• Eligibility
  • Maggie

    Getting Insurance Coverage for an Underinsured Pregnant Woman

    When 21-year-old Maggie was four months pregnant, she received a notice that she did not qualify for Medicaid health insurance. Maggie called PHLP’s Helpline to get legal advice about appealing this denial and whether she was eligible for Medicaid. Through advocacy with Maggie’s County Assistance Office (CAO), we were able to resolve the erroneous denial of Maggie’s Medicaid application and get her approved for health insurance that will meet her needs and the needs of her baby.

    Maggie had private health insurance coverage through her parents, but after she found out she was pregnant, she also discovered she was underinsured. Her private health insurance would leave her with thousands of dollars in medical bills. To help avoid these costs, it was recommended that Maggie apply for Medicaid as her secondary insurance. Medicaid often covers healthcare services that private insurance companies will not cover, and Maggie was pretty sure she was eligible for Medicaid based on what she had heard and read. She applied for Medicaid, but her application was denied because the CAO inappropriately viewed her as a household of one. Under Pennsylvania Medicaid law, pregnant people must be considered a household of two for eligibility purposes. The reason this mattered: Maggie was over the income limit for a household of one, but she met the income limit for a household of two. Thus, with the rules appropriately applied, Maggie should have qualified for Medicaid.

    PHLP reached out to the CAO and pointed out the error in Maggie’s household size calculation. We urged the CAO to re-review Maggie’s application a household of two based on her pregnancy. The CAO agreed an error had occurred and re-reviewed Maggie’s application. She was approved immediately.

    Thanks to quick legal advocacy by PHLP, Maggie was able to get approved for Medicaid so that she would no longer have to worry about being underinsured and incurring thousands of dollars in medical debt.