SSI and Medicaid During Pregnancy and Childbirth

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Having a baby can be an exciting time, but it can also carry significant expenses, depending on what kind of insurance coverage or assistance you have. Many pregnant people can find support through Supplemental Security Income (SSI), which is an income program for low-income people with disabilities, 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 assist with the costs of pregnancy and childbirth are more commonly used by those living in rural areas and by minorities. Here, we’ll explain what SSI and Medicaid covers during pregnancy and childbirth and who qualifies for this assistance.

Key Takeaways

  • You only qualify for SSI during pregnancy if you qualify for SSI on the basis of a permanent disability separate from your pregnancy. 
  • SSI is only available for low-birth-weight or disabled children in the 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 income qualifications.
  • Medicaid is available to children who are in households that meet income qualifications. 

SSI During Pregnancy

Supplemental Security Income (SSI) is a program that provides monthly payments to adult and children with disabilities who have income under specific limits. It’s is only available during pregnancy if you already qualify for it separately from your pregnancy.

To qualify for SSI you’ll need to have a disability or blindness that will permanently prevent you from working. You must have resources of under $2,000 and meet household income limits specific to your state.

SSI After Pregnancy

After you give birth, you may need to use SSI for a range of medical services, such as for care for low-birth-weight babies, for disabled children, or for yourself if you become disabled after pregnancy. Let’s look in more detail at what SSI provides in these scenarios.

Low Birth Weight Babies

If you give birth to a premature baby, the baby will qualify for SSI if they meet the low birth weight (LBW) requirements. SSI considers a child a LBW baby if they:

  • weighed 1200 grams or less at their birth
  • weighed 2000 grams or less and are less than the 3rd percentile of size for their age

Most hospitals have social workers who furnish paperwork to the 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 come home, they can be eligible for the full monthly SSI benefit payment only if your household meets the low income and resource limits. With a monthly payment so low, the main purpose of getting your preemie on SSI is to automatically qualify them for Medicaid.

Disabled Children

If your child is not born prematurely with a sufficiently low birth weight to qualify for LBW benefits, they may still be able to qualify for SSI if they have significant disabilities.

While they remain in the hospital, your household income isn’t 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.

Disabled Adults Post-Pregnancy

If you experience complications severe enough post-pregnancy to prevent you from working permanently, you may qualify for Social Security Disability Insurance (SSDI). For 2022, if your disability payment is below $861 per month and you meet household income and resource limits, then you may qualify for SSI.

Medicaid During Pregnancy

Medicaid is a public health insurance program for low income people. It is available during pregnancy for any person who meets the income requirements for their state.

Pregnancy is a qualifying event to enroll in Medicaid and states have multiple tiers of coverage dependent on household income level. Most states have both: 1) full-scope Medicaid that covers all medical services for low income households, and; 2) a more limited version of Medicaid that covers only pregnancy-related services for people with moderate household incomes.

Some states have additional tiers of coverage for higher income individuals like California’s Medi-Cal Access Program.

Income and Coverage Example

In California, a single person with no other children would qualify for full-scope Medicaid coverage if their monthly household income was under $2,106. They could qualify for pregnancy-related services if their income was under $3,251 per month. Finally, they would qualify for the Medi-Cal Access Program if their income was under $4,914 per month.

Medicaid for Children

After birth, Medicaid is available to all LBW children. Non-LBW children can qualify for Medicaid through the Children’s Health Insurance Program (CHIP) if their household meets income eligibility limits.

Each state has their own income limits based on the 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. Lower cost of living conservative states with no Medicaid expansion like Arizona have a limit of 147%.

Is pregnancy a qualifying life event for an ACA plan?

Pregnancy is not a qualifying life event to qualify for a special enrollment period for a plan through the Affordable Care Act (ACA). The birth of a child is a qualifying life event. If you are planning to get pregnant, you may want to sign up for a plan during open enrollment the year prior to get your prenatal care covered if you won’t qualify for Medicaid.

Are my resources counted for SSI and Medicaid?

Your resources are counted for SSI and traditional Medicaid. They include your cash, bank accounts, stocks, mutual funds, bonds, property, life insurance, vehicles, and anything else with value. For an Affordable Care Act (ACA) plan subsidy, your assets will not be counted.

Does my spouse’s income count for SSI and Medicaid?

If you have a spouse with income, that income counts towards your total household income for Supplemental Security Income (SSI) and Medicaid.

The Bottom Line

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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