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Page 4 – State Health Official

individuals enrolled in Medicaid on a basis that is not related to pregnancy status but who report a pregnancy or whom the state identifies as pregnant (e.g., based on claims data).

In states that cover children and/or pregnant individuals in a separate CHIP, if the state elects the extended postpartum coverage option in Medicaid, pregnant adolescents eligible as “targeted low-income children” and individuals eligible as “targeted low-income pregnant women” who are enrolled in the separate CHIP must also receive the extended postpartum coverage.

Section 9822 of the ARP did not change postpartum care for all pregnant individuals enrolled in CHIP, maintaining existing limitations.9 The 12-month extended postpartum coverage under section 2107(e)(1)(J) of the Act is only available to “targeted low-income children” who are pregnant or “targeted low-income pregnant women.” Pregnant individuals receiving CHIP services who do not meet the definition of either targeted population may not receive extended postpartum coverage under the ARP option. States should reach out to their CHIP Project Officer with any questions or technical assistance needs regarding coverage for such individuals.

States must submit a Medicaid and CHIP state plan amendment (SPA) to adopt the extended postpartum coverage option. In states that do so, the following populations must be provided continuous enrollment through the end of the 12-month postpartum period:

• Current beneficiaries who are pregnant as of the effective date of the SPA or who enroll based on pregnancy or become pregnant after the SPA is effective; • Current beneficiaries who were enrolled in Medicaid or CHIP while pregnant and who are no longer pregnant when the SPA becomes effective, but who are still within a 12- month postpartum period; and • Individuals who apply for Medicaid after their pregnancy ends, but who received Medicaid-covered services in the state while pregnant on or after the effective date of the SPA, if such services were received during a period of retroactive eligibility granted under section 1902(a)(34) of the Act and 42 C.F.R. § 435.915(a), provided that they would have been eligible when they received such services if they had applied.

When a state first implements the extended postpartum coverage option, there may be some individuals who were enrolled in Medicaid or CHIP while pregnant and are still less than 12 months postpartum, but whose coverage was terminated prior to the effective date of the extended postpartum coverage option in the state. While not required, states may choose to:

1) Identify these individuals and reinstate their coverage, provided they continue to be state residents. These individuals would be eligible for coverage with continuous eligibility in the group from which they were disenrolled for the remainder of their 12-month postpartum period; or

9 For individuals receiving pregnancy-related care who may not otherwise be eligible for Medicaid or CHIP, states may only provide postpartum care if (1) the post-birthing individual would otherwise satisfy all eligibility requirements for CHIP except age, as described at section 2112(f)(2) of the Act; (2) the postpartum coverage is included as part of a bundled payment for prenatal care and labor and delivery benefits (CMS SHO #02-004; available at https://healthlaw.org/wp- content/uploads/2018/09/cms release on prenatal care for fetuses.pdf); or (3) the state has implemented a health services initiative (HSI) to provide postpartum coverage. 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.