What to Know About Being Pregnant on Medicaid

What Is Medicaid?

Medicaid is a type of free or low-cost health insurance plan. It’s funded by the U.S. federal government and the state you live in.

Around 77.9 million Americans qualify for Medicaid coverage, including some:

• Pregnant people
• Children
• People with disabilities
• Low-income families
• Elderly adults

In fact, about 41% of births in the United States were covered by Medicaid in 2021.

The exact benefits and eligibility requirements (factors you have to meet to qualify) vary from state to state, says Louise Norris, health policy analyst for HealthInsurance.org.

The name for the program varies by state, too, says Amy Nash, business operations manager for the Department of Obstetrics and Gynecology at Tufts Medical Center. Although some states’ programs are simply called Medicaid, others are not. You can search HealthCare.gov to find the name of your state’s Medicaid plan.

When Can I Apply for Medicaid?

Anyone who is eligible can apply for Medicaid at any time throughout the year. It’s a good idea to apply as soon as you know you’re pregnant, advises Nash.

Insurance companies, including Medicaid, are not allowed to deny coverage or charge you more because you’re pregnant at the time of enrollment.

To learn more about your state’s eligibility requirements and what steps you need to take to enroll, visit the Medicaid website.

When Does Medicaid Coverage Begin?

Your state has 45 days to review your pregnancy-related Medicaid application. And many states process them faster than that, Norris notes.

If you’re approved, coverage begins on the stated Medicaid effective date. That could be the approval date. But in most cases, coverage may be backdated by up to 90 days if you were also eligible during that time. “So, depending on a pregnant person’s circumstances and where they live, their coverage might have a retroactive start date,” Norris says. That means you could get coverage for services you received within that time frame, too, before you applied.

What Services Are Covered Under Medicaid?

For those who enroll, Medicaid is required to provide full coverage (pay for all costs) for pregnancy-related services, including:

• Prenatal care
• Labor and delivery
• Other medical services deemed necessary for pregnancy

Depending on the state, Medicaid may also help cover the cost of:

• Prenatal vitamins (with a prescription)
• Doula services
• Childbirth classes
• Parenting classes
• Lactation consultant services
• A breast pump and other lactation supplies
• Birth control
• Abortion care
• Behavioral healthcare

“The specifics vary a lot from one state to another,” Norris says.

For example, a state might limit how many ultrasounds will be covered, she says. Or a state may require you to be a certain age or to have a high-risk pregnancy in order for genetic testing to be covered.

Because of these state-by-state differences, it’s important to understand what exactly is covered under your plan. You can contact your state Medicaid office and ask specific questions about coverage and benefits, Norris says.

What Out-of-Pocket Expenses Should I Expect?

Pregnancy is exempt from out-of-pocket costs under Medicaid. That means all prenatal care and pregnancy-related services that are covered in your state are free. They don’t require a co-pay.

You may have to pay for other care, though. “A pregnant person might have nominal out-of-pocket costs for other care that’s not related to pregnancy but that is covered by Medicaid,” Norris says. That can include things like sick visits.

“And there might be some services that a pregnant person wants but that aren’t covered by Medicaid.” That can include things like a prenatal massage or gender ultrasound.

What If My Pregnancy Is High Risk?

Medicaid is required to cover all pregnancy-related costs—even extra costs that may come with a high-risk pregnancy that requires more frequent monitoring.

Depending on the state, Medicaid may also cover additional services for high-risk pregnancies. These services may include:

• Genetic testing
• Case management services
• Transportation services

If your pregnancy is considered high risk, be sure to discuss coverage with your state Medicaid office or managed care organization (MCO), as well as your doctor or midwife, Norris says.

How Can I Find a Provider Who Accepts Medicaid?

To find a provider who will accept Medicaid, your best bet is to use the “find a provider” tool on your state’s Medicaid website, Norris says. These network search tools aren’t always accurate, so it’s also a good idea to call the provider you found, too. You’ll want to confirm that:

• They’re part of the network.
• They’re accepting new patients.

If you already have a preferred provider, you can call them to ask. Or you can check their website for your state’s Medicaid name. “Hospitals and clinics have their accepted insurance plans listed on their websites,” Nash says.

When Does Medicaid Coverage for Pregnancy End?

Previously, Medicaid provided pregnancy-related coverage to mom (or birthing parent) and baby through 60 days after giving birth. And there are still a few states where coverage ends after 60 days. But now, in nearly every state, Medicaid coverage has been extended to 12 months postpartum.

That means it covers the cost of care for both mom and baby throughout the first year after birth.

How to Stay Insured After Pregnancy

There are ways to continue your health insurance coverage if and when your Medicaid coverage ends.

Reaching the end of your Medicaid coverage means you qualify for a special enrollment period for health insurance. (A special enrollment period is also available immediately after your baby is born if you want to switch plans then.) This health insurance includes individual or family coverage, Norris says, or employer-sponsored coverage, if available.

For individual or family coverage, you can purchase insurance through your state’s Marketplace or exchange. “Significant income-based subsidies are available through the Marketplace,” Norris adds. Subsidies can decrease your portion of the cost if you qualify for them.

If it’s available to you, you could switch to private insurance instead. Contact your employer for information on how to enroll in employer-sponsored coverage during a special enrollment period.

Who Can I Contact If I Have Questions?

Your point of contact for questions also varies state by state. “Enrollees will receive communications from the state Medicaid office and can call the customer service number on their ID card if they have any questions about their coverage,” Norris says, so you’ll be able to get information easily.