Medicaid and Pregnant Women

During pregnancy, Medicaid beneficiaries are entitled to prenatal and postpartum care even if they do not qualify for the program based on income. Medicaid for pregnant women helps improve birth outcomes.

Medicaid benefits do this by ensuring beneficiaries have access to services such as prenatal counseling, prenatal vitamins and prescriptions and preventive medicine. Women are covered under this program up to 60 days after the child’s birth, while the child’s Medicaid coverage continues up to their first birthday.

Pregnancy is a preexisting condition that is covered under the Medicaid program. As such, the income requirements do not apply for pregnant women. However, they must qualify based on other criteria such as residency status and citizenship status. Individuals may apply online through the government’s Healthcare Marketplace. They may also apply by contacting their state’s Medicaid agency. Expectant mothers can read further for information on Medicaid for pregnant women and on the ways get coverage for an unborn child.

Benefits of Medicaid for Pregnant Women

During pregnancy, Medicaid beneficiaries are entitled to prenatal and postpartum care. This Medicaid program is a joint federal and state program that works to increase the mortality rate of newborns and to improve birth outcomes. The goal of the program is to reduce hospital stays and reduce the requirement for neonatal intensive care services.

Under current health care laws, pregnancy is a preexisting condition that qualifies for Medicaid pregnancy coverage. With this program, children of pregnant women are automatically eligible for Medicaid if their mother met Medicaid eligibility requirements on the child’s date of birth. The child’s Medicaid coverage continues up to the child’s first birthday. The child is eligible for the program even if their mother would not qualify based on income. No citizenship documentation is required for the child during this period.

Related Article: Becoming a Medicaid Beneficiary

As Medicaid is a needs-based program, Medicaid recipients pay no out-of-pocket costs or premiums for their coverage during pregnancy. This means that their Medicaid coverage is substantially lower than a plan from the Health Insurance Marketplace. Also, after pregnancy, the mother is eligible to immediately enroll the child in a health care program even if it is outside open enrollment. She has up to 60 days after the birth of the baby to apply for pregnancy Medicaid.

Services Covered Under Medicaid for Pregnant Women

Medicaid pregnancy coverage is much the same as it would be for regular Medicaid beneficiaries. Per government regulations, recipients must be provided with a set of Minimum Essential Coverage (MEC). MEC outlines the minimum set of services that each state must provide under the Medicaid program. As such, the program provides:

  • Emergency services
  • Hospitalization
  • Prescription drugs
  • Laboratory services
  • Rehabilitative care

The program recognizes that pregnant women require additional care beyond the MEC. As such, Medicaid provides an expanded set of services to women who are pregnant or who may become pregnant. During pregnancy, Medicaid recipients also qualify for help with breastfeeding equipment and counseling.

When pregnant, Medicaid requirements specify that individuals may receive a wide range of preventive care services. The program provides anemia screening, folic acid supplements, gestational diabetes screening and urinary tract screenings.

What are the pregnancy for Medicaid eligibility requirements?

During pregnancy, Medicaid eligibility is based on a variety of factors including income, pregnancy status and citizenship status. For a person to qualify for based on income, the applicant’s income may not exceed the income limits for their area. The amount is based on the federal poverty level and the modified adjusted gross income level for their area. For pregnancy, Medicaid eligibility rules state that recipients must also be residents of the state in which they are applying. They must also be a U.S. citizen or have approved immigration status.

How to Apply for Pregnancy Medicaid Coverage

Women have two options to apply for Medicaid for pregnant women. First, they may apply for prenatal Medicaid coverage through the Health Insurance Marketplace website. To begin the application process, women must create an account to login. The site may display a warning that the open enrollment period has ended. Applicants should note that the open enrollment period does not apply to pregnant women. These individuals may apply for Medicaid at any time. Once logged in, the applicant must provide information about their household such as:

  • Applicant name and address
  • Names of every member of the household
  • Household income

The website uses this information to determine if the individual meets the eligibility requirements for the program. If the applicant qualifies for Medicaid for pregnant women, their information is automatically sent to the applicant’s state Medicaid agency. Once the state receives the applicant’s information, the agency contacts the applicant for the next steps.

Before or during pregnancy, individuals may submit a pregnancy Medicaid application, by contacting their state Medicaid agency directly to apply. They will be required to complete an application and provide the information necessary to determine their eligibility. Women should apply for Medicaid even if they do not qualify based on their income. Most women are eligible for pregnancy coverage even if their income disqualifies them for regular Medicaid.

Related Article: Medicaid eligibility

During the process, applicants may need to provide proof of income with paystubs or letters from an employer. They may also be asked to provide proof of identification with a driver’s license or Social Security card. Lastly, they must prove their legal presence in the U.S. with a birth certificate, or documentation that shows their immigration status.

When applying for Medicaid pregnancy coverage, applicants may be required to provide documentation such as income, identification with a driver’s license or Social Security card, proof of citizenship with a birth certificate, passport or other documentation to prove they have a legal presence in the U.S.

Submitting a Pregnancy Medicaid Application for Presumptive Eligibility

Per Medicaid for pregnant women guidelines, pregnancy is a pre-existing condition covered by the program. As such, individuals may qualify for Medicaid pregnancy coverage even if they would not otherwise qualify based on their income. With preemptive eligibility, pregnant women get immediate coverage for themselves and their unborn child. To apply, individuals must apply for presumptive eligibility available on the Medicaid website. When filling out the application, the following information is required:

  • Name of applicant
  • Names of all members of the household
  • Income for the household

Once approved, beneficiaries may begin to use their Medicaid for pregnant women benefits for doctor visits, prescriptions and hospital care. Women are only covered under presumptive pregnancy eligibility if they have not used the presumptive eligibility during the current pregnancy.

Related Article: Using Medicaid Benefits

It might also interest you: