Does Medicaid Cover Pregnancy?
- Does Medicaid cover pregnancy? Find out what services Medicaid may cover for pregnant women, including prenatal care, labor and delivery and postpartum care.
Medicaid is an important source of health coverage for pregnant women. The program paid for 43% of all births nationwide in 2018, according to the Medicaid and CHIP Payment and Access Commission (MACPAC). This article explores the pregnancy-related services that may be covered by Medicaid.
Does Medicaid Cover Pregnancy?
State Medicaid programs may offer an array of prenatal care services to help pregnant women and their babies stay healthy during pregnancy. In many states, Medicaid may cover the ultrasounds that are necessary to monitor the progress of the pregnancy. Many states also cover prenatal vitamins, according to the Kaiser Family Foundation (KFF), a nonprofit organization that researches national health issues.
Medicaid may cover certain prenatal tests used to detect birth defects, such as amniocentesis or chorionic villus sampling. States may also provide coverage for genetic counseling.
To help pregnant women prepare for a healthy delivery, some states cover childbirth education classes.
How Much Does Medicaid Cover for Childbirth?
Pregnancy-related services covered by Medicaid are exempt from out-of-pocket costs. That means women covered by Medicaid don’t need to pay copayments, coinsurance or deductibles for labor and delivery services.
Most pregnant women who have Medicaid deliver their babies in a hospital setting, MACPAC reports. However, states may cover births in other settings. Most state Medicaid programs cover deliveries in birth centers, and around half will even cover home deliveries.
Medicaid doesn’t cover doula services in most states, according to the KFF. Pregnant women who want support from a doula may need to pay out of pocket.
Does Medicaid Cover Postpartum Care?
Medicaid’s pregnancy coverage extends to 60 days after you give birth. During this time, states may cover a variety of postpartum services. This may include postpartum visits to assess a mother’s physical and mental recovery from childbirth.
States may cover other services to support mothers in the postpartum period, such as infant care classes. Many states also cover breastfeeding services, from breastfeeding education and electric breast pumps to at-home or in-hospital lactation consultations.
When pregnancy Medicaid expires, some new mothers may continue to qualify for Medicaid based on their income. Others may no longer be eligible for Medicaid and could seek insurance coverage from other sources, such as Marketplace coverage.
How Do You Qualify for Pregnancy Medicaid?
Eligibility for pregnancy Medicaid may vary from one state to another. All states’ Medicaid programs are required to cover pregnancy-related services for women with household incomes up to 133% of the Federal Poverty Level (FPL). As of 2021, the FPL is $12,880 for a single person, $17,420 for a couple and $26,500 for a family of four. Many states have extended Medicaid coverage to pregnant women with higher household incomes.
To be eligible for pregnancy Medicaid, women must also meet their state’s non-financial eligibility criteria. These requirements may include:
- Living in the state in which they’re applying for Medicaid
- Being either a U.S. citizen or a qualified non-citizen, such as a lawful permanent resident
If you’re pregnant and uninsured, contact your State Medicaid Agency to learn more about pregnancy Medicaid.
Medicaid Presumptive Eligibility
Presumptive eligibility is temporary Medicaid coverage that helps pregnant women access prenatal care while they wait for their Medicaid application to be processed. This temporary coverage may last for up to 60 days, MACPAC explains. The coverage may continue after 60 days if your Medicaid application is approved.