1. California Health Insurance
  2. Covered California
  3. Health Insurance Companies
  4. Medi-Cal
  5. Maternity Coverage

Medi-Cal Maternity Coverage

A healthy baby begins with a healthy mother. All pregnant and new mothers deserve access to medical and prenatal care, but that’s not always possible. What happens when your household income is too high to meet the low-income Medi-Cal eligibility requirements for services but not high enough to afford maternity and prenatal care?

You need medical pregnancy coverage that will cover your doctor’s visits, prenatal tests, hospital stay for your delivery, potential hospitalizations due to complications and much more. If you’re a middle-income family and need maternity coverage, you may be eligible to enroll in the Medi-Cal Access Program (MCAP).

Understanding Medi-Cal Maternity Coverage

Under the Affordable Care Act, maternity coverage typically includes prenatal visits, hospital stays for labor and delivery, and newborn care. Some plans also cover:

  • Lab tests
  • Ultrasounds
  • Prenatal vitamins

MCAP helps pregnant women in middle-income families who can’t afford health insurance and have an income that places them out of range for receiving regular Medi-Cal benefits at a low or no cost. If you have health insurance but your plan does not provide coverage for your pregnancy-related medical needs or requires you to pay over $500 for your maternity-only deductible or copayment, you are also eligible for MCAP coverage.

The Managed Care Health Plan Directory

Some counties automatically enroll you in a health plan, but in others, you have 30 days to choose a health plan after your MCAP approval. In this case, you can find plans available according to your county and select one that suits your needs.

How Medi-Cal Maternity Insurance Differs From Covered California

If you’re enrolled in a Medi-Cal managed care health plan, you pay little to no money for services you receive while pregnant. Under the MCAP program, a pregnant woman receives comprehensive medical coverage without paying copayments or deductibles. All you pay is a one-time fee for services based on your income, calculated at 1.5% of your Modified Adjusted Gross Income. You can opt to pay your fee in a single installment or over the course of 12 months.

When you’re enrolled in a health care plan under Covered California, you pay a monthly premium for services, depending on your plan, as well as copayments and deductibles for office visits and other pre- and post-natal services.

Thanks to the Affordable Care Act changes, Medicaid maternity coverage is better than ever. Updates to the ACA require all health plans, including those under California’s Medicaid program Medi-Cal, to provide the 10 essential health benefits everyone needs to live healthy lives. One of these benefits is maternity and newborn care. Now, mothers don’t have to worry about whether they have insurance for routine doctor visits, hospitalizations, tests or other pregnancy-related medical services. In addition to MCAP, Medi-Cal provides a few options for uninsured pregnant women, which include:

  • Presumptive eligibility: Pregnant, low-income women receive immediate and temporary coverage for prenatal care for up to 60 days so they receive care as they complete the Medi-Cal application process. It excludes hospital coverage for labor and delivery.
  • Full-scope Medi-Cal: Eligible low-income pregnant women receive all medical services free of charge with full-scope Medi-Cal.
  • Pregnancy-related Medi-Cal: The pregnancy-related Medi-Cal option allows women who are not eligible for full coverage to receive all needed services.

How to Apply for Pregnancy Medi-Cal

Applicants must be 18 years or older and pregnant or the legal partner of the pregnant individual. Legal guardians, foster, natural or stepparents with whom a pregnant minor lives can also apply on their behalf. Follow these steps to apply:

  • Ensure you meet the income and residency requirements.
  • Collect necessary documents like proof of income and California residency.
  • Complete the application via the online form or in person at your local county human services office.
  • Submit your application and await approval, which can take a few weeks.
  • Receive your Medi-Cal card and coverage details in the mail.

If you qualify based on the Medi-Cal pregnancy income limits, your coverage details will confirm the date coverage starts. Coverage ends on the final day of the month, 365 days after the end of your pregnancy, so you must reapply for any subsequent pregnancies.

Registering Your Baby for MCAIP

If your baby is born while you are on MCAP, they automatically qualify and are eligible for the Medi-Cal Access Infant Program (MCAIP) unless you, as the mother, are enrolled in no-cost Medi-Cal or employer-sponsored insurance. MCAIP mails you the Infant Registration Form 30 days before your due date. You must complete and return the form within 30 days after your delivery, including the following information:

  • Baby’s full name
  • Date of birth
  • Gender
  • Birth weight
  • Social Security Number

Baby’s coverage starts when MCAP receives your Infant Registration Form and continues until their first birthday. Their vision, dental and health care coverage is provided by the California Department of Health Care Services through Medi-Cal providers.

If you have an alternative health care plan for your baby, you must still notify MCAP by completing the Infant Registration Form and checking the box indicating ‘I do not want to register my Infant into the Medi-Cal Access Infant Program.’

Maximizing Benefits and Resources

Familiarizing yourself with the MCAP-covered services, from prenatal care to postpartum care, empowers you to maximize your available benefits. Start by selecting your primary care provider and MCAP-partnered OB-GYN. Ensure you utilize covered preventive services like prenatal vitamins and ultrasounds. These services are essential for a healthy pregnancy.

Use additional resources like nutrition counseling, breastfeeding support and health education classes to support you throughout your pregnancy and postpartum. Keep a file with all your medical records, correspondence with health care providers, MCAP program details and appointment dates. It will help you manage your care effectively and simplify potential claims you have down the line.

Apply for MCAP Coverage Today

Pregnancy is a beautiful natural life event, but without health insurance and access to prenatal medical care, it can feel like a huge financial burden to new mothers and families — but it doesn’t have to be.

Health For California is here to help pregnant women find the right maternity insurance plans for their needs. Let us help you find the perfect provider for your growing family. Get a free quote today — it’s quick and easy!