Medicaid Coverage During Pregnancy: Benefits for Mothers and Babies

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Medicaid is the largest single payer of pregnancy-related services in the United States, financing 40% of all U.S. births in 2024 and more than 50% of births in three states. Federal law requires state plans to bar deductibles and cost-sharing for pregnancy care and cover infants through their first birthday.

Although the baseline federal statute guarantees only 60 days of mandatory postpartum coverage, Congress created a permanent state option for a full year of care after birth. Nearly every state has extended postpartum coverage from 60 days to a full year, leaving Arkansas as the last state yet to extend postpartum coverage.

How Federal Law Structures Pregnancy Medicaid

Every state Medicaid plan must provide medical assistance for pregnancy-related services and 60-day postpartum care to eligible low-income women. In 2023, women ages 19 to 49 made up 24% of all Medicaid enrollees nationwide.

In its May 2022 maternity survey report, KFF noted that Medicaid financed approximately two-thirds of births among Black and American Indian and Alaska Native mothers nationally. A September 2026 Government Accountability Office (GAO) maternal health review reported that “both Black and American Indian/Alaska Native women are twice as likely to die during or after pregnancy as white women.”

Federal law states that “no deduction, cost sharing or similar charge will be imposed” for care tied to pregnancy or conditions that may complicate the pregnancy. In its August 2026 review, KFF reports that Medicaid charges no deductibles and bars pregnancy copayments, and that lower-income women on Medicaid were less likely than uninsured or privately insured women to delay care due to cost.

While federal law locks in zero pregnancy cost-sharing and a minimum income floor, states retain broad discretion to set higher income limits, define covered maternity care beyond hospital stays, and apply prior review rules.

Who Qualifies by Income and Household Size

Every state must set a minimum pregnancy income threshold of at least 133% and “not more than 185 percent” of the federal poverty level (FPL). Across all states, KFF notes that the federal minimum income eligibility level for pregnant women is 138% FPL.

When a state agency counts the family size of a pregnant woman, “the pregnant woman is counted as herself plus the number of children she is expected to deliver.” Counting expected babies in the household raises the dollar income a pregnant woman can earn and still qualify.

Suppose a pregnant woman with one child is expecting one baby, which counts as a family of three. With 100% FPL set at $27,320 for a family of three in 2025, the 138% FPL floor equals about $37,700 in annual income, and a 200% FPL state limit equals $54,640.

Once a pregnant woman enrolls in Medicaid, the state must treat her as continuously eligible throughout her pregnancy “without regard to such change of income” if her pay rises. Across Medicaid and the Children’s Health Insurance Program (CHIP) in January 2026, the overall United States upper income limit is 2.13 times the poverty line, up from 2.05 between 2014 and 2022.

Idaho and South Dakota set the lowest state pregnancy income limits at 1.38 times the poverty line in January 2026, followed by Utah at 1.44, Wyoming at 1.59, Arizona at 1.61, and Montana at 1.62. Six places set limits above 3.0 times the poverty line in January 2026: the District of Columbia at 3.24, California at 3.22, Alabama at 3.17, Wisconsin at 3.06, and Missouri and West Virginia at 3.05.

What Prenatal and Delivery Benefits Are Covered

Federal rules define covered pregnancy-related services as care “necessary for the health of the pregnant woman and fetus,” or care needed because of the pregnancy. Required state plan benefits include prenatal care, delivery, postpartum care, family planning, and care for conditions that might complicate the pregnancy.

Alongside hospital delivery care, federal state-plan mandates require states to cover licensed certified nurse-midwife services, licensed “freestanding birth center services,” and “counseling and pharmacotherapy for cessation of tobacco use by pregnant women.”

States that expanded Medicaid under the ACA must cover all preventive care recommended by the U.S. Preventive Services Task Force (USPSTF) for expansion adults, including prenatal screenings, folic acid, and breastfeeding help. Traditional federal Medicaid law does not specify a uniform list of required prenatal care beyond hospital services.

