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Page 7 – State Health Official

individuals eligible as pregnant women (including any differences in benefits, premiums, and cost sharing).

While most states provide full coverage to all pregnant Medicaid beneficiaries, some states limit the coverage available to beneficiaries who are enrolled in the group for pregnant individuals described at 42 C.F.R. § 435.116 and have income above a threshold specified by the state.13 States that have elected to provide only services related to pregnancy or a condition that may complicate pregnancy and to COVID-19 vaccines (and their administration) must submit a SPA to remove this coverage limitation while the extended postpartum coverage option is in effect.

Under CHIP, the state must continue to provide the same scope of child health assistance as defined in section 2110(a) of the Act and pregnancy-related assistance as defined in section 2112(d) of the Act during the extended postpartum period. At a minimum, states must continue to provide comprehensive benefits consistent with the benefit coverage option elected in the CHIP state plan, as described in section 2103(a) of the Act, such as benchmark or Secretary- approved coverage; however, states may elect to provide a more generous coverage option during the extended postpartum period.

State Plan Amendment Submission

States that elect the extended postpartum coverage option in Medicaid must also elect the option for a separate CHIP, unless the state only provides coverage to unborn children in its separate CHIP. In order to elect the option, states must submit a Medicaid SPA through MACPro to extend postpartum coverage under Medicaid and, as appropriate, submit a CHIP SPA in the Medicaid Model Data Lab (MMDL) to extend postpartum coverage for pregnant individuals covered in a separate CHIP. Subject to the requirements at 42 C.F.R. § 430.12, et seq. and 42 C.F.R. § 457.60, states may submit SPAs with proposed effective dates no earlier than April 1, 2022. States are strongly encouraged, but not required, to maintain their SPA through March 31, 2027, when the current statutory authority for the extended postpartum coverage option expires. CMS will work with states to identify other options to maintain extended postpartum coverage if the statutory authority to extend coverage is not reauthorized. States may contact their Medicaid state lead for technical assistance to complete the Medicaid SPA and their CHIP project officer for technical assistance to complete the CHIP SPA. Federal Financial Participation for “Newly Eligible” Individuals Receiving Extended Postpartum Coverage

Currently, many Medicaid beneficiaries (such as, but not limited to, those covered under the eligibility group for pregnant individuals described at 42 C.F.R. § 435.116) become eligible for, and transition to, the adult group described at 42 C.F.R. § 435.119, at the end of the 60-day postpartum period. Some of the individuals who transition to the adult group after their 60-day postpartum period are “newly eligible,” as defined in 42 C.F.R. § 433.204(a)(1), for purposes of the increased FMAP described in section 1905(y) of the Act (“newly eligible FMAP”).

13 Clause VII in the matter following section 1902(a)(10)(G) of the Act. Services related to pregnancy include prenatal, delivery, postpartum, and family planning services. Because the health of a pregnant individual is so intertwined with the health of the expected child, most states consider all services required for categorically needy Medicaid beneficiaries to be pregnancy-related services. 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.