Health Insurance/Dental Coverage

The program provides health insurance for moderate-income, uninsured pregnant women who are not eligible for no-cost Medi-Cal. The program offers low-cost health insurance with no co-payments or deductibles for covered services. Participants' newborns may be covered by the Medi-Cal Access Infant Program (MCAIP).

Program coverage includes prenatal care, delivery, and health care for the woman until the end of the month of the 60th day following the end of the pregnancy. Services are provided by private health care providers who contract with the State. The subscriber pays a fixed fee which is 1.5% of family income after granted deductions (household MAGI), and has an option of health provider networks to choose from. If the subscriber is enrolled in MCAP, her baby has eligibility for coverage in MCAIP for up to two years, unless her baby is enrolled in employer-sponsored insurance or no-cost Medi-Cal, or her income no longer qualifies her on her infant's first birthday.

Other MCAP benefits include transfer to another health provider if moving within the state, and reimbursement of up to $125 of expenses incurred prior to enrollment which you have already paid. The services must be pregnancy-related and medically needed.

Participants are disenrolled if they move to another state, commit an act of fraud, or are no longer pregnant on the day that coverage is due to begin. Appeals can be made to review eligibility, disenrollment actions or decisions made about transfer requests.