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SF 2251 – Postpartum Coverage, Medicaid (LSB5156SV.3) Staff Contact: Eric Richardson (515.281.6767) eric.richardson@legis.iowa.gov Fiscal Note Version – Final Action

Description Senate File 2251 extends postpartum Medicaid coverage for women. The Bill does the following: • Extends postpartum Medicaid coverage from 60 days to 12 months after a pregnancy ends. • Amends the income eligibility threshold for infants and pregnant women to 215.0% of the federal poverty level (FPL) for postpartum Medicaid coverage. • Requires the Iowa Department of Health and Human Services (HHS) to submit a Medicaid State plan amendment to the Centers for Medicare and Medicaid Services (CMS) to provide continuous Medicaid eligibility to pregnant women until 12 months after a pregnancy ends, beginning January 1, 2025. • Requires the HHS to submit a Children’s Health Insurance Program (CHIP) State plan amendment to the CMS to update infant eligibility consistent with provisions of the Bill, beginning January 1, 2025.

The section of the Bill directing the HHS to submit a Medicaid State plan amendment to the CMS takes effect upon enactment. The eligibility measures in the Bill for infants and pregnant women take effect January 1, 2025. Background Iowa Code section 249A.3(1)(h) provides Medicaid coverage to women who meet eligibility requirements, except for income, for 60 days after a pregnancy ends. Currently in Iowa, children under one year of age and pregnant women are eligible for postpartum coverage with income eligibility requirements up to 375.0% of the FPL ($117,000 for a family of four in calendar year 2024). The American Rescue Plan Act of 2021 allowed states to submit a Medicaid State plan amendment, effective for five years, to provide postpartum Medicaid coverage for 12 months after a pregnancy ends. Subsequently, a provision in the Consolidated Appropriations Act of 2023 removed the five-year limitation period for the State plan amendment. As of March 2024, 46 states (including Washington, D.C.) have extended postpartum coverage to 12 months, with Nevada, Idaho, and Wisconsin having submitted State plan amendments to the CMS to implement a 12-month extension. Iowa and Arkansas have not formally submitted amendments to the CMS to increase postpartum coverage to 12 months.

Income eligibility for Medicaid for pregnant women and infants under one year of age is specified in 441 IAC 75.1(28) at a maximum of 375.0% of the FPL. The Healthy and Well Kids in Iowa (Hawki) program has an income eligibility limit of 302.0% of the FPL. Currently, pregnant women who lose Medicaid coverage after 60 days may be eligible to enroll in the Iowa Health and Wellness Program (IHAWP), which has an income limit of up to 133.0% of the FPL. 42 C.F.R. §435.116 details minimum and maximum federal income eligibility requirements for pregnant women who are eligible to receive Medicaid benefits.

Fiscal Note Fiscal Services Division