With Medicaid Expansion, Women Don't Have to Be Pregnant to Get Covered!

A woman came in the other day, proof of pregnancy in hand. I'll call her Jane. Though she already had other children, and all of her children had Medicaid, she herself did not. 


When I said, "You don't have to be pregnant to get medical coverage." Jane was shocked.  This is just one of the changes of the Medicaid expansion and the Affordable Care Act,

Back in the old days (pre-ACA), women would get Medicaid during pregnancy, and a couple of months after they gave birth, their Medicaid coverage would be ended. But the time period between pregnancies has been identified as an important time for health care [Pregnancy spacing], and health care during that time makes it less likely that women in the future will give birth to premature or low birth weight babies. Good health care for mom can also make it easier for her to take care of children at home!

It's a new world out there, and Jane--and thousands of women like her--are benefiting from the expansion of Medicaid into the Healthy Michigan Plan. Now, health care is covered year-round, and that health care coverage includes both pregnancy coverage and birth control.

[In fact--men--who (to state the obvious) are never pregnant and so never got pregnancy-related coverage before--benefit by being eligible for Healthy Michigan Plan and Medicaid.]

As it happens, though, there are some differences between Healthy Michigan Plan coverage and Medicaid for pregnant women coverage, and those relate to income limits.

If you are an adult, 19-64, and you are not pregnant, the Medicaid income limit is 138% of the poverty level

But if you are pregnant, the Medicaid income limit jumps to 195% (200% if you are including the 5%disregard)  of the poverty level. Also, when you are pregnant, the Medicaid system adds the pregnancy to the household size.



Take a family of 3 (two parents and one child).  

For the parents to be covered under the Healthy Michigan Plan (coverage for the parents), the maximum income for a family of 3 (in 2015) is $27,724/year. For children ages 1-18, the maximum income would be $32,144/year.

But if mom is pregnant, the Medicaid system counts the family as a family of four. So now, for the parent who is not pregnant, the maximum income would be $33,465/year; for the child, the maximum income would be $38,800/year. For mom, the maximum income is even higher, $47,288/year.

All of this results in more options for health coverage.

The good news is that the entire application can be done for the whole family, at michigan.gov/mibridges.  Or there are many agencies to help you

Now: Are you wondering about health coverage for adults who make between 138% and 195% of the poverty level and are not pregnant? Assuming they don't have the option of affordable employer coverage, that leads us back to the Marketplace (healthcare.gov).

Jane didn't know that she could get covered year round, whether pregnant or not.

There are other people like Jane out there. Let them know, it's easy to get covered.  

--Ruth Kraut

Related post: Congratulations, You're Pregnant! Now How Will You Pay For the Birth?

Related post: What is WIC?

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