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Does Medicaid Cover Pregnancy?

Update Date: Nov 10, 2020 10:58 AM EST
Does Medicaid Cover Pregnancy?
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Medicaid, America's most prominent health insurance program, is a boon for pregnant women, as well as women who are trying to conceive a child. It covers a plethora of reproductive healthcare services, including family planning and pregnancy-related care (prenatal services, childbirth, and postpartum services and care) without cost-sharing. Medicaid law strictly prohibits the states from charging co-payments, deductibles, or other such service charges. 

This government-sponsored insurance program helps low-income families without medical insurances to receive top-quality medical care. As per federal law, all American states should offer Medicaid coverage for pregnancy-related services and care to women with incomes up to 133% of FPL (federal poverty level). Not only prenatal and childbirth services, but the states are also instructed to cover pregnant women for up to two months postpartum. 

Although the Medicaid coverage of every state varies from the others, the core offerings remain the same. The federal law doesn't outline specific services that states must include in their Medicaid programs for low-income pregnant women beyond outpatient and inpatient hospital care, but the states should cover all the preventive services recommended by the USPSTF (the United States Preventive Services Task Force) to the eligible pregnant women. 

Eligibility criteria for Medicaid

Although the federal government dictates the general eligibility guidelines for Medicaid, each state has its specific requirements to rule out the non-eligible candidates. Hence, the eligibility criteria for Medicaid in NY may be completely different from that in Texas. 

All states have eligibility groups including, 

  • Categorically needy, covering pregnant women with an income level at or below 133% of the Federal Poverty Level. 

  • Medically needy, covering a pregnant woman ruled out of the categorically needy group as she makes good money. 

  • Special groups include women who have been declined Medicaid once but may qualify now. This is known as expanded eligibility. 

Presumptive Eligibility 

Medicaid also covers the cost of care and services received by eligible pregnant women before they applied and received Medicaid. This eligibility criterion was introduced to encourage women to start their prenatal care as early as possible.

Generally, the states qualify pregnant women for Medicaid within 2 to 4 weeks of their pregnancy. However, if you need treatment before that, talk to your local office to get the benefits. If you qualify, you will receive immediate, same-day Medicaid services. 

How to qualify for Medicaid? 

If you want Medicaid coverage, contact the local Medicaid office to know the eligibility criteria in your state and required documents. The majority of offices demand the following documents-

  • Proof of pregnancy

  • Proof of income 

  • Identification documents, like the birth certificate, to determine if you are a legal resident

  • Proof of non-citizenship (for immigrants) 

Medicaid does not offer monetary advantages to pregnant women. If you are eligible and want to reap the benefits of this government-run insurance scheme, contact the health care providers and facilities that accept Medicaid. 

While signing up for Medicaid, you will be given a list of doctors and facilities that accept Medicaid, or you can find out such healthcare providers on the Internet. Once you find such a provider, the cost of your prenatal care, childbirth, and postpartum care and services will be submitted via Medicaid. Moreover, this scheme also pays for any complication that occurs during pregnancy. 

The bottom line 

For years, Medicaid has been the primary and most essential funding source for low-income women in the United States of America. In the year 2016, Medicaid covered 43% of all childbirths in the United States of America. 

With this government-run healthcare coverage policy, more and more women are now getting the best prenatal and postpartum treatment and care, ensuring the future of the country is taken care of. Also, this ensures that people are not discouraged to have children due to high economic impact on their survival.

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