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conditions, have lower rates of postpartum care.4 Extended postpartum coverage presents an opportunity for states to improve postpartum care and address these disparities. States that have expanded Medicaid eligibility to provide coverage beyond 60 days postpartum report an increase in postpartum care visits, continuity in coverage, and enhanced engagement of individuals in health care.5 Background

Many pregnant individuals qualify for Medicaid on the basis of their pregnancy through the eligibility group for pregnant individuals described at 42 C.F.R. § 435.116. Pregnant individuals may also be eligible on another basis, for example, as a parent or caretaker relative or on the basis of disability status. States also have the option to extend coverage to lawfully residing pregnant individuals and children, if they otherwise meet eligibility requirements under the state’s program (commonly referred to as “the CHIPRA 214 option”). Under current law, pregnant Medicaid beneficiaries are eligible under the state plan for at least pregnancy-related services through the end of the month in which the 60-day period, beginning on the last day of pregnancy, ends (referred to as the “60-day postpartum period”).6 This continuous eligibility applies through the end of the 60-day postpartum period regardless of the eligibility group in which the beneficiary is enrolled, and is not affected by changes in income that would otherwise result in a loss of eligibility.7

Pregnant individuals also may be eligible for coverage in CHIP. Pregnant adolescents eligible as a “targeted low-income child” in CHIP can receive prenatal and postpartum care along with other child health assistance. States also have the option to extend CHIP eligibility to “targeted low-income pregnant women” through the end of the 60-day postpartum period, similar to Medicaid8, and to elect the CHIPRA 214 option for this population under section 2107(e)(1)(O) of the Act. In addition, states have the option to extend child health assistance to “unborn children” who meet other applicable eligibility criteria for coverage under the CHIP state plan, thereby providing coverage to pregnant individuals who themselves are not eligible for Medicaid or CHIP. Unlike postpartum coverage for targeted low-income pregnant individuals, postpartum coverage for pregnant individuals who received services during pregnancy on behalf of their unborn child is limited. State Plan Option to Provide 12 Months Postpartum Coverage

The ARP provides Medicaid and CHIP agencies a new state plan option to provide 12 months of continuous postpartum coverage, regardless of any changes in circumstances, in Medicaid and CHIP (hereafter referred to as the “extended postpartum coverage option” or “extended postpartum coverage”). Section 9812 of the ARP adds a new section 1902(e)(16) of the Social

4 Jones, E.J., T.L. Hernandez, J.K. Edmonds, and E.P. Ferranti. “Continued Disparities in Postpartum Follow-Up and Screening Among Women with Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review.” Journal of Perinatal Neonatal Nursing, vol. 33, no. 2, 2019, pp.136–148. 5 Gordon, S.H., B.D. Sommers, I. Wilson, O. Galarraga, and A.N. Trivedi. “The Impact of Medicaid Expansion on Continuous Enrollment: A Two-State Analysis.” Journal of General Internal Medicine, vol. 34, no. 9, 2019, pp. 1919–1924. 6 Section 1902(e)(5) of the Social Security Act; 42 C.F.R. § 435.170 7 Section 1902(e)(6) of the Social Security Act; 42 C.F.R. § 435.170; CMCS Informational Bulletin, “Medicaid and Children’s Health Insurance Program (CHIP) Renewal Requirements,” (December 2020). Available at https://www medicaid.gov/federal- policy-guidance/downloads/cib120420.pdf 8 Section 2112(d)(2)(A) of the Social Security Act 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.