Disability

Medicaid Letters: Medicaid and Pregnancy

What is Medicaid?

    Medicaid is a health insurance program for low income people. It pays most medical costs, including hospital care, doctors’ visits, prescriptions and prenatal care.

Is there a special Medicaid program for pregnant women?

    Yes. It is important for pregnant women to get medical care as early in their pregnancy as possible. Medicaid has a special program called Presumptive Eligibility, which pays for medical care for pregnant women before their Medicaid applications have been approved.

    To find out if you are eligible for Presumptive Eligibility, call one of the clinics on the list we have enclosed. People at the clinic can tell you if you qualify. If you do, you can immediately receive medical assistance. The Department of Social Services (DSS) will make a decision within 45 days of the 1st medical appointment/application being placed.

Is it easier to get Medicaid when I am pregnant?

    Yes. Because it is so important for pregnant women to get medical care, you are allowed to earn more money than other people. This is called Expanded Eligibility. Even if you have been denied regular Medicaid, you may be eligible under the expanded eligibility income levels. Any of the qualified clinics can tell you if you are eligible. Contact one of them.

What happens if I am “presumptively eligible” for Medicaid?

    You will get a Medicaid card in about three weeks. If you need treatment or medicine before that time, you can get a temporary Medicaid card. Take the documents that your health care provider gives you to the first floor of the Rath Building, 95 Franklin Street, Buffalo.

    Remember, to be eligible for ongoing medical care you must complete your application for regular Medicaidduring your 45-day period of presumptive eligibility.

What happens if I am found eligible for Medicaid under the Expanded Eligibility Program?

    You will get Medicaid for at least 60 days after your baby is born (or the pregnancy ends), regardless of your income. Your new baby may get Medicaid under expanded eligibility income amounts until the baby is a year old.

    Before the 60 days pass, the DSS will review whether you can continue to receive Medicaid benefits.

    You may lose your eligibility for Medicaid if your income is too high. But any of your children under ten years old may still qualify. Even if you are over income for Medicaid, ask the worker whether your child is still eligible.

What if my Medicaid application is denied?

    If your application is denied, call our office and we will review the decision with you by telephone. If it appears to be wrong, we will tell you how to challenge it, or we may agree to take your case.