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2) Approve coverage for any such individuals who submit a new application within their 12- month postpartum period and provide them with continuous eligibility for the remainder of their 12-month postpartum period.

In Medicaid, under both options, retroactive eligibility would be available, consistent with 42 C.F.R. § 435.915(a), to provide coverage for the three months prior to the date of reinstatement or reapplication if the beneficiary had received Medicaid services, at any time during that three- month period, and would have been eligible for Medicaid at the time they received the services if they had applied. In CHIP, states may develop a reasonable methodology in their state plan to determine the effective date of eligibility and avoid gaps in coverage for this population, consistent with 42 C.F.R. § 457.340(g), including providing retroactive eligibility.

Continuous Eligibility During Pregnancy and the Extended Postpartum Period

Pregnant individuals who are eligible for extended postpartum coverage in Medicaid and CHIP are entitled to continuous eligibility through the last day of the month in which the 12-month postpartum period ends.10 Unlike the continuous eligibility provided under section 1902(e)(6) of the Act, which ensures pregnant Medicaid beneficiaries continue to be eligible through the end of the 60-day postpartum period despite changes in income, the continuous coverage afforded under section 1902(e)(16) of the Act ensures such coverage despite any changes in circumstances, similar to the continuous coverage provided to children, at state option, under section 1902(e)(12) of the Act. Individuals receiving extended postpartum coverage remain eligible regardless of changes in circumstances that may affect eligibility such as a change in income, household composition, or categorical eligibility (e.g., reaching an age milestone or loss of Supplemental Security Income (SSI) for individuals eligible for Medicaid based on receipt of SSI). For example, eligibility continues through the duration of the extended postpartum coverage period for pregnant adolescents in CHIP turning 19 and pregnant individuals enrolled in the Medicaid mandatory group for children under age 19 described at 42 C.F.R. § 435.118 at the time that they would ordinarily age out of eligibility under that group.

We have determined that, despite the broad coverage protection afforded under the statutory language, states are expected to apply the same narrow exceptions applied to continuous eligibility for children under 42 C.F.R. § 435.926(d)(2) through (d)(5) to the continuous 12- month postpartum coverage provided under section 1902(e)(16) of the Act. Thus, states providing extended postpartum coverage must ensure that pregnant and postpartum individuals eligible under the extended postpartum coverage option, who would otherwise lose eligibility due to a change in circumstances, remain enrolled in Medicaid or CHIP until the end of the 12- month postpartum period, unless:

• the individual requests voluntary termination; • the individual 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 attributed to the individual; or • the individual dies.

10 American Rescue Plan Act of 2021, Pub. L. 117-2, §§ 9812 and 9822 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.