r/HealthInsurance • u/Streani • May 24 '25
Medicare/Medicaid My girlfriend is pregnant. How does insurance work for our child?
State: NY
In New York, children can be continuously enrolled in Medicaid or Child Health Plus (CHP) until they turn six, regardless of changes in their family's income as of 2024
Hello! My girlfriend was recently fired from her job and is on unemployment and thus on Medicaid, as she went from 50k/yr to less than 20k (unemployment), and she is due in September. Even if she finds a new job, she will still be on Medicaid as NY gives you continuous coverage for 1 year, and from what I can tell, it looks like the child will get 6 years also.
I work a W2 job and make approximately 100k. We do not have plans to get married at this time until 2027.
What is the proper way to do insurance for our unborn child? In my mind, the proper idea is for me to add the child to my insurance, and then Medicaid will be the secondary. Girlfriend will continue to stay on Medicaid until she finds a new job, pending its above the income threshold. My income will not count for her Medicaid as we are not married, but it would count for our child's even though he gets supported for 6 years. I've read online about Medicaid going after fathers for support, but it seems these articles are from the 2000s era.
I provide all family support at this time and they live with me, so I just want to make sure I'm doing everything correct.
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u/Vervain7 May 24 '25
I thought they look at household income not the married taxed income for Medicaid.
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u/321_reddit May 24 '25
For individual, adult Medicaid yes. OP’s and partner’s income both count for the child in common, irrespective of relationship status.
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u/Streani May 24 '25
I found this and I think this gives the best explanation for NY
I'm still not 100% sure though about my insurance as primary and medicaid secondary. Our gyno seemed to think it was correct lol
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u/321_reddit May 24 '25 edited May 24 '25
Yes, Doctor is correct. Medicaid will always be payer of last resort. Any other insurance is primary.
This assumes your private insurance allows you to add domestic partners. Your private insurance will cover child once born and you have added them to your plan. Partners’ insurance (Medicaid or otherwise) will pay for prenatal and delivery.
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u/Streani May 24 '25 edited May 24 '25
My insurance doesn't allow domestic partners
Ty!
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u/321_reddit May 24 '25
Partners’ Medicaid will pay prenatal and birth expenses, plus her and child up to a year after birth. Child age 1 to 6 is NY specific and subject to change, especially with proposed reduction in Medicaid spending.
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u/Streani May 24 '25
This is what I figured. I just couldn't find out if I had to put our child on my insurance or not, dr was unsure.
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May 24 '25
[removed] — view removed comment
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u/Blossom73 May 24 '25
You can’t have Medicaid as secondary. It’s a means based program and if you can get Medicaid you shouldn’t have other sources of insurance unless you are on Medicare.
That's absolutely not true.
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u/Streani May 24 '25
Medicaid isn't changing for pregnant adults much thankfully - Already read trumps bill
You can 100% have medicaid as a secondary though, I did for a couple of years.
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u/Streani May 24 '25 edited May 24 '25
From my understanding..
If you are not married, my income will not be counted toward my girlfriends eligibility. I would not be considered a household member. If I claims her as a tax dependent, I still would not be considered a household member (there is an exemption for “dependents claimed by non-parents/spouses”). I don't plan on claiming her because she worked this year and made income, but I will probably claim our child, depending on how it works with the better return
My income will be counted towards my unborn child's Medicaid eligibility, however, and they will be considered a part of her household.
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u/Concerned-23 May 24 '25
False. Medicaid uses household income not tax income. If you live together you’re a household
Edit: This is New York specific. You have to check based on your state
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u/Streani May 24 '25 edited May 24 '25
NY Rules on this
- Spouses: Legally married spouses are always included in the Medicaid household, regardless of how they file taxes.
- Unmarried Partners: An unmarried domestic partner is only considered part of the household if:
- They have a child together.
- They are claimed as a tax dependent.
- Other Individuals Living Together: Individuals who are not married, don't have a child together, and aren't claimed as a tax dependent are generally not considered part of the Medicaid household, even if they live together.
Doesn't this mean "living together" doesn't automatically make you a household? I wouldn't be a household with our roommate for example.
Because we are not married and the child is not yet born, I am still not a part of her household, but I will be a part of the childs household
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u/Working_Coat5193 May 24 '25
You will have a child together.
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u/Blossom73 May 24 '25
That doesn't matter. An unmarried couple, who doesn't file taxes together, nor are tax dependents of each other aren't a Medicaid household. Regardless of whether one of them is pregnant and regardless of whether they have a shared child.
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u/Concerned-23 May 24 '25
You have a child together. You are a household
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u/Streani May 24 '25
Read this. Multiple different "household" statuses.
This was the hard part for me to understand. We applied for my girls medicaid recently in person once she got fired and they said not to count my income.
It gets even more confusing for tax filing. I will file head of household and claim child and she will file single or vice versa
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u/_-Raina-_ May 25 '25 edited May 25 '25
Go to the local aid office and apply. They will very precisely explain to your girlfriend the requirements for assistance. You'll have to split the rent down the middle and anything else she wants to claim as an expense like utilities on paper that's her bills to report, they will give you a list, etc etc. It's not a big deal. But with the way things are going with our government, you should really get that application and approval done ASAP. Yes... Unmarried couples do not have to be a "household" because they share an address. But state to state rules vary and they are changing continuously almost at this point. Some states do now require that you include the father in the household if you share an address and a child. But that might be different today than last week, and next week it might change again. 🤷🏼♀️
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u/Streani May 25 '25
I should've mentioned this but the approval was already done last month!
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u/_-Raina-_ May 25 '25
That would've been handy to know. lol Whatever they told you is what you have to do. But read the instructions precisely. There are legal ways to separate your household. For Medicaid, if she's approved she's approved. Medicaid pays for everything. Putting the child on your insurance would be a waste of your money.
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u/Streani May 25 '25
Yeah, the thing I was told is they said there is a legal require after 1 year to put the kid on my insurance because of "medicaid enforcement support" but it seems like this is for child custody cases
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u/Blossom73 May 25 '25
OP, you're getting a lot of bad information on this post. She should just go ahead and apply, as soon as possible.
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u/Streani May 25 '25
She already applied in person and got Medicaid the week after her termination in April. However, the person we applied with didn't seem super knowledgeable about the unmarried child situation. She also has an active lawsuit on the company for termination as they terminated her after finding out she was pregnant, but said it was for a safety violation that happened 60 days prior.
I was mainly asking because the medicaid person said I'm not required to add the child to my insurance for the 1st year they are on Medicaid, but I can't find this info online, really.
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u/Blossom73 May 25 '25
The baby will be automatically eligible from birth for Medicaid, as a deemed infant, due to being born to a mother on Medicaid. Typically the baby will have guaranteed Medicaid coverage until their first birthday, but it sounds like NY extends that.
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u/pathto250s May 24 '25
So is she your wife or your girlfriend?
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u/Streani May 24 '25
we are engaged to be married in 2027, so fiancée, but for insurance purposes they don't consider engagements
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May 24 '25
[deleted]
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u/Streani May 24 '25 edited May 24 '25
We are getting married just not right now, we've already planned it out, we just aren't doing it this year. This was planned before she was pregnant too.
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May 24 '25
[deleted]
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u/Streani May 24 '25
She isn't at any risk of losing insurance right now, we have COBRA for dental+vision and Medicaid for health.
I did try to convince her of this, though, a while back, and she didn't want to do it. She hates the idea of a quick courthouse. One of the big reasons she's against this is her student loans, and the fact she wants to get married in mexico
I can't imagine this is an abnormal circumstance. There are plenty of people who don't marry and have kids.
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