Pregnant Women’s Medicaid Eligibility After 2014 – What’s the Minimum?

By Martha Heberlein

A great degree of confusion surrounds this question and for good reason. You may be surprised to learn that come January 1, 2014, states must cover pregnant women in Medicaid at either 133% of the FPL OR the income standard in place as of December 19, 1989 (or as of July 1, 1989, if the state had authorizing legislation to expand eligibility), whichever is higher. (For the reference in the regs, see §435.116.)

These are the same mandatory minimum requirements in place prior to passage of the ACA (in fact they’ve been in place since coverage was expanded to pregnant women back in the 80’s). States can certainly continue to cover pregnant women above these minimum values, but they are not able to roll back coverage below these well-established thresholds.

While it doesn’t seem all that distant in the past (the babies born that year would just be 23), many of you may not remember what your state was doing with respect to pregnant women’s coverage in 1989 and trying to track down these minimum eligibility standards for pregnant women is not an easy task. The closest we’ve come is a report from the National Governors Association that examined coverage for pregnant women and children as of January 1990. Table 1 provides a handy reference for recollecting where states stood on eligibility for pregnant women, showing that 19 states covered them above 133% of the FPL.