California

California offers several insurance options for maternal and child healthcare, ensuring access to prenatal, childbirth, postpartum, and pediatric care. These options range from government-sponsored programs to private health insurance plans.

A. Public (Government-Sponsored) Insurance Programs

Medi-Cal (California Medicaid Program)

Covers low-income pregnant women, children, and families.
Provides comprehensive maternity care, newborn coverage, pediatric care, mental health, dental (Denti-Cal), and vision services.

Eligibility

Pregnant women with incomes up to 213% of the federal poverty level (FPL) qualify for full-scope Medi-Cal.
Infants under age 1 are eligible up to 322% FPL.
Children up to age 19 qualify with family incomes up to 266% FPL.
No-cost or low-cost coverage, including delivery and postpartum care.

Medi-Cal Access Program (MCAP)

For middle-income pregnant women (200-300% FPL) who don’t qualify for full Medi-Cal.
Low-cost premium (1.5% of annual household income).
Covers prenatal, labor, delivery, postpartum, and newborn care.
Infants are enrolled in Medi-Cal Access Infant Program (MCAIP) after birth.

Covered California (State Health Insurance Exchange)

Marketplace for purchasing private health insurance with subsidies based on income.
Required to cover maternity and newborn care as essential health benefits.
Special enrollment for pregnancy, birth, or adoption.
Eligibility: Subsidies available for individuals earning 138%-400% of FPL.

California Children's Services (CCS)

Provides specialized care for children with serious medical conditions (e.g., congenital disorders, cancer, severe disabilities).
Available to children under 21 in low- to moderate-income families.

Access for Infants & Mothers (AIM) – Now Part of MCAP
Merged with MCAP; formerly served uninsured middle-income pregnant women.

B. Private Health Insurance

1. Employer-Sponsored Health Plans – The most common private insurance option, offering maternity and pediatric coverage.

1. Individual & Family Plans – Can be purchased through Covered California or directly from insurers.

Must cover prenatal, labor & delivery, postpartum, and newborn care under the ACA (Affordable Care Act).

C. Other Assistance Programs

1. California Women, Infants, and Children Program (WIC) – Provides nutritional assistance, breastfeeding support, and healthcare referrals for low-income mothers and children under age 5.

1. Children’s Health Insurance Program (CHIP) – Part of Medi-Cal – Offers low-cost healthcare to children in families that earn too much for Medi-Cal but cannot afford private insurance.