Special Medicaid Coverage
for Pregnant Women
If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and HIV positive, Medicaid may pay for counseling and medication to reduce the possibility of transmitting HIV to your baby, and treatment for your HIV infection. Your eligibility for Medicaid continues automatically for up to 90 days after you deliver your baby, and depending on the State in which you live, may continue for 1 year after you deliver your baby. Your eligibility after that will be redetermined separately. Medicaid is a health insurance program for certain individuals that is funded and administered through a State-Federal partnership.
Medicaid eligibility income limits are increased for pregnant women in all States to provide prenatal care (including HIV treatment, if necessary) to assure 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 list the percentages of the Federal poverty level that States have elected to use as their income limits for determining Medicaid eligibility for pregnant women. To find out if you may qualify for Medicaid, locate your State in the right hand column of Table 1, then match it with the Federal poverty level (FPL) required by your State (example: 133 percent of the FPL). However, many States also do not count some types or amounts of income to determine eligibility, so you could have more income than is shown below for a family of your size in your State and still be eligible. Contact your local or county medical assistance, welfare, or social services office to see if you qualify.
| Poverty Level Percentage Required for Pregnant Women to
Qualify for Medicaid (A pregnant woman can have a family income for two (herself and unborn 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 | $1,010.00 | - |
| 133% of the FPL | $1,343.50 | Alabama, Arkansas, Colorado, Idaho, Louisiana, Montana, Nevada, North Dakota, Pennsylvania, South Dakota, Texas, Utah, Virginia, Wyoming |
| 140% of the FPL | $1,414.00 | Arizona |
| 150% of the FPL | $1,515.00 | Indiana, Kansas, Nebraska, Ohio, West Virginia |
| 170% of the FPL | $1,717.00 | - |
| 185% of the FPL | $1,868.50 | Connecticut, Florida, Hawaii ($2,118.00), Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Washington, Wisconsin |
| 200% of the FPL | $2,020.00 | California, Delaware, District of Columbia, Illinois, Maine, New York, Vermont |
| 235% of the FPL | $2,373.50 | Georgia |
| 250% of the FPL | $2,525.00 | |
| 275% of the FPL | $2,770.50 | Minnesota |
| 300% of the FPL | $3,030.00 | Rhode Island |
2003 Monthly Federal Poverty Level Guidelines
Figures Below are for All States and D.C. (Except Alaska and Hawaii)
| Family Size | 100% Poverty* | 133% Poverty** | 150% Poverty | 185% Poverty | 200% Poverty |
|---|---|---|---|---|---|
| 1 | $748.33 | $995.28 | $1,122.50 | $1,384.42 | $1,496.67 |
| 2 | $1,010.00 | $1,343.30 | $1,515.00 | $1,868.50 | $2,020.00 |
| 3 | $1,271.67 | $1,691.32 | $1,907.50 | $2,352.58 | $2,543.33 |
| 4 | $1,533.33 | $2,039.33 | $2,300.00 | $2,836.67 | $3,066.67 |
| 5 | $1,795.00 | $2,387.35 | $2,692.50 | $3,320.75 | $3,590.00 |
| 6 | $2,056.67 | $2,735.37 | $3,085.00 | $3,804.83 | $4,113.33 |
| 7 | $2,318.33 | $3,083.38 | $3,477.50 | $4,288.92 | $4,636.67 |
| 8 | $2,580.00 | $3,431.40 | $3,870.00 | $4,773.00 | $5,160.00 |
How to calculate allowable income for FPL percentages not shown on
the FPL chart:
- Determine your family's size and locate income for your size family at 100 percent FPL.
- Determine the correct FPL percentage for your State (from Table 1)
- Insert a decimal point in the FPL percentage (ex. 140% = 1.40; 170% = 1.70; 225% = 2.25; 250% = 2.50; 275% = 2.75; 300% = 3.00)
- Multiply family income at 100% FPL (from step 1) by the decimal number
determined in step 3.
Table 2
2003 Monthly Federal Poverty Level Guidelines
Figures Below are for Alaska
| Family Size | 100% Poverty* | 133% Poverty** | 150% Poverty | 185% Poverty | 200% Poverty |
|---|---|---|---|---|---|
| 1 | $934.17 | $1,242.44 | $1,401.25 | $1,728.21 | $1,868.33 |
| 2 | $1,261.67 | $1,678.02 | $1,892.50 | $2,334.08 | $2,523.33 |
| 3 | $1,589.17 | $2,113.59 | $2,383.75 | $2,939.96 | $3,178.33 |
| 4 | $1,916.67 | $2,549.17 | $2,875.00 | $3,545.83 | $3,833.33 |
| 5 | $2,244.17 | $2,984.74 | $3,366.25 | $4,151.71 | $4,488.33 |
| 6 | $2,571.67 | $3,420.32 | $3,857.50 | $4,757.58 | $5,143.33 |
| 7 | $2,899.17 | $3,855.89 | $4,348.75 | $5,363.46 | $5,798.33 |
| 8 | $3,226.67 | $4,291.47 | $4,840.00 | $5,969.33 | $6,453.33 |
Table 2
2003 Monthly Federal Poverty Level Guidelines
Figures Below are for Hawaii
| Family Size | 100% Poverty* | 133% Poverty** | 150% Poverty | 185% Poverty | 200% Poverty |
|---|---|---|---|---|---|
| 1 | $860.83 | $1,144.91 | $1,291.25 | $1,592.54 | $1,721.67 |
| 2 | $1,161.67 | $1,545.02 | $1,742.50 | $2,149.08 | $2,323.33 |
| 3 | $1,462.50 | $1,945.13 | $2,193.75 | $2,705.63 | $2,925.00 |
| 4 | $1,763.33 | $2,345.23 | $2,645.00 | $3,262.17 | $3,526.67 |
| 5 | $2,064.17 | $2,745.34 | $3,096.25 | $3,818.71 | $4,128.33 |
| 6 | $2,365.00 | $3,145.45 | $3,547.50 | $4,375.25 | $4,730.00 |
| 7 | $2,665.83 | $3,545.56 | $3,998.75 | $4,931.79 | $5,331.67 |
| 8 | $2,966.67 | $3,945.67 | $4,450.00 | $5,488.33 | $5,933.33 |
* Denotes income level for mandatory Medicaid coverage of children under age 19.
** Denotes minimum income level for mandatory Medicaid coverage of pregnant women. Infants and children under age 6
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, social services or welfare 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.
Contact the person listed in the CMS regional office nearest to you if you have questions about CMS's Maternal HIV Consumer Information Project.
