Nearly half of babies born in Michigan are covered by Medicaid. But for some pregnant women, coverage is not something they can rely on when they need it most.
A few Thursdays each month, dozens of expecting mothers gather inside a Lutheran church in southwest Detroit. Inside, the Luke Clinic offers free prenatal and infant care. For many, it is the first place they have found that helps them navigate a health care system that can feel out of reach.
Inside the church, the clinic moves with steady urgency. Doctors move between rooms. Nurses take vitals and measure babies’ head circumferences. Doulas sit with first-time mothers, talking through pregnancy and support options while children stay close by. A pastor helps guide patients between spaces.
In one corner, a child tiptoes toward a stack of stuffed animals, choosing one to take home under the clinic’s “one toy per child” rule. Tables are lined with baby clothes, formula, and supplies. Nearby are HIV tests and Narcan kits, reminders of broader health risks many patients are navigating alongside pregnancy.
State data shows that about 5% of Michigan women of childbearing age are uninsured, about 1 in 19 women. Beginning in 2023, when pandemic-era Medicaid protections ended and states resumed eligibility checks, more than a million Michiganders lost automatic coverage during the process, mostly due to procedural issues like missed renewal notices or incomplete documentation.
For many women who become pregnant during that shift, finding care feels more like a treasure hunt.
For some, the first barrier is often navigating the paperwork.
Melody Armstrong found the clinic after being referred by UM Health-Sparrow. At eight and a half months pregnant, she drives from St. Clair County for every prenatal appointment.
“I got my insurance turned on at roughly 20 weeks,” Armstrong said. “They were like, well, you could try to transfer your care. But I was like, well, I'm comfortable here and I'd rather just keep coming here.”
She said the clinic helped her get Medicaid halfway through her pregnancy, after her first attempt at enrolling in Medicaid was not successful.
“Honestly, in America, it’s pretty normal. You just get told, like, ‘refile if you can,’” Armstrong said, "and I was like, I have no idea what I’m doing.”
Even with coverage now, Armstrong said access to care near her home is not guaranteed because of provider shortages.
“I tell people about this place all the time,” she added. “My WIC caseworker, my caseworker through the health department, the maternal infant health program. They’re like, ‘We need one of those. We need one of those really badly.’”
Katlyn Syrett also remembers uncertainty when she confirmed her pregnancy and realized she did not have health insurance.
“As far as medical care, I truly don’t know what I would have done,” she said. “I was already freaking out when we found out and I had nowhere really to go.”
Syrett’s sister-in-law, a former patient, pointed her to the Luke Clinic.
“The clinic was awesome because they had somebody who was there who literally just helped me through the whole process,” Syrett said. “I sat down and I gave him my information and he just did everything.”
With Medicaid in place, she said, the experience of pregnancy became more manageable.
“It made ... everything so much lighter because I didn’t have to worry about financial struggle,” she said. “I could just focus on being pregnant and having my baby.”
Now one year postpartum, she said the impact continues.
“I can just focus on being a mom and not have to sit there and be in crazy medical debt,” she said. “I had to have a C-section too, so my medical bill would have been astronomical.”
Dr. Katherine Gold, a physician at the University of Michigan, serves as the clinic’s medical director. She has worked with the Luke Clinic for 10 years.
She said what patients describe as confusion around paperwork is something she sees repeatedly inside the clinic.
“We see folks who have challenges reading or understanding stuff they're reading. And so they may just get partway through the application and get confused and not continue,” she said. “They may not realize that they absolutely have to have insurance to deliver, because it's going to cost $20,000 to have a baby … as long as everything goes well.”
Even with help from volunteers, she said, the Medicaid enrollment process itself often slows or stops patients before they ever reach care.
She said the clinic mirrors a traditional prenatal practice, but operates only a few days each month and depends heavily on volunteers and grant funding.
Patients receive ultrasounds, prenatal vitamins, medications, and referrals. The clinic also partners with the Detroit Health Department to help patients access Medicaid and other support programs.
But that support system is at maximum capacity.
“For a while, we had someone who would come in-house and sit at a table and patients could go and he would help them sign up,” Gold said. “That person has gotten so stretched thin over the last year or two that now we have to give patients an email to contact.”
She added that transportation challenges, unstable housing, and lack of childcare often compound the problem, leading to missed appointments and delayed care.
Those delays can have consequences early in pregnancy.
Gold recalled a patient carrying twins who did not receive prenatal care in her first trimester because she did not have insurance.
“They wouldn’t see her,” Gold said. “So here was I as a family doc, trying to do an ultrasound on somebody with twins, which is high risk. But that was her only option.”
In another case, a patient did not complete prenatal lab work until late in pregnancy.
“That was the first time we could get all her labs,” Gold said. “She came back HIV positive, which was a brand-new diagnosis for her.”
Gold said while the clinic was able to help the patient, early detection could have changed the timing and management of care.
She said consistent prenatal care is critical for maternal and infant health.
“I’m so frustrated. I feel like the people who are getting hurt are the babies that are getting delivered,” she said. “There's very good data that the better prenatal care you get during pregnancy, getting early care, identifying risk factors, getting treated, improves outcomes.”
Michigan has made steps to expand coverage. In 2023, Gretchen Whitmer extended Medicaid coverage for new mothers to one year postpartum, part of a broader effort to reduce maternal mortality and improve outcomes.
But expanded coverage does not always translate into access.
“In most communities, there are not clinics like ours,” Gold said. "In the United States, there are about 1,400 free clinics, and only about 7% provide prenatal care."
Gold said about 10% of patients return for future pregnancies even after gaining insurance, because of trust built at the clinic.
“They know we care for them. They can show up at any time. They can show up with their kids,” she said. “We’re not going to turn anybody away.”
In the past five years, visits to the clinic have doubled, reflecting growing demand for this kind of care.
For Syrett, the impact is lasting.
“I love it,” she said. “It’s more than I ever dreamed of. It’s harder than anything I’ve ever done, but it’s the best.”
At the Luke Clinic, that outcome is the goal. But it depends on its volunteers and limited funding to help patients who often arrive only after they have nowhere else to go.
