How Much Does Medicaid Cover for Pregnancy?

Vilma Ruddock

Low income and unemployed pregnant women can qualify for Medicaid if they meet eligibility requirements. This United States federal government-sponsored insurance will cover the cost of a woman's prenatal care, postpartum care, labor and delivery, and newborn and infant medical care.

What Is Medicaid?

Medicaid is a state-run federal health insurance program granted to states through the United States Department of Health and Human Services (DHHS) for people in need. At the state level, Medicaid is administered by your state or local Department of Health or Public Welfare offices.

Medicaid Pregnancy Coverage

According to a Jacobs Institute of Women's Health study, Medicaid pays for about 48% of all births in the United States. Medicaid programs at the state level cover medical care for an eligible pregnant woman and baby through the pregnancy and after, based on guidelines from the federal government.

Pregnancy-Related Benefits Only

All states provide coverage for "pregnancy related services" and "conditions that might complicate pregnancy" for women who are eligible for Medicaid. You will be covered for all pregnancy services even if you apply after you become pregnant.

Comprehensive Medicaid Benefits

In addition to pregnancy-related services, in the states that also provide comprehensive Medicaid benefits for eligible pregnant women, you are covered for medical problems that are not related to your pregnancy.

According to a review of Medicaid coverage for pregnant women by the National Women's Law Center, there are 37 states that provide comprehensive Medicaid coverage beyond pregnancy care. Services noted as optional on the Medicaid benefits list, such as vision and dental, are usually not covered.

Covered Pregnancy Services

newborn

When you meet federal and state income and other eligibility criteria for Medicaid benefits, you are covered for mandated pregnancy-related services whether you have a normal or a high risk pregnancy, which includes the following care:

  • Standard, routine prenatal visits
  • Routine prenatal blood work and other lab tests
  • Additional prenatal visits and lab testing needed in a high risk pregnancy
  • Tobacco cessation counseling
  • Drug abuse or addiction management, such as methadone treatment
  • Transportation to any medical care
  • Physician or midwife services
  • Management of any complications during pregnancy including:
  • Labor and delivery in-hospital, including the cost of, when necessary:
    • Induction of labor
    • Cesarean section
  • Labor and delivery in a licensed free-standing birth center
  • Postpartum care for mother up to 60 days after delivery.
  • Postpartum maternal family planning and contraception
  • Newborn and infant medical care for up to 60 days postpartum
  • Often, the cost of a car seat
  • Home visiting program to improve maternal and child health and safety

Although prescription drug coverage is listed as an optional benefit, according to the Medicaid website, prescriptions are generally covered by all states for pregnant women

How Is Your Bill Paid?

Medicaid pays for your care directly to your pregnancy care providers or hospital facilities with whom they have contracted to provide medical care to their enrollees. You have to get your care through providers and hospitals that accept Medicaid, and they will submit your bill to Medicaid.

Co-Payments

By law, providers are not allowed to ask for a co-payment so if you are on Medicaid and receiving covered services, there is no cost to you.

Who Can Qualify?

Pregnant women must meet certain federal and state income guidelines and other requirements of their state to qualify for Medicaid coverage. The following facts are helpful to know:

  • Federal requirement is that states provide Medicaid coverage for pregnant women whose household income is at or below 138 percent of the federal poverty level (FPL).
  • According to a Kaiser Family Foundation report, by January 2016 two years after the Affordable Care Act (ACA), 33 states had raised the income eligibility limit to 200 percent of the FPL or over.
  • If you reside in one of these states, you may be income eligible during your pregnancy even if you were ineligible before you became pregnant.

You can contact your state's office through their website for details on their eligibility criteria for Medicaid coverage. Most physician or hospital-based prenatal clinics will also have resources to help you apply. In this way, they ensure you have insurance and they get paid.

Medicaid Benefits Many Women

Medicaid insurance is of benefit to many women in financial need during pregnancy. Even if you were not eligible before, you may become eligible once you are pregnant. At the least, all your pregnancy-related medical care will be covered and depending on which state you reside in, you may qualify for medical care not related to your pregnancy.

How Much Does Medicaid Cover for Pregnancy?