in conserving financial resources does not justify discriminating among citizens who are eligible for public benefits.
Access to Care Critical and Cost Effective
Research shows that time is of the essence in obtaining access to prenatal care, especially in the first trimester. This care can help prevent premature delivery and low birth weight and help ensure the health of the mother.
The sixth-month in-state residency requirement meant that working poor women who were new residents in California might not have been able to obtain timely prenatal care through AIM at all. Moreover, in denying a woman AIM coverage, the state was also depriving the newborn of healthcare coverage guaranteed if the mother was in the program.
According to the federal government's Institute of Medicine, each dollar spent on providing adequate prenatal care saves $3.38 on medical care that would otherwise be necessary for low birth weight infants during the first year of life. Other investigators have computed different, even higher, ratios, but virtually all find evidence of cost effectiveness.
The Superior Court ruling clears the way for working poor women to obtain the essential prenatal and other medical care they need.