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Page 17 – 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. For example, Ava submits an application on June 15, 2022 and is determined eligible for Medicaid. Ava was pregnant and gave birth on May 15, 2022, which is within the 3-month period prior to the month in which Ava applied for coverage. The agency determines that Ava would have been eligible for Medicaid had she applied in May, and thus is covered retroactively to May, when she was pregnant. Ava is entitled to extended postpartum coverage from the time of enrollment through the end of the month in which Ava’s 12-month postpartum period ends (May 31, 2023).

Q11. Do pregnant individuals who receive Medicaid or CHIP coverage under the “CHIPRA 214 option” qualify for extended postpartum coverage?

A11. Yes. A state that has elected to cover lawfully residing pregnant individuals in Medicaid and CHIP under the option provided for at sections 1903(v)(4)(A)(i) and 2107(e)(1)(O), and has also elected the extended postpartum coverage option, must provide 12 months of extended postpartum coverage to such individuals under the option described at 1902(e)(16) and/or 2107(e)(1)(J) of the Act. Sections 1903(v)(4)(A) and 2107(e)(1)(O) of the Social Security Act provide states the option to provide full Medicaid and/or CHIP coverage to lawfully residing children and pregnant individuals, if they otherwise meet eligibility requirements under the state’s program (e.g., income and state residency requirements). This option is commonly referred to as “the CHIPRA 214 option.”

Section 1902(e)(16) of the Act, added by section 9812 of the ARP, and section 2107(e)(1)(J) of the Act, added by section 9822 of the ARP, provide states with an option to provide coverage during an extended 12-month postpartum period for individuals who, while pregnant, were eligible for and received Medicaid or CHIP under the state plan, or a waiver of such plan. If this option is elected, states cannot offer extended postpartum coverage to only some individuals enrolled in Medicaid or CHIP while pregnant, but must provide extended postpartum coverage to all such individuals. Thus, in a state which has elected both the CHIPRA 214 option for pregnant individuals in Medicaid and CHIP and also elects the option to provide 12 months of extended postpartum coverage under sections 1902(e)(16) and 2107(e)(1)(J) of the Act, lawfully residing adolescents who become pregnant while enrolled in Medicaid or CHIP and pregnant individuals covered under the Medicaid or CHIP state plan (or waiver of the state plan) during pregnancy would be eligible for the extended 12-month postpartum coverage.2 Continuous Eligibility for Individuals During Pregnancy and the Postpartum Period

Q12. Does the ARP require states that elect the option to provide 12 months postpartum coverage to provide continuous eligibility to individuals in Medicaid and CHIP during the pregnancy and extended postpartum period?

A12. Yes. Individuals who are eligible for extended postpartum coverage in Medicaid and CHIP are entitled to continuous eligibility throughout the pregnancy and postpartum period until the last day of the month in which the 12-month postpartum period ends. Pregnant and postpartum individuals in states that elect the ARP option remain eligible regardless of changes

2 A list of which states have elected to cover lawfully residing children and pregnant women in Medicaid and CHIP, is available at https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant- women