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Medicaid as a Realistic Option

 

Medicaid continues to receive a bad viewpoint due to the connection with welfare and issues within the welfare system. The truth is that Medicaid is a necessity for a vast majority of Americans, especially those who are pregnant. There is a common misconception that women who are accepted for Medicaid during their pregnancies are also on multiple forms of Medicaid, taking advantage of the system or have other options for insurance coverage. This is a huge misconception. Medicaid is one of the few options available for pregnant women who may not be able to receive standard insurance coverage.

This guide will discuss several aspects of Medicaid for pregnancy. The misconceptions of the Medicaid program and pregnancy, what the Medicaid program covers for pregnancy, how to enroll and the requirements for Medicaid as well as what to expect with appointments and delivery. Before we begin discussing these various aspects of the Medicaid system, we would first like to discuss the reasons that someone may need to obtain Medicaid in lieu of other forms of maternity insurance.


Pre-Existing Conditions and Insurance Limitations

There are a large number of women who obtain Medicaid for maternity care due to their current insurance companies' limitations. These limitations may consider pregnancy as a pre-existing condition if the mother has not had the insurance for a specific amount of time. Some insurance providers will not allow maternity care for up to two years, meaning that the mother must be covered on the policy for at least two years before receiving any type of maternity care. There are insurance companies that will not allow maternity to be covered at all under the particular policy. This puts several women in a bind. For example, if they already have a basic insurance policy and find out they are pregnant, there may be a maternity policy plan available. However, there may be limitations on that plan as well that prevent the woman from obtaining that policy due to time limitations or pre-existing condition limitations that basically state the maternity policy is a policy the mother should have obtained as part of a major medical plan in order to utilize it when needed. All of these reasons are part of the health care reform questions that has reached the White House and Congress, but still remain unanswered or vague under new health care acts. Until they are resolved, Medicaid is the most realistic option.


Income Limitations

Pregnancy requires at least one medical visit each month for a check-up and health appointments. In addition to these appointments there are blood tests, sonograms, screenings and possible prescriptions for the health of the mother and baby. Though a woman may be employed, she may be facing income limits that would prohibit her from obtaining the proper health care treatment for a healthy pregnancy and delivery. In these cases, when other insurance may not be an option or may not cover the necessary procedures, Medicaid for pregnancy is the realistic option.

 

Misconceptions of Medicaid for Pregnancy

 

There are several misconceptions that the general public, and unfortunately some government officials, have regarding the Medicaid program for pregnancy. These misconceptions have led to debates, harsh treatments and reactions to those on Medicaid and many mothers fearing they will not be able to maintain Medicaid coverage during their pregnancy. The following are a few of the misconceptions that run rampant throughout the nation regarding this vital health program.


Women on Medicaid are Milking the System

This is the most common misconception regarding pregnancy and the need for Medicaid coverage. There are several steps required to obtain Medicaid for pregnancy. The two main indicators for someone receiving Medicaid during pregnancy are income and health need. There really is nothing to “milk” either. Medicaid does not provide a mother or family with any money or other financial assistance that would directly give the mother an income. Once a month doctors visits, sonograms, and any health related screenings are covered under Medicaid. In fact, the Medicaid services themselves are listed for the baby rather than the mother. When the baby is born the Medicaid switches to cover the baby and no coverage is related to the mother at that point.


Medicaid for Pregnancy is Used as a Gateway to Welfare

This misconception is based on several factors. One of the main factors is related to the WIC program. In most states, when a mother is awarded Medicaid coverage, she will be sent to the local WIC office in order to sign up for the program. The WIC program goes hand in hand with Medicaid to provide the mother and child with the nutrition they need and may not be receiving otherwise. No cash money passes hands in this program. WIC offers checks with very detailed and specific items that can be purchased. These items include milk, cheese, eggs and beans. The total amount is usually around $50 worth of food coverage. Definitely not enough to live off of and not enough to sustain a mother and growing baby for an entire month. It is meant as a supplement program only and does discontinue after the child reaches a certain age. In fact, the program continues for the children and is only beneficial to the mother if she chooses to breastfeed after the baby is born. Otherwise, the checks are strictly for food items and not for cash and are geared to the health of the child.


Mothers Stop Working to Get on Medicaid

This is another huge misconception regarding the program. In fact, most women are still working or have a spouse who is working while they are on Medicaid. Medicaid is not solely based on income or the mother having a job. There are other factors that come into play.

 

Enrollment in Medicaid for Pregnancy

 

There are several steps in the Medicaid enrollment process for pregnancy. Some of these steps are very quickly while others may take several days to several weeks. The following are the common steps required, in most states, to apply for and receive Medicaid so you can begin seeing a doctor.


Proof of Pregnancy

The first thing you are going to be asked is to prove the pregnancy. This may sound straight forward, but there are some things you need to know about the process. Let’s say you are going to the hospital or a doctor to have a blood test done. The blood test proved you were pregnant. Unfortunately, if the doctor did not list a possible delivery date based on the blood test, then Medicaid will not accept that as proof. In most cases, you will need to go to a local county health clinic and have a urine based pregnancy test performed and a delivery date given based on that test. You will be given the date and the results in writing. This form will need to be scanned and sent or given directly to a Medicaid case worker.

Most county health clinics have Medicaid representatives available at the clinic. This means that right after you receive your documentation to prove the pregnancy, you will be able to see a Medicaid case worker and begin the application process.


The Application

The application process is a bit stressful. In addition to providing your basic information and the proof of pregnancy, you will also be asked to provide several other documents and pieces of information. This information will include a valid state ID, social security number, information on any other insurance that you may have, a statement of income and possibly your previous years taxes. If you work from home or if you are an independent contractor, you will need to provide a letter or statement of income from your client to prove income.

After you have compiled all the necessary information for the application, you will need to mail in or bring in your application to the Medicaid office. An appointment will be set or the social worker may decide to go ahead and review the documents without an appointment. If your application is approved you will receive a letter in the mail within 5 to 7 business days.


Getting a Doctor

When your paperwork has been approved you will be sent a letter. You will also be told the next steps which may include choosing a hospital, contacting a maternity case worker at the hospital, setting up an appointment and scheduling a WIC appointment. You will have to make these appointments and go through the steps in order to see a doctor and begin your maternity care.

 

Medicaid Maternity Appointments: What to Expect

 

There are a lot of questions, misconceptions and fears when it comes to the maternity care appointments offered through Medicaid. Some mothers may not know what to expect at all. Other mothers may have experience with maternity that stemmed from a traditional health plan point of view. Regardless of your personal history with maternity appointments, here are some of the aspects you should expect when dealing with maternity appointments and Medicaid coverage for pregnancy.


Nurse Practioners

One of the first things to expect from Medicaid structured maternity appointments is who you will be seeing at each appointment. Most mothers are accustomed to seeing an OBGYN. However, with Medicaid you will likely be attending appointments through a maternity clinic and seeing one to several nurse practitioners.