In a July 2021 KFF survey of 41 states and Washington, D.C. (42 programs total, though one or two states did not answer every question), all 42 responding states covered prenatal visits, vitamins, and ultrasounds, and 36 of 40 covered low-dose aspirin to prevent preeclampsia. Across four areas, states reported the following in July 2021:

• Ultrasounds and monitors: In 2021, 10 states capped covered ultrasounds. Meanwhile, 31 of 41 responding states in 2021 covered home blood pressure monitors, and 35 covered continuous glucose monitors for gestational diabetes.
• Home births and classes: Across 42 responding programs in July 2021, 25 states covered home births, 15 covered childbirth education classes, and 12 covered group prenatal care.
• Substance use and dental care: All states in 2021 had to cover Medication-Assisted Treatment (MAT) for pregnant people. In 2021, 39 of 42 responding states covered dental care for pregnant enrollees, including five (Arizona, Hawaii, Maine, Texas, and West Virginia) covering only emergency dental care.
• Breastfeeding help: Only 15 states in the July 2021 survey covered all surveyed breastfeeding benefits across classes, hospital, clinic, and home lactation visits, and electric and manual breast pumps.

In the July 2021 KFF survey, only three responding states covered doula services (Indiana, New Jersey, and Oregon). By March 2026, 26 states and Washington, D.C. reimburse doula services in Medicaid, up by 14 states since April 2024.

The National Academy for State Health Policy (NASHP) notes that doula care is associated with reductions in preterm births and cesarean delivery, with 17 states covering care for a full year after birth and delivery pay ranging from $459 to $1,500 in March 2026. In January 2025, the Centers for Medicare & Medicaid Services (CMS) selected 15 state Medicaid agencies (including Washington, D.C.) for the 10-year Transforming Maternal Health Model (2025 to 2034), offering up to $17 million each to expand access to midwives, doulas, and birth centers.

Benefits for Newborns and EPSDT Protections

A child born to a woman on Medicaid at birth “shall be deemed to have applied for medical assistance” and stays eligible for one year. States must provide this one-year newborn coverage without an application even when the mother had only Emergency Medicaid at birth.

A deemed newborn “remains eligible regardless of changes in circumstances” until the child’s first birthday, unless the child dies, moves out of state, or a parent asks to end coverage. Up to age 21, the child is entitled to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) care.

The EPSDT benefit requires states to provide periodic health and developmental exams, lead blood tests, and vaccines, plus vision, dental, and hearing care. States must also cover all medically necessary care “to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.”

The Postpartum Cliff and 12-Month Extension

The mandatory federal floor runs only “through the end of the month in which the 60-day period (beginning on the last day of her pregnancy) ends.” In September 2026, GAO reported that “more than 600 women die during pregnancy or from causes aggravated by pregnancy each year in the U.S.; over 80 percent of these deaths are preventable, according to the Centers for Disease Control and Prevention (CDC).”

Medicaid.gov states that “more than half of pregnancy-related deaths occur in the postpartum period, and 12 percent occur after six weeks postpartum.” In February 2026, the Georgetown University Center for Children and Families (CCF) noted that “about a third of maternal deaths occur between one week and one year postpartum” and that “for every maternal death, there are at least 70-80 cases of severe maternal morbidity.”

The American Rescue Plan Act of 2021 gave states the option to extend postpartum Medicaid and CHIP coverage from 60 days to a full year, made permanent in 2023. An electing state must provide full state-plan Medicaid benefits throughout the 12-month postpartum period ending on the last day of the 12th month after pregnancy ends.

Representatives from five of 10 selected state Maternal Mortality Review Committees told GAO in 2026 that their states extended postpartum Medicaid based on committee findings. In February 2026, Wisconsin’s State Assembly voted 95 to 1 to pass the extension, leaving Arkansas as the last state at 60 days.

