Issues in Pregnancy Coverage under Medicaid and Exchange Plans

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March 2014 | Medicaid and Other Payers

Medicaid plays an important role in financing health care for low-income pregnant women, covering a vulnerable population and promoting healthy birth outcomes. It covers almost half of all births in the United States.

However, although all states are required to provide pregnancy-related care for women below 138 percent of the federal poverty level, they are not required to provide full Medicaid benefits. In Medicaid-expansion states, this can lead to inequities in coverage. Women in the new adult group receive an alternative benefit package consisting of all essential health benefits, which they can retain if they become pregnant. But women who are already pregnant when they apply for Medicaid qualify for Medicaid under a mandatory poverty-related pregnancy pathway with more limited benefits.

In Chapter 3 of our March 2014 report, MACPAC recommends that Congress require states to provide the same benefits to women who are eligible for Medicaid on the basis of their pregnancy as women are eligible because they are parents. We also have made a companion recommendation that women enrolled in qualified health plans should be allowed to retain their coverage even if pregnancy makes them eligible for Medicaid. Read more about Medicaid’s variability in coverage for pregnant women.

Publication Type: Reports to Congress

From: March 2014 Report to the Congress on Medicaid and CHIP

Tags: Affordable Care Act, benefits, churning, eligibility, emergency services, exchanges, maternity services, pregnant women, prenatal care