Medical Eligibility

Pregnant Women

Income Guidelines for Full Medical Coverage for Pregnant Women

Family Size:  Eligibility for Limited Medical Coverage for Pregnant Women includes coverage for a pregnant woman and does not include other household members.  The family size includes the pregnant woman, the spouse of the pregnant woman (the father of the unborn child is not included in the family size unless he is married to the pregnant woman); the pregnant woman’s children, including stepchildren, if any; the parent(s) of the pregnant woman if she is living in the same household as the parent(s) and is under age 18; and the unborn (or unborns if multiple births have been verified).

To determine if a pregnant woman may be eligible for medical assistance, follow the steps below:

Step 1: Begin with the monthly gross income (income before deductions) from employment/self-employment of individuals included in the family size.  NOTE:  If the minor parent is ineligible due to the minor parent’s parent(s) income/resources, the Benefits Specialist will recalculate eligibility based on “deeming” during the application process.

Step 2: Subtract $90 of gross monthly income from employment for each employed parent/stepparent living in the household.  (NOTE:  Subtotal of Step 1 and Step 2 cannot be less than $0).

Step 3: Add gross monthly income from non-employment (i.e., child support, Social Security, BIA General Assistance) of each person in the family size.

Step 4: Subtract the following income deductions:

  • $50 of child support received
  • Any court-ordered child support a parent/stepparent living in the household pays to another household monthly
  • Any child care paid monthly so a parent/stepparent living in the household can work

Step 5: The amount remaining is the adjusted income.  Compare the adjusted income to the chart below. If the household’s adjusted income is at or below the amount for the family size, the pregnant woman may be eligible for full medical assistance.

WORKSHEET:

Step 1
Income from employment
Step 2 $90 of gross monthly earnings
(-)
Step 3 Income from non-employment
(+)
Step 4 Income deductions
(-)
Step 5 Adjusted income
(=)

Compare your adjusted income from Step 5 to the chart below:

With full shelter expenses:

Family Size
Adjusted Income
1 Person
NA
2 Persons
$448
3 Persons
$507
4 Persons
$563
5 Persons
$622
6 Persons
$680
*Amount increases with each additional family member.

Living with others, in subsidized housing or other shelter:

Family Size
Adjusted Income
1 Person
NA
2 Persons
$295
3 Persons
$354
4 Persons
$412
5 Persons
$470
6 Persons
$528
*Amount increases with each additional family member.

NOTES:

  • Resources are limited to $1,000 not including the family’s home, personal effects, one household vehicle with an equity value under $1,500.  Resources include Cash, Checking, Savings, Credit Union, Stocks, Bonds, Certificates of Deposit, Life Insurance, Trust Funds, Individual Indian Monies (IIM), Money Market Funds, Deferred Compensation Plan, Burial Funds, Contracts for Deed, IRAs, 401K, Keogh plan, and other items of value.

  • If the pregnant woman is under age 18 and living with a parent(s), a portion of the parents' income and resources are countable.
  • If a member of your family receives SSI DO NOT include him/her in the family size and DO NOT count his/her income.