In March 2024, Arkansas Governor Sarah Huckabee Sanders rejected expanding postpartum Medicaid, stating, “I don’t believe creating a duplicative program just for the sake of creating a program is actually going to fix the issue.” She added, “We already have so many women who aren’t taking advantage of the coverage that exists. Creating more coverage doesn’t get more women to the doctor.”

Maternal health advocates in the September 2024 KFF Health News report countered that Arkansas begins moving women out of pregnancy Medicaid six weeks (42 days) after delivery. In Arkansas, 20% to 29% of women are uninsured at some point between conception and after birth, and Arkansas Birthing Project director Zenobia Harris noted that women can apply for other coverage six weeks after birth via a paper form.

After postpartum coverage ends, 40 states and Washington, D.C. cover adults under the ACA expansion as of May 2026, while parent income limits in the 10 non-expansion states range from 15% FPL in Texas to 105% FPL in Tennessee. In expansion states, the 2025 reconciliation law imposes work rules on expansion adults starting January 1, 2027 (exempting parents of children under age 14). The Congressional Budget Office estimates the law will cut federal Medicaid spending by $326 billion over 10 years and raise the uninsured count by 5.3 million in 2034.

Coverage Pathways for Immigrant Mothers

Undocumented immigrants are ineligible for full federally funded Medicaid or CHIP, and many lawfully present immigrants, including most green card holders, must wait five years before enrolling. HealthCare.gov notes that only Lawful Permanent Residents, Cuban or Haitian entrants, and Compact of Free Association (COFA) migrants qualify for general full coverage, though “pregnant women and children may be eligible for full Medicaid or CHIP coverage” by state:

• The Lawfully Residing Pregnancy Option: States may waive the five-year wait to cover “children and pregnant women who are lawfully residing in the United States.” As of January 2025, 31 states plus Washington, D.C. had adopted this option for pregnant people, and 37 states plus D.C. had adopted it for children.
• The CHIP From-Conception-to-End-of-Pregnancy (FCEP) Option: Federal CHIP rules define a “Child” as “an individual under the age of 19 including the period from conception to birth.” Because eligibility attaches to the unborn child, 23 states plus Washington, D.C. as of January 2025 used the FCEP option to cover prenatal care and delivery regardless of immigration status.
• Emergency Medicaid: For low-income noncitizens who do not qualify under those options, federal payment covers only an “emergency medical condition,” including emergency labor and delivery. Emergency Medicaid spending totaled $3.8 billion (0.4% of total Medicaid spending) in fiscal year 2023.

How to Apply and Get Immediate Coverage

Pregnant people can apply for Medicaid and CHIP at any time of year without waiting for an open-enrollment period. Applicants can file at HealthCare.gov or apply directly with their state Medicaid agency.

If a state denies an application for full Medicaid or CHIP, the state transfers the applicant’s information to the Marketplace to check for private plan savings. Enrollees with Medicaid limited to family planning or emergency conditions can also apply through the Marketplace for a subsidized plan.

To keep processing delays from blocking early care or leaving families with unpaid bills, states may offer temporary prenatal coverage during application review alongside prior-month retroactive Medicaid payment:

• Same-Day Presumptive Eligibility (State Option): A state Medicaid plan may let qualified clinics grant immediate temporary coverage for “ambulatory prenatal care” on the day a provider finds that a pregnant woman’s family income meets state limits. That period lasts until the state decides her formal application, or, if she does not file one, until “the last day of the month following the month during which the provider makes the determination.”
• Retroactive Coverage Through 2026: Before Public Law 119-21 (the 2025 reconciliation law) takes effect in 2027, Medicaid covers care “furnished in or after the third month before the month in which he made application” if the applicant qualified for Medicaid during that three-month period.
• Starting 2027: For applications made on or after the first quarter after December 31, 2026, Section 71112 of Public Law 119-21 limits prior-month coverage for pregnant women and traditional groups to “the second month before the month in which the individual made application.” For ACA expansion adults (enrolled under paragraph (10)(A)(i)(VIII)), Section 71112 covers care only “in or after the month before the month in which the individual made application.”