Pregnant Without Insurance | Don’t Qualify for Medicaid

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.

Women rejected because of excess household income should first consider filing an appeal after reviewing the most common mistakes. Then CHIP, private healthcare, and a change of address might do the trick.

Women denied because of their immigration status can apply for Emergency Medicaid or charity care through a local hospital.

Meanwhile, other government programs use different criteria and could help with the costs of having a baby without insurance, such as food, energy, prenatal care, parental support, and more.

Make Too Much for Medicaid

Women who are pregnant without health insurance and think they make too much money to qualify for Medicaid still have publically funded options that make it affordable to keep your baby.

File Appeal

Filing an appeal is the first step if Medicaid denied your initial application because you make too much money. The denial notice should inform you that you have a right to a hearing and spell out the next steps.

The stakes are high if you are pregnant without insurance, so the extra effort could prove worthwhile. Plus, the rules are confusing. File an appeal if one of these oversights applies to your situation. 

  1. Overstating income by not subtracting the excluded items
  2. Understating the number of household members
    1. Failing to include your unborn baby in the household
    2. Counting twins or triplets as one household member
    3. Filing a tax return as a dependent of high-income parents

Need Ultrasound

If you are pregnant without insurance, you need to get an ultrasound – especially if Medicaid turned you down because you earn too much money and want to file an appeal. Each state bases its income limit guidelines on a percentage of the Federal Poverty Level, adjusting to household size.

  • Iowa: 138%
  • Texas: 198%
  • District of Columbia: 319%

A local clinic’s free pregnancy ultrasound is ideal for determining if you are carrying more than one baby. Each unborn infant counts as an additional family member and boosts the cutoff. However, the bump in the income limit per infant differs based on your state of residence.

Minimum Bump (138%)Maximum Bump (380%)

Singleton

$6,177

$17,024

Twins

$12,354

$34,048

Triplets

$18,531

$51,072

Medically Needy

Women having a baby without insurance whose household members earn too much money to qualify for Medicaid could become eligible under the medically needy criteria. In this program, large unreimbursed medical expenses could subtract from your earnings and push you under the state income limit.

For example, an uninsured woman with health problems might have significant doctor bills that could wipe out most of her earnings. Keep detailed records to substantiate these expenses to speed possible approval.  

Full Scope

Women having a baby without insurance who were ineligible for full-scope or regular Medicaid because their household earnings are too high might want to re-apply or file an appeal. The full-scope version has the strictest qualifying criteria.

Meanwhile, the limited pregnancy-related coverage has much looser eligibility rules for earnings, as illustrated by this simple chart. As you can see, there is a significant increase in allowed salary.  

Each state sets income limits based on a percentage of the Federal Poverty Level.

Lowest %Highest %

Full Scope

18%

138%

Limited Pregnancy

138%

380%

CHIP

Uninsured pregnant mothers who do not qualify for Medicaid because they make too much money might be eligible for CHIP (Children’s Health Insurance Plan). Some states define an unborn baby as a child and cover the mother’s medical care because the two are entwined.

Contact your state office to see if CHIP extends to pregnant women, and inquire about their income criteria. Below is a partial listing that included expecting mothers in the past.[1]

Arkansas

California

Colorado

DC

Illinois

Louisiana

Massachusetts

Michigan

Minnesota

Nebraska

New Jersey

Oklahoma

Oregon

Rhode Island

Tennessee

Texas

Washington

Wisconsin

Marketplace

Women who are pregnant without insurance and earn too much to qualify for Medicaid can purchase private coverage through the online state exchange.

You can buy health insurance without waiting periods and still receive two forms of income-based subsidies that make keeping your baby more affordable.

  • Advance Premium Tax Credits lower the upfront monthly costs
  • Cost Sharing Reductions lower unreimbursed medical expenses

However, this alternative has one big potential drawback: you might have to delay the coverage start date until January 1 of the next year, unless you have a qualifying life event that enables you to enroll right away.

Change Residency

Changing your residency state is another alternative for uninsured pregnant women whose household members earn too much money to qualify for Medicaid. The income limits vary by state, and it is possible to exceed the threshold in your home location yet fall well under the maximum in another.

Women living in a region with a lower-income cap could move to a neighboring state with a higher maximum that must accept her application under the law. For instance, Idaho has the lowest limit at $23,791 for a two-person household, and two neighboring states approve applicants earning much more.

  • Oregon: $32,756
  • Washington: $34,135

Medicaid cannot decline coverage based on the length of residency in a state. Therefore, changing addresses could be a viable solution, provided you update your driver’s license and voter registration right away.

Government Aid for Mothers

Women who are pregnant without health insurance and don’t qualify for Medicaid could be eligible for other government programs that help with related expenses. Sometimes, the criteria vary between initiatives.

  • Count income differently
    • Calculation methods
    • Sources to include or exclude
  • Include domestic partners in the household

Federal Government

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. In some cases, the rules for calculating income and counting household members are different.

LIHEAPMedicaid

Calculate Income

Gross

MAGI

Count Household Member

Unspecified

Tax Return

State Government

Women having a baby without insurance who do not qualify for Medicaid should also research local government resources that might help with related expenses. Each state designs unique programs that could offer assistance.

For example, some of these state-specific initiatives could help.

Fail Medicaid Immigration Guidelines

Women who are pregnant without health insurance but ineligible for Medicaid because of their immigration status have a different set of options to explore. However, meeting the low-income thresholds will remain a barrier.

Emergency Medicaid

Uninsured pregnant women and do not qualify for Medicaid because they are undocumented immigrants can apply for emergency coverage – provided they meet the income limits established in their state.

Emergency Medicaid does not cover non-urgent needs, such as prenatal care, ultrasounds, breast pumps, and other routine issues. However, it should pay for acute conditions such as labor and delivery in a hospital, representing the most significant expense.

Apply for Emergency Medicaid at your local county office.

Charity Care

Women pregnant without insurance who are ineligible for Medicaid because of their immigration status can turn to charity care from a local hospital. By law, hospitals and medical centers cannot deny care to anyone needing critical services.

Many states enact uncompensated care requirements for patients who are uninsured, underinsured, or ineligible 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.

Final Thoughts

Pregnant women without health insurance have many options worth exploring if they do not qualify for Medicaid, and the alternatives differ depending on the denial reason.

Women whose household income is too high might want to file an appeal if they overlooked one of many different nuances that influence eligibility.

  • Overstated earnings accidentally
  • Understated the size of their household
  • Assumed they had to apply as a dependent
  • Overlooked invoking medically needy criteria
  • Failed the criteria for full-scope rather than limited pregnancy coverage

If the appeals process does not bear fruit, CHIP, private healthcare, and a change of address might cover the costs of having a baby.  

Undocumented immigrants can tap into Emergency Medicaid, which covers critical needs, and charity care, which helps out low-income people without insurance.

Furthermore, other government programs could lower related expenses for all mothers. The rules for each initiative vary enough to allow some to get extra benefits.

Footnoted Sources: 

[1] March of Dimes CHIP Coverage

More About Medicaid