Having a baby in the U.S.: practical and paperwork basics

Step 1 — Get coverage for the pregnancy and birth

All Marketplace and Medicaid plans cover pregnancy and childbirth, even if the pregnancy began before your coverage started (HealthCare.gov). Being pregnant does not open a Special Enrollment Period (a chance to sign up outside the yearly Open Enrollment), but the birth of a child does (HealthCare.gov).

Medicaid and CHIP give free or low-cost coverage to eligible people, including pregnant women, and accept applications all year (HealthCare.gov). HealthCare.gov now says that, because of a law change, the only immigrants eligible for full Medicaid or CHIP are green card holders, Cuban or Haitian entrants and Compact of Free Association (COFA) migrants; depending on the state, “lawfully residing” pregnant women and children may also be eligible (HealthCare.gov). If you’re found eligible during pregnancy, you’re covered for at least 60 days after the birth, depending on your state, and some states offer 12 months (HealthCare.gov). Details, the 2027 changes and “public charge”: health insurance for newcomers.

If labor starts and you have no coverage. Under a federal law called EMTALA, a hospital emergency department must offer a screening exam and treatment for an emergency medical condition, “which can include experiencing contractions,” even if you have no insurance, can’t pay or aren’t a U.S. citizen (CMS). For bills, see where to get medical care.

Step 2 — Start prenatal care, even without insurance

Prenatal care means regular check-ups during pregnancy. Community health centers provide prenatal care and “baby shots,” and what you pay depends on your income (HealthCare.gov). According to HRSA, the federal agency behind them, health centers have obstetricians/gynecologists and pediatricians, adjust fees to income and family size, and must serve everyone, even people who cannot pay (HRSA). Use Find a Health Center to locate one (HRSA). For your right to a free interpreter, see where to get medical care.

Step 3 — Apply for WIC while you’re pregnant

WIC, a U.S. Department of Agriculture program, provides healthy foods at no cost to you, nutrition education, breastfeeding support and referrals (USDA). It is available to women who are pregnant, postpartum (up to 6 months after the end of a pregnancy) or breastfeeding (up to the baby’s first birthday), and to infants and children up to their fifth birthday (USDA — WIC Eligibility).

You apply through a WIC agency in your area, sometimes online, and get a free health check by WIC staff (USDA). If you get Medicaid, SNAP or TANF, you may already be income eligible, and a pregnant person may count one extra household member for each expected baby (USDA). More: raising kids in the U.S.. Worried how a program could affect an immigration case? Ask an authorized legal helper first: free immigration legal help.

Step 4 — Know your rights at work

• Accommodations. Under the Pregnant Workers Fairness Act (PWFA), a covered employer must make reasonable changes for limitations related to pregnancy or childbirth, such as more breaks, a stool, a different schedule or leave for appointments and recovery, unless that causes an “undue hardship” (EEOC). It can’t make you take leave if another accommodation would let you keep working (EEOC).
• Unpaid, job-protected leave. The Family and Medical Leave Act (FMLA) gives eligible employees up to 12 workweeks of unpaid leave in 12 months for the birth and care of a newborn, with group health coverage kept (DOL). Eligibility rules include at least 12 months and 1,250 hours of work for a covered employer, with at least 50 employees within 75 miles (DOL). You return to the same or an equivalent job, and some states have their own leave laws (DOL — Fact Sheet #28).
• Breaks to pump breast milk. For one year after the birth, nursing employees covered by the law get reasonable break time and a place other than a bathroom, shielded from view (DOL). Some small employers may be exempt (DOL — Fact Sheet #73).

Pregnancy discrimination is illegal at employers with 15 or more employees, and the deadline to file a charge with the EEOC is generally 180 days (EEOC); see where to file a complaint. Leave and pumping questions: Wage and Hour Division, 1-866-487-9243 (DOL).

Step 5 — Get a car seat before the birth

NHTSA, the federal road safety agency, says a child under age 1 should always ride in a rear-facing car seat (NHTSA). Install it before your due date. Certified technicians at inspection stations check seats and show you how to install them, free of charge in most cases, and you can register the seat with its maker to get recall notices (NHTSA). Used seats, state laws and safe sleep: raising kids in the U.S..

