SSI and Medicaid During Pregnancy and Childbirth
Having a baby can be an exciting time, but it can also involve significant expenses, depending on the type of insurance coverage or assistance you have. Many pregnant women can find support through Supplemental Security Income (SSI), which is an income program for low-income disabled people, and Medicaid, which is an insurance program for low-income people. In fact, Medicaid paid for 42% of all births in 2020.
Public benefits that contribute to the costs of pregnancy and childbirth are more commonly used by people living in rural areas and by minorities. Here, we’ll explain what SSI and Medicaid cover during pregnancy and childbirth and who can get this assistance.
Key points to remember
- You are eligible for SSI during pregnancy only if you are eligible for SSI on the basis of a permanent disability separate from your pregnancy.
- SSI is only available to low birth weight or disabled children in hospital or a long-term care facility, unless your household is low-income with limited resources.
- Medicaid is available for pregnancy and childbirth to any parent who meets the income requirements.
- Medicaid is available for children who live in households that meet the income criteria.
ISO during pregnancy
Supplemental Security Income (SSI) is a program that provides monthly payments to adults and children with disabilities whose income is below specific limits. It is only available during pregnancy if you are already entitled to it separately from your pregnancy.
To qualify for SSI, you must have a disability or blindness that will prevent you from working permanently. You must have resources of less than $2,000 and meet state-specific household income limits.
ISO after pregnancy
After you give birth, you may need to use SSI for a range of medical services, such as caring for low birth weight babies, disabled children, or for yourself if you become disabled after pregnancy. Let’s take a closer look at what SSI provides in these scenarios.
Low birth weight babies
If you give birth to a premature baby, the baby will be eligible for SSI if they meet the low birth weight (LBW) requirements. SSI considers a child an LBW baby if they:
- weighed 1200 grams or less at birth
- weighed 2000 grams or less and was below the 3rd percentile of height for age
Most hospitals have social workers who provide documentation to Social Security Administration (SSA) to qualify for benefits. If yours does not, you can file online at ssa.gov and an SSA employee will contact you to complete the application.
LBW Benefit Payments
When your LBW baby is in the hospital, you will only receive $30 per month. Once they return home, they may only be eligible for the full monthly payment of SSI benefits if your household meets the low-income and means limits. With such a low monthly payment, the main goal of getting your premature baby on SSI is to automatically qualify for Medicaid.
children with disabilities
If your child was not born prematurely with a low enough birth weight to qualify for IPN benefits, they may still qualify for benefits SSI if they have significant disabilities.
While they remain in the hospital, your household income is not considered for their eligibility. But once your child leaves the hospital, they will only continue to qualify for SSI benefits if your household meets low income and resource requirements.
Adults with disabilities after pregnancy
If you experience complications severe enough after pregnancy to prevent you from working permanently, you may be eligible for Social Security Disability Insurance (SDI). For 2022, if your disability award is less than $861 per month and you meet household income and resource limits, you may qualify for SSI.
Medicaid during pregnancy
Medical help is a public health insurance program for low-income people. It is available during pregnancy to anyone who meets the income requirements for their state.
Pregnancy is an eligible event to enroll in Medicaid, and states have several levels of coverage based on household income level. Most states have both: 1) Comprehensive Medicaid which covers all medical services for low-income households, and; 2) a more limited version of Medicaid that only covers pregnancy-related services for low-income people.
Some states have additional coverage levels for high-income earners, such as California’s Medi-Cal Access Program.
Income and coverage example
In California, a single person with no other children would be eligible for full Medicaid coverage if their monthly household income was less than $2,106. They could be eligible for pregnancy-related services if their income was less than $3,251 per month. Finally, they would qualify for the Medi-Cal Access Program if their income was less than $4,914 per month.
Medicaid for children
After birth, Medicaid is available to all LBW children. Non-LBW children are eligible for Medicaid through the Children’s Health Insurance Program (CHIP) whether their household meets the income eligibility limits.
Each state has its own income limits based on federal poverty level and household size. For example, Hawaii has an income limit of 308% of the federal poverty level for a household with one child. Conservative low-cost-of-living states without Medicaid expansions like Arizona have a 147% cap.
Is pregnancy an eligible life event for an ACA plan?
Pregnancy is not an eligible life event for a special enrollment period in a plan through the Affordable Care Act (TO THAT). The birth of a child is a qualifying life event. If you’re planning to get pregnant, you may want to sign up for a plan during open enrollment the previous year to have your prenatal care covered if you don’t qualify for Medicaid.
Are my resources counted for SSI and Medicaid?
Your resources are counted for SSI and traditional Medicaid. They include your money, bank accounts, stocks, mutual funds, bonds, property, life insurance, vehicles, and anything of value. For an Affordable Care Act (ACA) plan grant, your assets will not be counted.
Does my spouse’s income count for SSI and Medicaid?
If you have a spouse with an income, that income counts toward your total household income for Supplemental Security Income (SSI) and Medicaid.
The essential
Medicaid is available to many people during pregnancy and childbirth to help cover some of the enormous financial burden of having a child. Depending on your state, even someone working full time may be under the income limits to qualify for Medicaid. SSI income can also help during pregnancy and childbirth, but it only serves low-income people with permanent disabilities.
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