An Overview of Medicaid for Pregnant Women

Adequate health care during pregnancy is vital for both mom and baby’s well being, yet pregnancy can often come with a multitude of doctor visits. With the prospect of mounting medical bills, the uninsured or lower income pregnant woman is often prevented from seeking appropriate prenatal care. As a joint federal-state response, Medicaid was initiated to cover prenatal, delivery, and postnatal care for eligible pregnant women throughout the nation.

Eligibility requirements for Medicaid

Medicaid, in general, aims at providing health coverage to specific priority groups, including children, people with disabilities, and senior citizens who require consistent nursing care. Pregnant women are also considered a high priority group, and in some cases, can receive Medicaid under “Expanded Eligibility,” even if their income level is higher than the normal Medicaid income requirements.

Being funded by both federal and state programs, Medicaid has general eligibility requirements established nationwide, yet also some specific eligibility requirements that can vary from state-to-state. Pregnant women whose household income level is at or below 133% of the federal poverty level are considered “Categorically Needy” and would be eligible for Medicaid. Through Expanded Eligibility, some pregnant women who make over the income requirements can still qualify for Medicaid as “Medically Needy” applicants. Pregnant women who are applying for Medicaid can contact their local Medicaid office to find out more about their state’s specific eligibility requirements.

Presumptive Eligibility for pregnant women

In an effort to encourage uninsured pregnant women to begin receiving prenatal care early on in their pregnancies, Medicaid offers what is called “Presumptive Eligibility” to qualifying women. Presumptive Eligibility is a form of back coverage for prenatal care received prior to the date a pregnant woman applied to Medicaid or began receiving Medicaid benefits. Expediency is usually given to a pregnant woman during the application process, and if her application is accepted, benefits usually can be accessed within 2-4 weeks. A temporary health card may also be issued if prenatal care is required immediately.

Pregnancy services covered under Medicaid

A woman receiving Medicaid for her pregnancy can expect most services relating solely to her pregnancy to be covered. This usually includes prenatal care appointments, cost of delivery, postpartum care for the first sixty days after delivery, services needed to treat a complicated pregnancy, childbirth classes, and family planning services. As long as a pregnant woman is seen by a participating Medicaid provider, the medical costs should be covered. In some cases, a small co-payment may be required at appointments.

With the option of Medicaid, many low-income pregnant women can still acquire affordable and appropriate health care throughout their pregnancies. If interested in applying for Medicaid, pregnant women can contact their local Medicaid office to begin the process. Medicaid enables a healthier pregnancy journey for many women who would otherwise be unable to afford the medical costs.