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Page 15 – FAQs

The contents of this document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law. enrolled in Medicaid or CHIP on the effective date of the SPA and who are pregnant or who are within an extended 12-month postpartum period on such date.

For example, a state elects to extend postpartum coverage beginning April 1, 2022. Julie is enrolled in Medicaid on April 1, 2022, and had given birth while enrolled on November 15, 2021. The state must provide Julie with continuous extended postpartum coverage through the end of the month in which her 12-month postpartum period ends (November 30, 2022).

Q4. Do states have the option to provide extended postpartum coverage under the state plan for a period of less than 12 months?

A4. No. The state plan option provides 12 months of postpartum coverage. States extending postpartum coverage under the state plan option do not have the flexibility to establish a different postpartum period.

Q5. Can a state implement the 12-month extended postpartum coverage SPA option before April 1, 2022?

A5. No. States may only elect the 12-month extended postpartum coverage SPA option with an effective date on or after April 1, 2022.

However, states that wish to implement extended postpartum coverage before April 2022 may work with CMS to propose a section 1115 demonstration project for Medicaid and/or CHIP. Eligibility for Extended Postpartum Coverage

Q6. Does the American Rescue Plan (ARP) establish a new optional eligibility group in order for states to provide 12 months postpartum coverage in Medicaid?

A6. No, the ARP does not establish a new eligibility group. Individuals who receive the 12- month postpartum extension remain in the eligibility group in which they were enrolled when pregnant for the duration of the postpartum period. For additional information on Federal Medical Assistance Percentage (FMAP) and coverage in the adult group, see questions Q21-22, below.

Q7. Is an individual entitled to extended postpartum coverage if they enroll in Medicaid or CHIP during the postpartum period?

A7. No. To be eligible for extended postpartum coverage, the individual must have been eligible for and enrolled in Medicaid or CHIP while pregnant (including during a period of retroactive eligibility in Medicaid). Individuals who apply for and are enrolled in Medicaid or CHIP after a pregnancy ends are not entitled to continuous eligibility for the remainder of their 12-month postpartum period because they were not enrolled under the Medicaid or CHIP state plan while pregnant. For additional information on eligibility for extended postpartum coverage granted during a period of retroactive eligibility, see question Q10, below.