Perinatal health outcomes directly relate to insurance coverage. The Medicaid program is the single largest health insurer of children, providing coverage to almost half of births nationally. Organized as a federal-state partnership, Medicaid allows states to modify minimum standards of eligibility and coverage created by the federal government. The dual funding structure of Medicaid, however, exposes the program to national and local politics, often placing funding in jeopardy. This paper reviews the history, basic design and scope of Medicaid coverage for infants and birthing people. It introduces policy tools such as waivers and amendments used by states to alter their programs and reviews funding threats that may reduce benefits. Recent history related to the impact of the Affordable Care Act and its effect on the number of insured individuals will be discussed as well as 2025 changes to Medicaid funding. Ultimately, physician advocacy is required to ensure Medicaid continues to protect families.