222 Pregnancy and Postpartum
Effective Date: January 1, 2024
No Previous Policy
A. Eligibility
A CHIP eligible member who is pregnant at application or becomes pregnant during their certification period is protected from most changes in circumstance through the duration of their pregnancy and a 12-month postpartum period.
Once the agency has been notified of a pregnancy for a covered CHIP member, only review for Medicaid eligibility for that member at the member’s request.
The first month of the 12-month postpartum period is the month after the pregnancy ends.
If the covered CHIP member becomes pregnant again during their postpartum period, their eligibility extends through the subsequent pregnancy and postpartum period.
This does not apply to a member covered by State CHIP after age 19.
A CHIP member who is eligible for the 12-month postpartum period cannot have a reduction in coverage group.
Can move from CHIP plan C to CHIP plan B.
Can move from State CHIP to CHIP plan B or C.
Can not move from CHIP plan B to CHIP plan C during pregnancy or postpartum period.
Can move from CHIP plan B or C to State CHIP due to a loss of citizenship status.
B. Exceptions to the Extended Pregnancy and Postpartum Eligibility
The only changes in circumstance (i.e. age, access or enrollment in insurance, income, etc.) that allow a CHIP eligible member who is pregnant or in the 12 month postpartum period to terminate are:
The member requests voluntary termination;
The member ceases to be a state resident;
The agency determines that eligibility was determined incorrectly at the most recent determination or redetermination of eligibility because of agency error or fraud, abuse, or perjury attributable to the individual;
The member dies;
The member is eligible for Medicaid and requests to move programs;
Enrollment in another insurance.
Changes in citizenship status. A child who loses citizenship status can be moved to State CHIP even if the member has reached 19 years of age at the time of the loss. A child who gains citizenship status must be moved to Medicaid or CHIP plan B or C.