What is pregnancy medicaid like in Maryland?

August 29, 2018 5:04 AM

My sister just found out she's pregnant. She's an independent contractor in MD about to be dropped from our parents' insurance plan. Is pregnancy medicaid a good option for her and what can she expect?

She's pregnant with her boyfriend of three years. I don't know if they're going to get married but she wants to keep the baby (he knows). He is currently unemployed. She is a freelance photographer/other stuff and makes around $40,000 - $45,000 before tax. They live in Baltimore. I don't know if this is relevant, but she doesn't want our parents to know she is pregnant. I want to help but I live and work overseas.

She is overwhelmed with trying to find an insurance plan for pregnancy and even if she wasn't going to be dropped from our parents' plan due to her age, I don't know if it would have even covered her pregnancy.

I think she'd be a good candidate for pregnancy medicaid. It seems like her income would qualify her in Maryland and the benefits are quite generous (she'd even get dental) and it would cover her baby for a year once he/she is born. Obviously, I'd hope the boyfriend could get a job with insurance and marry her but I've never met the guy so...

She is skeptical about pregnancy medicaid and thinks she'd only have access to bad doctors/OBGYNs or those who are way overworked or finding a "good" doctor would be really difficult. I admittedly know nothing about what pregnancy medicaid is really like or what the process of finding an OBGYN or any baby-related stuff is like.

Can anyone shed light on what pregnancy medicaid is like, specifically in Maryland? If she goes through with it, are finding "good" doctors/hospitals going to be very hard? What does she need to look out for? As an addendum, is there anything I can do to help from overseas?

posted by anonymous to Health & Fitness (8 answers total)

Medicaid these days partners with private insurance groups ("managed care organizations") to provide in-network coverage, and medicaid enrollees can select which MCO best fits their needs. Your sister can review the options here and see which one fits best with her location. Physician participation in Medicaid insurance plans is slightly lower than for private insurance plans, but it's not drastically lower (like, 70% of doctors in the country are accepting new patients on some form of Medicaid insurance, compared to 84% who are accepting new patients on some private insurance plan). It's basically the same hurdle that anyone in the U.S. using health care insurance faces: not all doctors take all insurances, which is not exceptionally problematic in a large urban areas because there are so many doctors to chose from. In areas with fewer providers that can lead to problems with access.
posted by drlith at 5:24 AM on August 29, 2018

It may be helpful to know that 44% of babies born in Maryland were on Medicaid. This would lead one to believe that there would be a fair number of doctors accepting Medicaid, not all of which could be bad. You can typically call a prospective doctor's office to figure out what insurance they accept. Or you can search Zocdoc (specify location, OB/GYN, insurance). But like drlith noted, Medicaid comes in several different forms these days.
posted by yonglin at 5:27 AM on August 29, 2018

Before she worries about it she should find out if she would even be eligible with her income.
Check here.
posted by mareli at 5:46 AM on August 29, 2018 [1 favorite]

Please tell your sister to take a look at the community health programs available through Baltimore Medical System ... not sure where exactly she is located, but they have a number of clinics and they offer strong prenatal and new-parent programming, along with comprehensive medical care for both mother and baby. They also have benefits advisors who can help her select the right Medicaid options and can assist her with enrolling the child.

443-703-3600 is their phone number. They will prioritize appointments for pregnant women, with the goal of getting her into prenatal care as soon as possible.

Her reluctance is not surprising but is based on some outdated notions ... Medicaid for primary care and maternal/child health has come a long way. Access for specialty care can still be difficult, and it's harder to find providers in high-income areas, but she should have a range of options in Baltimore.
posted by mccxxiii at 5:49 AM on August 29, 2018

Medicaid has a big advantage over a crappy exchange plan- low to no out-of-pocket costs. Beats paying thousands out of pocket.
posted by ThePinkSuperhero at 7:07 AM on August 29, 2018 [2 favorites]

She will qualify for MD Medicaid. For pregnant women, household size of 1, there’s no income requirement. (See https://www.marylandhealthconnection.gov/shop-and-compare/medicaid-basics-and-benefits/). She should apply, and her coverage starts the day she applied. Even if she starts with an OBGYN prior to enrollment and then went on Medicaid, if the doctor accepts Medicaid then she can continue her care with them.

Is she in Baltimore city or county? I have a friend who used University Maryland Medical and she said good things (https://www.umms.org/ummc/health-services/womens-health/obstetrics-gynecology). I don’t know how good Kaiser is but they take Medicaid and it would be everything in one place if she is stressed.

(I’m typing quick on my phone but happy to help more if you memail me. I’m in heath policy and am local.)
posted by inevitability at 7:12 AM on August 29, 2018 [5 favorites]

Don't forget that the baby, once born, will also need insurance. Once discharged from the hospital he/she will need a pediatrician pronto and his/her own insurance.

Medicaid is a wonderful program, and hospital staff, at least, usually don't even know who has what insurance. Two deliveries on the same day might have had the same primary OB/GYN where one patient was private insurance and one was Medicaid. OB/GYNs have such crushingly expensive malpractice insurance rates that very few are independent any more, but have joined hospital groups that cover this expense. Many rural hospitals have also stopped delivering babies because of the enormous overhead required; it's a big problem in a lot of the country. Most larger hospitals have dedicated OBs who deliver, so that your sister's baby would be delivered by the doctor who is doing his or her shift that day, rather than "her" doctor. Her own doctor might not even be insured to deliver babies. It's possible to do just prenatal Obstetrical practice, while some do only deliveries.

One enormous advantage to Medicaid is that there are usually NO COPAYS or DEDUCTIBLES, unlike commercial plans that have deductibles and copays the patient needs to pay (sometimes many thousands) before the plan covers. Pregnancy is one of the most expensive conditions to cover, too. Medicaid eliminates this and is an incredible blessing to the financially insecure and poor people who are covered by it. And it leads to healthier births and healthier moms.


There may be a community nonprofit in her area who works with expectant moms to help with Medicaid insurance and other issues. They would probably be enormously helpful. If she's near Baltimore, I'd call Johns Hopkins to see if they have a prenatal social worker willing to speak with her - at the very least she will have the names of nonprofit partners who could help her sort out how to move forward. Good luck to her and the baby.


Source: my OB/GYN cousin who practices at a hospital in Maryland
posted by citygirl at 12:17 PM on August 29, 2018

The less-expensive exchange plans will also most likely have her going to the doctors whose patient population is mostly poor, with limited choice of doctors. I'm not sure what she thinks her alternative is, other than getting her boyfriend to man up?
posted by praemunire at 1:07 PM on August 29, 2018