Orlando Harmon
If you're pregnant and want to ensure your baby has health insurance, you may be eligible for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). All Marketplace and Medicaid plans cover pregnancy and childbirth, and you can add your baby to your plan within a certain window of time after they're born. If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. If you're found eligible for Medicaid or CHIP, you will be covered for pregnancy and newborn care, and your information will be sent to the state agency.
| Characteristics | Values |
|---|---|
| Coverage for unborn babies | In 1999, Florida began issuing Medicaid ID numbers and gold cards to pregnant women for their unborn children. |
| Coverage for newborn babies | If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. |
| Special Enrollment Period | Having a baby qualifies you for a Special Enrollment Period, allowing you to enroll in Marketplace coverage outside the Open Enrollment Period. |
| Coverage for pregnant women | Medicaid and CHIP provide free or low-cost health coverage to pregnant women, including outpatient services and, in some cases, inpatient hospital services. |
| Income requirements | Eligibility for Medicaid and CHIP depends on household size, income, and citizenship or immigration status. |
| Application process | You can apply for Medicaid or CHIP at any time during the year. For CHIP, the child must be under 19, and for Medicaid, under 21. |
| Coverage for adopted children | You can add your adopted child to your plan within a certain window of time, typically 30-60 days after adoption. |
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What You'll Learn
Medicaid eligibility for unborn babies
If you are pregnant and have Medicaid coverage, your newborn will be automatically enrolled in Medicaid and will remain eligible for at least a year. This is because childbirth is considered a qualifying life event, allowing you to add your baby to your insurance plan within a certain window of time.
If you are pregnant and uninsured, you may be able to enroll in Medicaid if you meet certain income requirements. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) gave states the option to provide Medicaid coverage to pregnant individuals who are lawfully residing in the United States, including those within their first five years of having certain legal status.
Medicaid eligibility for pregnant women can vary by state, so it is important to check with your state's Medicaid program to understand the specific requirements and coverage options available to you. Some states, like Utah, offer temporary Medicaid coverage for low-income pregnant women who qualify, known as "Baby Your Baby" (BYB). BYB covers pregnancy-related outpatient services but does not cover the delivery of the baby.
It is important to note that if you have an employer-based health plan or a federal or state marketplace health plan, you may be able to add your unborn baby to your existing coverage. Birth is considered a qualifying life event, allowing you to make changes to your insurance plan. However, it is always a good idea to research and compare different plans to find the one that best suits your needs and budget.
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Temporary coverage for pregnant women
Pregnant women can get free or low-cost health coverage through Medicaid or the Children's Health Insurance Program (CHIP). These programs provide coverage to millions of Americans, including some low-income people, families, and children.
Eligibility for Medicaid and CHIP depends on household size, income, and citizenship or immigration status. Specific rules and benefits vary by state. For example, in Texas, to get Medicaid for Pregnant Women or CHIP Perinatal, one must be a Texas resident and a U.S. citizen or qualified non-citizen. Additionally, Utah's Baby Your Baby (BYB) program offers temporary medical coverage for low-income pregnant women who qualify. BYB covers pregnancy-related outpatient services but does not cover the delivery of the baby.
Medicaid for Pregnant Women includes the full array of Medicaid services, such as prenatal doctor visits, prenatal vitamins, labor and delivery, and checkups and other benefits for the baby after leaving the hospital. CHIP Perinatal provides limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for women who do not qualify for Medicaid and do not have health insurance.
Pregnant women can apply for Medicaid or CHIP at any time during the year, not just during the annual Open Enrollment Period. They can apply directly through their state agency or by filling out a Marketplace application and selecting that they need help paying for coverage. If found eligible, coverage can begin at any time during the pregnancy, and the woman will be covered for at least 60 days after giving birth, depending on the state. Some states offer coverage for a full 12 months after giving birth.
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Income requirements for coverage
Medicaid eligibility is generally based on income, with each state having different income limits. For instance, persons residing in Medicaid-funded nursing homes are permitted to have a monthly income as high as $2,901 in 2025, while those receiving Medicaid long-term care at home are allowed to keep their monthly income up to a certain amount to pay for expenses like rent, food, and utilities.
Some individuals are exempt from the income-counting rules, such as those over 65 or with blindness or a disability. Eligibility for these individuals is determined using the income methodologies of the SSI program. States may also establish a "medically needy program" for individuals with significant health needs whose income is too high to qualify for Medicaid under other groups. These individuals can become eligible by "spending down" their income above the state's medically needy income level.
Additionally, states have the option to provide Medicaid coverage to children and pregnant individuals who are lawfully residing in the United States, including those within their first five years of obtaining certain legal status.
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Adding a newborn to your plan
Adding a newborn to your health insurance coverage is a relatively easy process. Birth and adoption are considered qualifying life events, which means you can add your baby to your plan within a certain window of time. If you have an employer-based health plan, you have at least 30 days after your child's birth or adoption to enroll them in your plan. If you have a federal or state marketplace health plan, you have 60 days. No matter when you enroll your child during that window, the policy will retroactively cover medical bills from the day of their birth.
If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. If you have Marketplace coverage, you can keep your current plan and add your baby to your coverage, or create a separate enrollment group for your baby and enroll them in any plan for the remainder of the year. If you were covered by Medicaid during your pregnancy, you'll be covered for 60 days after you give birth. After that, you may not qualify, but your little one will remain on Medicaid for at least a year.
If you have employer-based health insurance, contact your company's human resources department to enroll your baby. Let them know you just had a baby and that you'd like to add them to your plan. Don't forget to ask about potential costs. Get in touch with your insurance company to check what paperwork you need. Most of the time, you'll just need your baby's birth certificate or proof of birth.
If you don't have health insurance, your baby may still be eligible for Medicaid or the Children's Health Insurance Program (CHIP). These programs provide free or low-cost health coverage to millions of Americans, including some low-income people, families, and children. Eligibility depends on your household size, income, and citizenship or immigration status, and specific rules and benefits vary by state. You can apply for Medicaid or CHIP any time during the year, not just during the annual Open Enrollment Period.
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Marketplace coverage options
If you already have a Marketplace plan when your baby is born, you can either keep your current plan and add your baby to your coverage or create a separate enrollment group for your baby and enrol them in any plan for the remainder of the year. The ability to select any plan only applies to your baby. You're generally not allowed to change plans until the Open Enrollment Period.
If you have a federal or state marketplace health plan, you have 60 days to enrol your baby in your plan. No matter when you enrol your child during that window, the policy will cover medical bills from the day of their birth.
If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. If you had Medicaid or CHIP coverage that ended after you gave birth, you can apply for Marketplace coverage. Losing other coverage qualifies you for a Special Enrollment Period.
If you don't qualify for Medicaid, you can find a separate plan just for your baby. Your baby qualifies for a special enrollment plan. You can revisit coverage for the rest of the family during the next open enrollment period.
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Frequently asked questions
If you are pregnant and meet the income requirements for Medicaid, you can get temporary coverage for yourself and your unborn child. This coverage will extend for a minimum of one year after your baby is born.
Eligibility for Medicaid depends on your household size, income, and citizenship or immigration status.
Medicaid covers maternity care and newborn care, including prenatal checkups, doctor visits, lab tests, prenatal vitamins, medicine, specialty medical care, eye care, dental care, emergency room care, mental health and substance abuse services, transportation to get medical care, and other services.
You can apply for Medicaid or CHIP any time during the year, not just during the annual Open Enrollment Period. If you are eligible, your information will be sent to the state agency, and you won't be given the option to keep your Marketplace plan.
If your Medicaid coverage ends after you give birth, you can apply for Marketplace coverage.
