How Medicaid Works

Medicaid is a state and federally funded program designed to provide health and maternity insurance to pregnant women, children, seniors, and people with disabilities. However, it can be a bit tricky to understand if you are unfamiliar with the system.

How Do I Know if I Am Eligible for Medicaid?

Patients can be declared eligible for Medicaid based on a number of different factors. Categorically needy patents must have an income which falls 133% below the poverty line; this type of eligibility is based upon financial need. Medically needy candidates are those who make more money than this, but still do not have health insurance and are unable to receive treatment for a serious condition or conditions because they are uninsured; this may apply to pregnant women who would not otherwise be eligible.

What Do I Need to Prove My Eligibility?

Requirements will vary from state to state, but in general you will need proof that you are pregnant, proof of citizenship or legal immigration, and proof of income when applying for Medicaid. Proof of pregnancy is not difficult; simply speak to your doctor about getting a note or statement of verification before the appointment. If you do not have a doctor, and have discovered your pregnancy by some other means, consult with your local Medicaid office when you go to apply.

What Benefits Will I Receive?


Medicaid generally pays for all medical expenses relating to prenatal care, birth and any subsequent complications, and 60 days of postpartum care. In many cases this will cover alternative options such as the cost of a midwife or birthing center as well. Like most government aid programs, Medicaid does not pay any money directly to covered individuals; health care providers will bill the program for reimbursement, although in some cases you may be required to provide a small co-pay.

Presumptive Eligibility

Pregnant women may be eligible to receive reimbursement for services received before they were approved by the Medicare program; this is called presumptive eligibility, and is designed to encourage women to get prenatal care as early as possible. It is vitally important to monitor the health of your baby and to make sure you have access to prenatal vitamins, healthy foods, and other aspects of a healthy lifestyle. If you are uninsured and have applied to Medicaid, consider accessing the services of a low-cost clinic in the meantime, or speak to Medicaid about a temporary card.

After Benefits Begin

Once you are enrolled in the Medicaid program, you may begin accessing services right away. It can take 2-4 weeks for the organization to process your application; while pregnant women are given priority, aid organizations like Medicaid must serve a large number of people, and cannot offer instant approval. Your doctor or health care provider will make copies of your Medicaid forms during the first visit, and will then bill the program as services are provided.

While it can be intimidating to try and understand how Medicaid works, nothing should be more important than the health of you and your child!

Article on How Medicaid Works

Medicaid is federally funded state insurance program for certain (i.e. pregnant women) low income individuals and families. The first step is to determine if you qualify for Medicaid.

Unfortunately, the guidelines, income calculations, and restrictions differ between states. A simple rule of thumb is that if you make less than $30,000 a year, you should apply for Medicaid.

Once you are enrolled in Medicaid you will be provided with the appropriate documentation. The next step involves finding a healthcare provider that accepts Medicaid. Most states have a health department hotline which helps you find a local provider.

After receiving your Medicaid acceptance, you can make an appointment with your healthcare provider. Your healthcare provider will makes copies of your Medicaid documentation and provide you with the healthcare services (your prenatal care) that you need. In most cases you do nothing else. Your healthcare provider will bill Medicaid directly and be reimbursed for the services that you received. There are some states that do have a small co-payment that you must make.

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