What It's Like to Have a Baby on Medicaid, According to Parents Who've Been There

No matter how you slice it, having a baby is expensive. Data from 2016–2017 suggests that with employer-sponsored insurance, vaginal delivery costs around $12,235 on average and delivery by cesarean section (C-section) costs around $17,004. With private health insurance, out-of-pocket costs average between $1,000 to $2,500. But without it, your first instinct may be to panic.

Fortunately, your costs will likely be covered if you qualify for state-covered health insurance (Medicaid). Medical providers have a duty to provide the same level of care to every patient they see, no matter the insurance type. But many expecting parents fear that "free" health care will be subpar, and for good reason: Sometimes it is.

Read on for the experiences of three women who have delivered babies on both Medicaid and private insurance. Plus get expert insight on how to get the care you deserve if you find yourself seeking federal or state insurance.

What Is Medicaid?

Federal and state insurance called Medicaid is income-based insurance that usually has no co-pays and helps those with limited income. Since 2020, the number of Medicaid recipients has steadily increased, likely due to the economic ramifications of the COVID-19 pandemic. In February 2020, Medicaid enrollment was around 64 million; as of October 2022, enrollment was 84 million.

Many state marketplaces and Healthcare.gov will inform you of your Medicaid eligibility. The Kaiser Family Foundation also offers a tool to help you know if you qualify.

What to Expect While Expecting With Medicaid

First things first: Your insurance does not dictate your level of care, says Philadelphia-based health care consultant Kyana Brathwaite, R.N., who has over 20 years of experience in the medical field.

Fortunately, many people note that prenatal and labor and delivery care is similar to care received through private insurance (most basics are covered). But, anecdotally, there may be some differences.

Confronting biases

For one, Brathwaite explains that some health care providers have presumptions about Medicaid. "Sometimes people look at Medicaid on your chart and treat you as if you're lazy and you're just trying to live off the government," she says. "They have no idea what your situation is." She has experienced this and witnessed it herself.

When Suzanne Nelson, 48, of West Deptford, New Jersey, was on Medicaid, she notes she was asked multiple times if she wanted to have her tubes tied. "My private doctor kept asking me to have more kids, but I felt judged and guilty at the Medicaid facility, even though I was working part-time at a doctor's office that didn't offer benefits."

It's an example of the bias that Brathwaite has pushed back against in her work.

Limited scheduling

Nelson had three children using both state and private insurance. She says that she dealt with limited scheduling when she gave birth on Medicaid. She says doctors at the Medicaid clinics also maintained private practices and prioritized those patients over the low-income ones.

Eunice Diaz, 34, of New York City, also notes that New Jersey's Medicaid program did not cover doula care until after she needed it.

Limited provider network

Diaz also discovered that she could not keep her highly-rated OB-GYN when she switched from private insurance to Medicaid since the doctor did not take state insurance. Of course, many top doctors do take Medicaid; in fact, a 2019 report from the Medicaid and CHIP Payment and Access Commission found that 81% of OB-GYNs accept new patients on Medicaid. But even though they may take some patients, that does not mean they will take every person using state insurance.

According to the Medicaid and Children's Health Insurance Program Payment and Access Commission, the reasoning is that Medicaid pays 40% less for care than private insurance. This can make it challenging to cover overhead fees. Therefore, health care providers must balance private and state insurance clients.

When she sought a provider specializing in unmedicated births, Diaz says that finding a specialist through the state's database also had logistical challenges. For example, most of the phone numbers listed didn't take you to a particular doctor but to a group of doctors. And many numbers were no longer in service.

Lower out-of-pocket costs

In the end, Diaz was relieved that, with Medicaid, she didn't have a $5,000 bill after giving birth to her daughter, Chloe, as she did with her first daughter, Riley. Both girls were born in the same hospital.

Financial motivation

But, the lower costs may come with some downsides. For example, some question whether their type of birth or interventions were financially motivated.

There are several reasons a doctor might need to perform a C-section, mainly involving the health of the parent and baby. But, the comfort level of the health care provider also plays a role, says Brathwaite. "The one that makes me cringe is that C-sections yield more money." Theoretically, performing a C-section could potentially be a way to make up for lower reimbursements from Medicaid.

Sindy Lozada, a 32-year-old in Marlton, New Jersey, who has given birth four times, delivered her third baby stillborn at 36 weeks on Medicaid. She notes that her physician pushed her to deliver via C-section when she felt that would be more traumatic for her.

Ultimately, Lozada advocated for herself and pushed her baby out vaginally. But she felt like her doctor had more of a financial focus than caring about her well-being.

C-sections are more costly than vaginal births with private insurance and Medicaid. And the U.S. performs a lot of C-sections. In most states, C-section rates are over 25%; in many states, C-sections account for more than one-third of all births.

The practice has drawn criticism from the World Health Organization (WHO), which says that cesarean rates should ideally be no more than 10% to 15% of births. In addition, WHO says C-sections should only be performed when medically necessary, which wasn't the case for Lozada.

How to Prepare for a Medicaid Birth

The good news is that empowering yourself and being informed can help you get the best support and care possible. Here's how to prepare for delivering a baby on Medicaid.

Know what's covered

The Kaiser Family Foundation has an extensive list of what is covered by Medicaid in each state. While coverage varies, all cover:

• Basic prenatal care
• Vitamins (some require a prescription for prenatal vitamins)
• Ultrasounds (may limit how many ultrasounds you can get)

The Affordable Care Act (ACA) also mandates that states must cover birthing centers they license (very few cover home births). The ACA also requires breast pump coverage, though the type is up to the insurance.

Doula care is also covered in New Jersey, Minnesota, and Oregon. And testing for genetic abnormalities is offered in most states—with most covering chorionic villus sampling (CVS) and amniocentesis. Also, nearly all states provide case management to aid people in getting specialty services, such as depression screenings and financial assistance (though some limit it to high-risk cases).

To ensure you're getting everything you are entitled to, Brathwaite suggests calling your insurance company and asking for a breakdown of your postpartum, prenatal, and preventative gynecological options. Finding the right plan for you and your particular needs can also ensure you get the care you seek.

Advocate for yourself

Everyone has a right to informed consent and a thorough explanation of benefits and risks before deciding. For instance, before your OB-GYN decides on a particular kind of testing, ask if there are any indications that one would be necessary and if there are alternatives.

Brathwaite also recommends shopping around for doctors like pediatricians, reminding parents that if they don't want to stick with the one who took care of their baby in the hospital, they don't have to. It is an empowering practice to have a say in every part of your and your baby's care.

Report malpractice

Brathwaite recommends informing your practice of any mistreatment. "In a hospital system, speak to your nurse manager on the unit. The next step is the nurse supervisor, then the director of nursing. An office manager can handle your concerns at a private office."

If it isn't clear who is in charge within a hospital system, you can find the patient relations phone number and ask for the best person to handle a complaint. You can also request not to deal with someone within the practice if you have had a bad experience. The last resort: changing doctors.