Using Medicaid During Pregnancy

Medicaid is government-sponsored health insurance for individuals who are low-income or have certain disabilities. Every state has Medicaid (or a similar program) and is required to cover people who are “medically needy,” “categorically needy,” or fall into “special groups” such as low-income individuals with disabilities or seniors. An individual is “categorically needy” if he or she has an income level at or below a certain value (specified by the state). The qualifications for Medicaid and the required documents needed to apply vary from state to state, so consult your state’s Medicaid guidelines (1).

Nearly half of all pregnant women in the United States rely on Medicaid (2). This happens because a pregnant woman is considered “medically needy.” Women who may not have qualified for Medicaid in the past may qualify during pregnancy because of expanded eligibility. Pregnant women are also usually evaluated for Medicaid eligibility much more quickly, from 2-4 weeks after submitting their application (1). Normally, the process can take 45-90 days or longer if a candidate doesn’t send out the necessary proofs. Pregnant women also can apply for presumptive eligibility, which means Medicaid will cover their prenatal care retroactively; in other words, they can still receive prenatal care while their application is being processed. Every effort is made for pregnant women who should qualify for Medicaid to receive their care immediately (3). So be sure to mention your pregnancy to the Medicaid office if you think you may qualify.

What does Medicaid cover when you’re pregnant?

Medicaid covers the following services for pregnant women across the country:

  • Prenatal care from Medicaid health care providers
  • Any prenatal care that occured before applying for Medicaid (presumptive eligibility)
  • Delivery services (any type of delivery) from Medicaid health care providers
  • Complications that may occur from Medicaid health care providers
  • Postpartum care up to 60 days from a Medicaid health care provider (1)

What else does Medicaid cover during pregnancy and childbirth?

Because Medicaid programs are different from state-to-state, it’s difficult to say what exactly your state’s Medicaid program will cover. Here is a list of things you should call your state’s Medicaid program to confirm are covered by Medicaid:

  • Ultrasounds (it is likely that Medicaid will cover one ultrasound and multiple other ultrasounds if a health risk or fetal abnormality is detected)
  • Prescription prenatal vitamins
  • Pregnancy tests
  • Gynecological visits
  • High-risk pregnancy care
  • Normal labor and delivery needs
  • Labor induction if medically necessary
  • Out-of-state labor if there is an emergency during travel outside of the state
  • Epidurals
  • Elective c-sections
  • Complete hospital stay needs
  • Neonatal Intensive Care Unit (NICU) stay and care if medically necessary
  • A breast pump (4)
  • Breastfeeding support and lactation consultation while in the hospital (5)

What doesn’t Medicaid cover during pregnancy?

There are a few costs during the prenatal period and delivery that Medicaid won’t likely cover, although there are some state-specific exceptions. These include:

  • Doula or birth partner
  • OTC medications or vitamins
  • Birthing classes
  • Maternity support belt
  • Prenatal massage
  • Prenatal workout or yoga classes
  • DNA-paternity testing
  • Genetic testing
  • Gender ultrasound (4)
  • Breastfeeding support and lactation consultation after returning home from the hospital (5)

Each state’s Medicaid programs are different, so call your Medicaid office today to learn about qualifications, coverage, and benefits.

Related Reading on Insurance


Sources:

  1. American Pregnancy Association (2016, September 2). Medicaid for Pregnant Women. Retrieved from http://americanpregnancy.org/planning/medicaid-for-pregnant-women/
  2. NPR (2017, June 27). From Birth to Death, Medicaid Affects the Lives of Millions. Retrieved from https://www.npr.org/sections/health-shots/2017/06/27/534436521/from-birth-to-death-medicaid-affects-the-lives-of-millions
  3. MACPAC (2017). Pregnant Women: Eligibility. Retrieved from https://www.macpac.gov/subtopic/pregnant-women/
  4. Growing Family Benefits (2017, February 13). Medicaid Coverage During Pregnancy, Labor & Delivery. Retrieved from https://www.growingfamilybenefits.com/medicaid-coverage-during-pregnancy/
  5. Henry J Kaiser Family Foundation (2017, April 27). Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey. Retrieved from https://www.kff.org/womens-health-policy/report/medicaid-coverage-of-pregnancy-and-perinatal-benefits-results-from-a-state-survey/