What Does Medicaid Cover for Pregnancy?

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According to the American Pregnancy Association, 6 million women get pregnant every year in the United States alone. Many of these expectant mothers do not have health insurance that will cover their pregnancies. Medicaid, a government-sponsored health insurance system, provides coverage for prenatal and postpartum care for low-income pregnant women who do not possess health insurance. A familiarity with the application process will help you understand what Medicaid covers for pregnancy.

Pregnant woman with hand on belly
Pregnant woman with hand on belly (Image: Creatas Images/Creatas/Getty Images)

Income Guidelines

Although each state also has specific requirements for eligibility, the federal government sets the general eligibility requirements for Medicaid for pregnant women. Medicaid typically covers pregnant women whose annual income is at or less than 133 percent of the federal poverty level, according to the American Pregnancy Association. Income qualification varies depending upon what state you live in, so contact your state department of social services to determine the exact eligibility requirements. In addition to providing coverage for pregnant women who meet the income guidelines (those who are categorically needy), Medicaid could also be available for women who fail to meet the income guidelines (those who are medically needy).

Woman talking with doctor
Woman talking with doctor (Image: Jupiterimages/Creatas/Getty Images)

Documentation

Once you know you meet basic eligibility requirements for Medicaid for pregnant women, you must provide documentation before your acceptance can be processed. Although state requirements vary, most Medicaid offices request proof of your pregnancy (official proof from a doctor’s office or a health department office), proof of your citizenship and identity (a birth certificate or Social Security card) and proof of your income. Contact your local Medicaid office to determine if it requires additional documentation. As a pregnant woman who needs prenatal care as soon as possible, your eligibility request for Medicaid will be given priority, with most offices providing a decision within two to four weeks, according to the American Pregnancy Association.

Pregnant woman on phone
Pregnant woman on phone (Image: Photodisc/Photodisc/Getty Images)

Providers

Once you have been approved for Medicaid coverage as a pregnant woman, you should receive a list of providers that accept Medicaid. You must choose your prenatal care provider from this list to have your pregnancy costs covered by Medicaid. If you already have an obstetrician who you have been seeing, check to make sure he accepts Medicaid. According to PregnancyInsurance.org, you should bring your Medicaid documentation to your first prenatal visit for your obstetrician to copy; from that point on, your obstetrician’s office will deal with Medicaid directly.

Woman talking with doctors
Woman talking with doctors (Image: George Doyle/Stockbyte/Getty Images)

Coverage

The American Pregnancy Association states that Medicaid covers all costs associated with your pregnancy, labor and delivery, as well as any complications during pregnancy or up to 60 days following your baby’s birth. In certain instances, however, depending upon your state’s individual guidelines, you may be required to pay a small deductible or co-payment, according to PregnancyInsurance.org. Your Medicaid provider has a contract with Medicaid to provide care for you and, as such, submits your health care costs to Medicaid directly for reimbursement without requiring paperwork or additional input from you.

Pregnant woman holding stomach
Pregnant woman holding stomach (Image: Jupiterimages/liquidlibrary/Getty Images)

Considerations

By the time your application for Medicaid has been accepted, you may already have incurred expenses for prenatal visits. If this is the case, then you may qualify for presumptive eligibility, a feature of Medicaid that allows the program to pay for prenatal services you obtained during your waiting period. According to the American Pregnancy Association, presumptive eligibility allows you to obtain prenatal care as early as possible in your pregnancy without being penalized monetarily. Check with your local Medicaid office to see if expenses you incurred may be covered.

Pregnant woman having ultrasound done
Pregnant woman having ultrasound done (Image: Stockbyte/Stockbyte/Getty Images)

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