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Special Medicaid Coverage for Pregnant Women

January 1, 1981

If you are pregnant with HIV, Medicaid may cover prenatal care and any treatment you need to reduce the transmission of HIV to your baby. Medicaid is a health insurance program for certain individuals that is funded and administered through a State-Federal partnership.

Medicaid eligibility has been expanded for pregnant women in all States to provide prenatal care (including HIV treatment, if necessary) and the healthiest possible pregnancy. To find out if you meet the expanded eligibility requirements, contact your local or county medical assistance, welfare, or social services office. The number should be listed in the blue pages of your telephone directory. If you are unable to find that number, contact your State Medicaid Office

It is now easier for pregnant women to get Medicaid coverage. The following tables show income guidelines for pregnant women who may be eligible for Medicaid. To find out if you qualify for Medicaid, locate your state in the right hand column of Table 1, then match it with the federal poverty level required by your state (ex: 133% of the FPL). Once you have identified the Federal Poverty Level percentage your state uses for Medicaid eligibility, consult Table 2 for the maximum monthly income amount.

Poverty Level Percentage Required for Pregnant Women to Qualify for Medicaid

(A pregnant woman can have a family income for two (herself and child) up to this % of federal poverty level (FPL)and still qualify for Medicaid. See Table 2 for FPL monthly figures).
Example
(A single pregnant woman can have a monthly income up to this amount to qualify for Medicaid)
States
100% of the FPL $884.17 -
133% of the FPL$1,175.94Alabama, Alaska ($1,470.76), Arkansas, Colorado, Idaho, Illinois, Louisiana, Montana, Nevada, North Dakota, Ohio, Oregon, South Dakota, Utah, Virginia, Wyoming
140% of the FPL$1,237.83Arizona
150% of the FPL$1,326.25Indiana, Kansas, Nebraska, Oklahoma, West Virginia
185% of the FPL$1,635.71Connecticut, Delaware, District of Columbia, Florida, Georgia, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Washington, Wisconsin
200% of the FPL$1,768.33California
225% of the FPL$1,1989.51Vermont
250% of the FPL$2,210.42Rhode Island
275% of the FPL$2,431.46Minnesota
300% of the FPL$2,652.51Hawaii


Table 2: 1997 Monthly Federal Poverty Level Guidelines (For All States and D.C., Except Alaska and Hawaii)

Family Size100% Poverty*133% Poverty150% Poverty185% Poverty***200% Poverty****
1$657.50$874.48$986.25$1,216.38 $1,315.00
2$884.17$1,175.94$1,326.25$1,635.71$1,768.33
3$1,110.83$1,477.41$1,666.25$2,055.0 4$2,221.67
4$1,337.50$1,778.88$2,006.25$2,474.3 8$2,675.00
5$1,564.17$2,080.34$2,346.25$2,893.7 1$3,128.33
6$1,790.50$2,381.81$2,686.25$3,313.0 4$3,581.67
7$2,017.50$2,683.28$3,026.25$3,732.3 8$4,035.00
8$2,244.17$2,984.74$3,366.25$4,151.7 1$4,488.33

For family units of more than 8 members, add $283.33 for each additional member.

How to calculate allowable income for FPL percentages not shown on FPL chart:

  1. Determine your family's size and locate income for family size at 100% FPL.
  2. Determine the correct FPL percentage for your state (from Table 1)
  3. Insert a decimal point in the FPL percentage (ex. 140% = 1.40; 225% = 2.25; 250% = 2.50; 275% = 2.75; 300% = 3.00)
  4. Multiply family income at 100% FPL (from step 1) by the decimal number determined in step 3.


Table 2: 1997 Monthly Federal Poverty Level Guidelines (Alaska)

Family Size100% Poverty*133% Poverty**150% Poverty185% Poverty***200% Poverty****
1$822.50$1,093.93$1,233.75$1,521.63$1,645.00
2$1,105.83$1,470.76$1,658.75$2,045.7 9$2,211.67
3$1,389.17$1,847.59$2,083.75$2,569.9 6$2,778.33
4$1,672.50$2,224.43$2,508.75$3,094.1 3$3,345.00
5$1,955.83$2,601.26$2,933.75$3,618.2 9$3,911.67
6$2,239.17$2,978.09$3,356.75$4,142.4 6$4,478.33
7$2,522.50$3,354.93$3,783.75$4,666.6 3$5,045.00
8$2,805.83$3,731.76$4,208.75$5,190.7 9$5,611.67

For family units of more than 8 members, add $283.33 for each additional member.


Table 2: 1997 Monthly Federal Poverty Level Guidelines (Hawaii)

Family Size100% Poverty*133% Poverty**150% Poverty185% Poverty***200% Poverty****
1$755.83$1,005.26$1,133.75$1,398.29$1,511.67
2$1,016.67$1,352.17$1,525.00$1,880.8 3$2,033.33
3$1,277.50$1,699.08$1,916.25$2,363.3 8$2,555.00
4$1,538.33$2,045.98$2,307.50$2,845.9 2$3,076.67
5$1,799.17$2,392.89$2,698.75$3,328.4 6$3,598.33
6$2,060.00$2,739.80$3,090.00$3,811.0 0$4,120.00
7$2,320.83$3,086.71$3,481.25$4,293.5 4$4,641.67
8$2,581.67$3,433.62$3,872.50$4,776.0 8$5,163.33

For family units of more than 8 members, add $283.33 for each additional member.

* denotes mandatory Medicaid coverage of children 7 to 13 years old

** denotes mandatory Medicaid coverage of pregnant women and of the newborn for 1 full year as long as the child continues to reside with the mother.

*** denotes Mandatory Medicaid coverage of children under 6 years old

**** denotes optional Medicaid coverage of pregnant women and the newborn child for one full year as long as the child continues to reside with the mother.

**** Through a 1115 Waiver, a state can increase Medicaid eligibility to 200% of the FPL or more. Check with your state Medicaid office.

In some States, the income level for Medicaid eligibility during pregnancy is even higher. To find out if you meet the requirements for expanded eligibility, please contact your local or county medical assistance, welfare, or social services office. The number should be listed in the blue pages of your telephone directory. If you are unable to find that number, contact your State Medicaid Office.


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This article was provided by U.S. Health Care Financing Administration. It is a part of the publication Pregnancy and HIV -- What Women and Doctors Need to Know. You can find this article online by typing this address into your Web browser:
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