Step 6 — At the hospital: birth certificate and SSN

At the hospital, you give the information for your baby’s birth certificate. SSA calls this the easiest moment to apply for your newborn’s Social Security number (SSN): you’ll be asked whether you want one and for both parents’ SSNs, and you can still apply if you don’t know both (SSA; USA.gov). Check every name and date before you sign.

An SSN for a newborn is voluntary, but SSA says you need it to claim your child as a dependent on your tax return (SSA). It’s free; report anyone who wants to charge you to SSA’s Inspector General at 1-800-269-0271 (SSA). Applying later means starting online and finishing at a Social Security office with original documents, and it may take longer (SSA).

Documents for children whose parents aren’t U.S. citizens. The rules on U.S. documents for children born in the U.S. to parents who are not U.S. citizens have been the subject of executive orders and court cases. On June 30, 2026, the Supreme Court held that children born in the United States to parents “unlawfully or temporarily present” are “citizens at birth” under the Fourteenth Amendment (Supreme Court — Trump v. Barbara). A new executive order signed on August 6, 2026 then named situations in which agencies are not to issue documents recognizing citizenship when neither parent is a U.S. citizen (Federal Register). SSA and the State Department have published plans for applying that order, and both say their plans may still change (SSA; State Department). We don’t summarize these rules, because they are changing and depend on each family’s situation. If this may affect your family, talk to a licensed immigration attorney or a DOJ-accredited representative: see free immigration legal help.

For your own number, see how to get a Social Security number.

Step 7 — Add your baby to health coverage

• Marketplace: having a baby opens a Special Enrollment Period. Apply within 60 days of the birth; coverage can start on the day your baby was born (HealthCare.gov; HealthCare.gov — SEP). Already in a Marketplace plan? Report the birth as soon as possible; you can add your baby to your plan or enroll them separately (HealthCare.gov).
• Medicaid: if you have Medicaid when you give birth, your newborn is automatically enrolled and stays eligible for at least a year (HealthCare.gov). If your own Medicaid or CHIP ends after the birth, you can apply for a Marketplace plan (HealthCare.gov).
• Insurance through a job: ask your employer’s benefits office how and by when to add your baby.

Step 8 — Get birth certificate copies and a passport

Birth certificates are kept by the vital statistics office of the state (or a city or county office) where the birth happened, not by the federal government (CDC). CDC’s Where to Write for Vital Records links to each state’s office, with its fees and a phone number to check them (CDC). Keep the originals safe: SSA doesn’t accept photocopies or notarized copies (SSA).

A U.S. passport for a child under 16, according to the State Department (page updated April 2, 2026) (State Department):

• You apply in person with Form DS-11. Both parents or guardians must approve and come with the child; if one can’t, you need extra documents, such as a notarized Statement of Consent (Form DS-3053) signed within the last three months.
• You submit paper evidence of U.S. citizenship. A U.S. birth certificate must show the issuing office’s seal, the child’s full name, date and place of birth, the parents’ full names, a filing date within one year of birth and the registrar’s signature.
• You bring each parent’s photo ID, photocopies and a photo of the child, and pay one fee to the State Department and one to the acceptance facility. The passport is valid for 5 years.

Before you apply, read the note in Step 6.

Step 9 — Find a doctor for your baby and plan vaccines

Choose a pediatrician or a health center before the birth if you can. Ask the doctor which vaccines your baby needs and when; the CDC publishes schedules by age group (page dated July 2, 2025) (CDC). The Vaccines for Children (VFC) program gives free vaccines to children 18 or younger who are Medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native, and providers can’t refuse because you can’t pay the administration fee (CDC — VFC). Under CHIP, routine “well child” visits are free (HealthCare.gov). Safe sleep and more: raising kids in the U.S.; later, enrolling your child in school.

Step 10 — Contact your home country’s consulate

Your home country may have its own rules and deadlines for recording a birth abroad or issuing your baby a passport. Ask its embassy or consulate in the U.S. what it needs before you travel; finding your home country’s community explains how to reach it.