Many pregnant women without health insurance do not qualify for Medicaid because they make too much money or do not meet the citizenship and legal immigrant criteria.
If this describes your dilemma, learn what to do next.
First, you might want to file an appeal. The rules can be confusing, and one minor mistake could be the difference between denial and approval if corrected.
Second, you might be able to buy maternity insurance with no waiting periods and get government help with premium costs and unreimbursed expenses.
Third, other government programs help many pregnant women with other everyday expenses, making it easier to afford to bring a new baby home.
Pregnant Without Insurance: File Medicaid Appeal
Filing an appeal is the first thing to do if you are pregnant without health insurance but don’t qualify for Medicaid. It is easy to overlook minor details with significant implications as the rules are challenging.
Make Too Much
Double-check your accounting if you are pregnant without insurance and ineligible for Medicaid because you make too much money. File an appeal if you mistakenly overstated income or understated household size.
Medicaid can deny coverage to pregnant women when they live above a state-specific Federal Poverty Level (FPL) threshold, which has two components.
- Projected (not past) annual household earnings based on the IRS Modified Adjusted Gross Income (MAGI) definition excludes child support, some alimony payments, and other sources.
- The number of household members you plan to claim in the next tax year includes your unborn baby or babies.
Verify that you submitted the appropriate documentation if you are pregnant without insurance but don’t qualify for Medicaid. Each state needs proof that you reside in their jurisdiction and are legally in the country.
The second thing to do if denied Medicaid while pregnant is to file an appeal, supply any missing documents that establish residency in the state, and verify citizenship or legal immigration status.
- State Residency
- Driver’s license
- Utility bill
- Credit card statement
- Birth certificate
- Certificate of naturalization
- Green card (permanent residence)
Pregnant With No Insurance: Buy Private Coverage
If you are pregnant without health insurance and still do not qualify for Medicaid after filing an appeal, purchasing private coverage is the next thing to do – if possible. The federal government may subsidize costs, and your benefits could begin immediately.
You can buy private maternity insurance when you are already pregnant. Even if you make too much money to qualify for Medicaid, the government may help pay for the coverage and limit your exposure to unreimbursed expenses.
Apply for private health insurance through healthcare.gov and see if you qualify for additional government support based on your household income and size (Federal Poverty Level between 100% and 400%).
- Premium tax credits reduce the coverage costs
- Cost-sharing reductions shrink unreimbursed expenses
- Out-of-pocket maximum
No Waiting Periods
Many uninsured expectant women can purchase private pregnancy health insurance with no waiting periods, while others cannot. The Affordable Care Act (ACA) inadvertently established a lottery system built around expected due dates.
Under the ACA, all private medical insurance plans must cover preexisting health conditions (including pregnancy) with no waiting period. However, coverage begins on January 1 of the following year unless you qualify for a special enrollment.
When coverage begins on January 1, some women win with immediate pregnancy benefits, while others lose by giving birth before the new policy kicks in.
|Lucky Due Dates||Unlucky Due Dates|
All uninsured women can purchase pregnancy health insurance with no waiting period when they qualify for a special enrollment. The coverage begins immediately in these cases, eliminating the due date-based lottery system.
Determining if you qualify for special enrollment is crucial when pregnant without insurance – especially if your due date falls from September through December. These situations could make you eligible immediately.
- Loss of health coverage within 60 days
- Moving to a new address
- Marrying the father of your unborn baby
Pregnant No Insurance: Other Government Benefits
As seen above, many women pregnant without health insurance do not qualify for Medicaid. They cannot purchase private coverage that kicks in before their due date. In these cases, other government benefits might help.
Women pregnant with no health insurance who are ineligible for Medicaid because of their immigration status can turn to charity care from a local hospital. Hospitals and medical centers cannot deny treatment to anyone needing critical services by law.
Many states enact uncompensated care requirements for uninsured, underinsured, or ineligible patients for other government programs.
Under the charity care program, undocumented immigrants who meet income and asset requirements can receive financial aid to cover medically necessary services such as labor and delivery in a hospital.
Women having a baby without insurance because they are ineligible for Medicaid could qualify for other programs supported by the federal government, which are available nationwide.
Government assistance for pregnant mothers sometimes follows different rules for calculating income, counting household members, or employing higher eligibility thresholds. Apply for every possible benefit that might reduce other expenses so you can afford to bring a new child into the world.
- Utility bills (gas and electric)
- Apartment rentals for housing
- Baby formula
- Home repair
- Replacement appliances
Women pregnant with no health insurance should also research local government resources that might help with related expenses such as prenatal care. Each state designs unique programs that could offer assistance.
For example, some of these state-specific initiatives could help.
- The California Medi-Cal Access Program (MCAP) offers low-cost health insurance to middle-income pregnant women.
- The Texas Maternal & Child Health Program supports women, children, and adolescents who aren’t eligible for Medicaid, CHIP, or CHIP Perinatal.
- The New York State Prenatal Care Program seeks to improve the health of under-served women, infants, and children through improved access to services.
- The North Carolina Child Support initiative encourages parental responsibility so that children receive financial, emotional, and medical support from both parents.
- The Washington State Within Reach Organization helps people across the region navigate complex health and social service systems.
- Arizona Health Start can connect you with various community organizations that provide health care, education, parenting resources, and application assistance for other programs.