Health Coverage Options for Pregnant Women
Pregnancy is an important time for women to get the services they need as early in the pregnancy as possible. In California, there are several options for uninsured pregnant women to get health coverage. These options include Covered California health insurance plans and the following Medi-Cal programs:
- Presumptive Eligibility for Pregnant Women is immediate and temporary coverage for low-income women who are pregnant and might be eligible for Medi-Cal. Coverage is available for up to 60 days while you apply for ongoing Medi-Cal. Presumptive Eligibility offers prenatal care and care related to pregnancy loss, as well as dental services. It does not cover labor and delivery or other hospitalization.
- Full-scope Medi-Cal covers all medically necessary medical services, preventive services and dental services at no cost to eligible women. You must be a U.S. citizen or have a satisfactory immigration status to enroll in full-coverage Medi-Cal.
- Pregnancy-related Medi-Cal covers all medically necessary pregnancy-related services for pregnant women who do not qualify for full-scope Medi-Cal. These services include prenatal care, labor, delivery, care after delivery, family planning services, care related to pregnancy loss and services for conditions that might complicate the pregnancy. Dental care and mental health services are also included.
- Medi-Cal Access Program (MCAP) offers low-cost comprehensive coverage for pregnant women, with no copayments, deductibles or coinsurance, regardless of citizenship or immigration status. The program requires a fee of 1.5 percent of yearly family income that can be paid in monthly installments over 12 months. After your pregnancy and postpartum coverage with MCAP ends, you can transition to Covered California or Medi-Cal, depending on your household size, income, and immigration status at that time.
If your household income is too high to qualify for Medi-Cal, you may be eligible for a Covered California health plan with tax credits to help lower monthly premiums and out-of-pocket costs. Covered California provides comprehensive health care coverage. Be sure to compare copayments, especially the hospitalization copayment for your delivery, deductibles or coinsurance, to choose the health plan that is right for you. You must be a U.S. citizen, U.S. national or be lawfully present to enroll in coverage through Covered California. You can read the list of lawfully present immigration statuses and the documents that may be needed to verify each status.
When you apply through Covered California, your application is automatically checked to see if you are eligible for Medi-Cal, MCAP or Covered California.
When can you enroll?
Medi-Cal programs enroll new members anytime.
Covered California enrolls new members only during the open-enrollment period that begins in the fall, unless you qualify for special enrollment. Pregnancy is not considered a qualifying life event for special enrollment in Covered California, but you may have a different qualifying event like recently losing your health care coverage.
How can you apply?
The fastest way to start temporary Medi-Cal is to go to a participating Presumptive Eligibility provider.
The fastest ways to find out if you are eligible for ongoing Medi-Cal are to:
- Search for in-person help near you for someone who can help you complete your application.
- Apply online on http://www.benefitscal.com or CoveredCA.com.
- Call or visit a Medi-Cal office in your county.
- Call Covered California at (800) 300-1506.
The fastest way to find out if you are eligible for MCAP is to:
- Contact MCAP at (800) 433-2611. You can call Monday through Friday, 8 a.m. to 8 p.m., and Saturday, 8 a.m. to 5 p.m.
- Call Covered California at (800) 300-1506.
- Apply online at CoveredCA.com.
For Current Medi-Cal, MCAP and Covered California Members
If you are already enrolled in Medi-Cal, you are required to report your pregnancy to your local county social services agency. They will update your case and coverage. You can also report the pregnancy and other changes such as family size, address or income online at CoveredCA.com (you will need a CoveredCA.com account to do this).
If you are already enrolled in MCAP, you can update your case information by contacting the MCAP program at (800) 433-2611, or calling Covered California at (800) 300-1506, or by reporting changes online at CoveredCA.com (you will need a CoveredCA.com account to do this). If you are already enrolled in MCAP, reporting a change in your case may make you eligible for a Covered California plan with financial assistance. If this happens, your MCAP enrollment will continue as normal unless you actively decide to switch to Covered California. In other words, you will have the option to “Keep or Switch” your MCAP coverage. You will only be able to switch to if it is open enrollment or you qualify for special enrollment due to a qualifying life event. Some women may want to switch from MCAP to Covered California to join other family members in a Covered California plan, or to gain access to a different hospital or provider network. Other women will want to keep MCAP due to cost savings, or because switching programs may require moving to a new hospital or provider network. You can make the decision to keep or switch your plan immediately, or later in your pregnancy after considering your coverage options and priorities.
If you are already enrolled in a Covered California plan, reporting a pregnancy may make you eligible for Medi-Cal or MCAP. If this happens, your Covered California enrollment will continue as normal unless you actively decide to switch to another program. You are not required to report a pregnancy to Covered California and do not need to unless you are interested in other coverage options during pregnancy such as Medi-Cal or MCAP. You can report the pregnancy and discuss these other programs by calling Covered California at (800) 300-1506. You can also report the pregnancy online at CoveredCA.com.
If you choose to report your pregnancy and you become eligible for Medi-Cal or MCAP, you will have the option to “Keep or Switch” your Covered California coverage. Some women may want to switch from their Covered California plan to Medi-Cal or MCAP because those programs offer comprehensive coverage for low or no cost. Other women will want to keep their Covered California plan because switching programs may require moving to a new hospital or provider network. You can make the decision to keep or switch your plan immediately, or later in your pregnancy after considering your coverage options and priorities.
Enrolling a Newborn
Be sure to tell your health care program — Medi-Cal, MCAP or Covered California — when your baby is born, so that he or she can get covered right away.
For mothers who have Medi-Cal coverage at the time of delivery, call your county Medi-Cal office or fill out and send in the Newborn Referral Form. The newborn will be eligible for Medi-Cal until at least age one if living in California. During the first two months, coverage will be under the mother’s Medi-Cal number if the newborn has not yet been enrolled into Medi-Cal.
For mothers who have MCAP coverage at the time of delivery, call MCAP at (800) 433-2611 or complete and return the Infant Registration Form. If living in California, the newborn will be enrolled in the Medi-Cal Access Infant Program until age one regardless of family income changes and until age two if family income is at or below the income level allowed for the program.
For Covered California, add your newborn to your plan by calling (800) 300-1506 or update your family information online through your Covered California account.