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The Ins and Outs of Trying to Conceive (TTC) on Medicaid

Updated on July 11, 2016
Public domain.
Public domain.

If you are planning to have a baby or are TTC while on Medicaid, you are not alone. According to the National Institutes of Health, 45% of all births in the United States were paid for by Medicaid health insurance between the years of 2008 and 2010.

And since the Affordable Care Act (Obamacare) was passed in 2010, it is expected that Medicaid and state-expanded Medicaid will have covered over half of births between 2011 and 2015.

But the road to getting pregnant can be complicated for women on Medicaid.

The problem that women encounter while trying to have a healthy pregnancy under this coverage is that pre-pregnancy and fertility services are rarely offered under this national health insurance, as it is taxpayer-funded, but medical services are still provided that coincidentally might help a woman become pregnant.

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Suggestions on How to Approach Infertility Issues With Your Doctor for Likely Treatment

  • If you ask your doctor or your healthcare plan representative about fertility treatments, you will most likely be answered with a comment such as, "Unfortunately, that is not covered." But there is a different approach you may use with your doctor.
  • It is important to note that you must be suffering from a symptom that is associated with a disease that coincides with infertility to be treated for the disease. Often the treatments will also help you get pregnant, such as pharmaceutical medicines Clomid or Metformin.
  • According to the Office on Women’s Health under the U.S. Department of Health and Human Services, PCOS is the leading cause of infertility in the United States. If you have menstrual cycle irregularities, frequent pelvic pain, hormonal imbalances, or excessive body hair, which are associated with PCOS, you should then be offered hormonal tests. If your hormones are indeed out of normal bounds, you will either be prescribed medication that can coincidentally help you get pregnant or be advised of lifestyle changes, such as diet and exercise. According to Harvard Health Publications, even proper diet and exercise alone helps to increase fertility in some women. Medicaid in most states offers screenings and consultations with medical professionals which will help you get on the right track with weight loss.
  • If you already have diabetes or high cholesterol, which can coincide with PCOS, you can approach your physician about fears of PCOS.
  • You can also approach your doctor about symptoms associated with other health issues that cause infertility, such as pelvic inflammatory disease, endometriosis, or uterine fibroids.

Planning to have a baby on Medicaid? Public domain.
Planning to have a baby on Medicaid? Public domain.

Medicaid Family Planning Services You Will Most Likely Be Avoiding

According to a report by the Kaiser Family Foundation, Medicaid pays for "family planning" services, but the dirt is in the details. You might use these family planning services at some point but when you are TTC, you will generally be avoiding these services. Medicaid's official family planning services are mostly limited to:

  • Birth control
  • The treatment of STDs or STIs that, left untreated, could lead to infertility.
  • Reproductive services such as PAP smears
  • Sterilization

Medicaid does not cover:

  • Advanced reproductive services like IVF (in vitro fertilization)
  • Egg freezing
  • Preconception genetic screening

Prenatal Vitamin Coverage by Medicaid

Coverage for prenatal vitamins pre-pregnancy is not offered.
Coverage for prenatal vitamins pre-pregnancy is not offered.

What to do on your own while you are TTC

  • It is important to take prenatal vitamins while you are having unprotected intercourse. You will need to purchase them yourself until you are confirmed to be pregnant. Medicaid will not pay for prenatal vitamins until you are actually pregnant. Prenatal vitamins with folate and iron are recommended for women to help prevent birth defects of the baby's brain and spinal cord.
  • Take care of yourself. Do not smoke, drink alcohol, take illegal drugs, or eat high-mercury seafood. If you are already taking medicine, ask your doctor if it is okay if you become pregnant while on the medication.
  • Always speak to a health professional before getting pregnant and to ensure you and your partner are healthy.

In summary, if you are suffering from any symptoms associated with diseases that lead to infertility and you want to have a baby, Medicaid can be helpful in addressing the root of the disease and can often help restore fertility with no cost to you.

Sources

http://www.ncbi.nlm.nih.gov/pubmed/23993475

http://kff.org/report-section/medicaid-and-family-planning-medicaid-family-planning-policy/reproductive

https://arm.coloradowomenshealth.com/resources/medicaid-fertility-treatments/

http://www.health.harvard.edu/diseases-and-conditions/follow-fertility-diet

http://womenshealth.gov/publications/our-publications/fact-sheet/infertility.html#

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/downloads/rtc-preventive-obesity-related-services2014.pdf

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