Medicaid can deny coverage to pregnant women for several reasons. Learn about the guidelines before completing an application to avoid needless rejection.
Medicaid is a publicly-funded program designed to act as a safety net for low-income families, disabled individuals, senior citizens with few resources, and pregnant women.
The government must have a cutoff point because it cannot offer taxpayer-supported benefits to every applicant. Household income levels compared to size and citizenship status are the two primary eligibility criteria.
As always, the devil is in the details. Pay close attention to boost your approval odds.
Pregnancy Medicaid Income Limits
Medicaid often denies pregnant women because their household income exceeds the limit established by their state. Therefore, you do not want to over-report your earnings or live in a region with a low threshold.
- Uninsured women who make too much to qualify for Medicaid still have many options, including CHIP, private insurance, moving to another state, and the medically needy program.
- Maternity insurance with no waiting periods is one of the alternatives but you may have to hold off until January unless you have a qualifying life event (getting married)
The state earnings limits for pregnancy Medicaid use a formula called Modified Adjusted Gross Income (MAGI), which includes the wages for each member of your household reported on your tax return.
Make sure that you do not over-report MAGI when completing the application and accidentally cause a declination.
|Include in MAGI||Exclude from MAGI|
|Federal taxable wages||Child support|
|Tips||Supplemental Security Income (SSI)|
|Self-employment||COVID Economic Stimulus|
|Investment Earnings||Workers Compensation|
|Social Security Disability (SSDI)||Veterans Disability Payments|
|Rent and Royalties||Loan proceeds|
Alimony counts towards MAGI for divorces and separations finalized before January 1, 2019. Women divorced or separated on or after this date do not include alimony in their total.
Pregnancy Medicaid Household Size
Medicaid can also deny pregnant women because their household size is too small relative to the total income. Therefore, you do not want to omit a dependent unknowingly or include an extra wage earner and hurt your eligibility.
The Medicaid rules for counting household members contain two key stipulations that determine where your income falls relative to the Federal Poverty Level.
- Based on your plan to file a tax return at the end of the year
- Filing an independent return
- Claimed as a dependent
- Not filing taxes
- Includes your unborn babies as a member
Therefore, getting a free pregnancy ultrasound can help mothers qualify if they are carrying twins or triplets. Every extra person raises the income limit! Each state sets its income limit as a percentage (at least 138%) of the Federal Poverty Level, which grows with household size as depicted by this chart.
Single pregnant women can cause an inadvertent Medicaid denial by completing their application while unaware of the rules for determining household membership. Therefore, pay close attention to the guidelines about your intended tax filing status in the next year.
- Tax dependents (teenage girls living at home and full-time college students under 24) count their parents’ income, and household size includes mom and or dad plus siblings under the age of 19
- Tax independents (single mothers living alone) count only their income, and household members include unborn babies and other children you support
In other words, teenage girls and college students might want to consider filing as independent taxpayers if their parents make too much money. They lose a valuable deduction, but the coverage is often far more critical.
Married pregnant women can still get Medicaid if their household income falls below their state’s income guidelines. However, denial is more likely because there could be two wage earners rather than one.
Marital status is not a qualifying criterion, but their combined income relative to the number of household members does matter. Their joint return for the next tax year should include at least one dependent and perhaps more.
A married couple expecting a baby has at least three household members by counting the husband, wife, and unborn infant, and could have more if they already have children or are expecting twins or triplets.
The chart below summarizes the Pregnancy Medicaid monthly income limits by state. Notice that each state works from a guideline percentage of the Federal Poverty Level, which varies by household size, to determine your eligibility.
Pregnancy Medicaid Immigrant Guidelines
Medicaid can also deny some pregnant women who are immigrants and do not meet the criteria as a “qualified non-citizen,” and other legal definitions. As before, income limits vary by the state of residency, as does the length of time living in this country.
Illegal (undocumented or unauthorized) immigrants are ineligible for pregnancy Medicaid regardless of their household income levels. Each state follows the same guidelines for approving or denying applications from women who are not in this country legally.
However, undocumented aliens can enroll in alternative programs that make having a baby more affordable, and each state may have additional options.
For example, Emergency Medicaid is available to illegal aliens who meet each state’s income limits. The emergency benefits do not apply to non-urgent services such as prenatal care, ultrasounds, or breast pumps. They could still pay for acute care that happens suddenly with severe symptoms – such as labor and delivery.
Green Card Holders
Lawfully present immigrants such as Green Card holders are sometimes eligible for pregnancy Medicaid, while others face denial until they have lived in the USA for at least five years. Once again, the rules in the state where you live preside.
- Refugees, asylees, and other humanitarian immigrants qualify anytime during the first seven years of residence in all fifty states
- Lawful permanent residents such as green card holders can begin after a five-year waiting period across the country
- Lawfully present pregnant women can enroll without a waiting period in twenty-five states that adopted CHIPRA
Pregnant women do not have guaranteed Medicaid coverage. This publically-funded welfare program helps legal residents with obvious financial needs. Therefore, rejection is a distinct possibility.
As with many government entitlements, the rules are hard to follow, and mistakes are common. You do not want to complete your application and risk inadvertent denial because you missed one of these critical details.
- Calculating MAGI without subtracting the excluded items
- Counting twins or triplets as one household member
- Filing a tax return as a dependent of high-income parents