Medi-Cal Maternity Coverage/MCAP

A healthy baby begins with a healthy mother. All pregnant and new mothers deserve access to medical and prenatal care, but that’s not always possible.

If you’re pregnant and uninsured or have a low income, you can receive free or low-cost maternity care when you enroll in a Medi-Cal managed care plan. But, what happens when your household income is too high to meet the low-income Medi-Cal eligibility requirements for services, but not high enough to afford maternity and prenatal care? You could be stuck paying a significant amount in out-of-pocket expenses throughout your pregnancy.

You need a maternity insurance plan that will cover your doctor’s visits, prenatal tests, hospital stay for your delivery, potential hospitalizations due to complications and much more. If you’re a middle-income family and find yourself in need of maternity coverage, you may be eligible to enroll in the Medi-Cal Access Program (MCAP).

What Is MCAP and Who Is Eligible for Services?

The Medi-Cal Access Program (MCAP) helps pregnant women in middle-income families who can’t afford health insurance and have an income that places them out of range for receiving regular Medi-Cal benefits at a low or no cost. If you have health insurance but your plan does not provide coverage for your pregnancy-related medical needs or requires you to pay over $500 for your maternity-only deductible or copayment, you are also eligible for MCAP coverage.

How Medi-Cal Maternity Insurance Differs From Covered California

If you’re enrolled in a Medi-Cal managed care health plan, you pay little to no money for services you receive while pregnant. This differs slightly under the MCAP program. As a pregnant woman enrolled in MCAP, you receive comprehensive medical coverage without paying copayments or deductibles. Instead, you pay a one-time fee for services based on your income. The fee is calculated at 1.5 percent of your Modified Adjusted Gross Income. You can opt to pay your fee in a single installment or over the course of 12 months.

When you’re enrolled in a health care plan under Covered California, you pay a monthly premium for services, depending on your plan, as well as copayments and deductibles for office visits and other pre- and post-natal services.

Thanks to changes made to the Affordable Care Act, Medicaid maternity coverage is better than ever. Updates to the ACA requires all health plans, including those under California’s Medicaid program Medi-Cal, to provide the 10 essential health benefits everyone needs to live healthy lives. One of these benefits is maternity and newborn care. Now, mothers don’t have to worry about whether they have insurance for routine doctor visits, hospitalizations, tests or other pregnancy-related medical services.

In addition to MCAP, Medi-Cal provides a few options for uninsured pregnant women, which include:

• Presumptive eligibility for pregnant women: Pregnant, low-income women receive immediate and temporary coverage for prenatal care for up to 60 days so they don’t have to wait to receive care as they complete the Medi-Cal application process. Hospital coverage for labor and delivery is not included.
• Full-scope Medi-Cal: Eligible low-income pregnant women receive all medical services free of charge.
• Pregnancy-related Medi-Cal: For women who are not eligible to receive full coverage Medi-Cal, this option allows them to receive all needed services.

Apply for MCAP Coverage Today

Pregnancy is a beautiful natural life event, but without health insurance and access to prenatal medical care, it can feel like a huge financial burden to new mothers and families — but it doesn’t have to be.

Health For California is here to help pregnant women find the right maternity insurance plans for their needs. Let us help you find the perfect provider for your growing family. Get a free quote today — it’s quick and easy!