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States that adopt the extended postpartum coverage option and intend to claim the newly eligible FMAP using a proxy methodology must submit an FMAP SPA amendment that meets the requirements of 42 C.F.R. § 433.206(h), as relevant to the proxy methodology. CMS is available to provide technical assistance to states interested in developing a proxy methodology to claim the newly eligible FMAP for certain individuals during the extended postpartum coverage period. Opportunities to Improve Maternal Health

In order to realize the potential of extended postpartum coverage to improve postpartum care and advance equity in health outcomes for beneficiaries, CMS encourages states to make a concerted effort to increase awareness of the extended postpartum coverage to both providers and beneficiaries. To maximize the impact of adopting the extended postpartum coverage option, it also will be critical for states to measure and monitor utilization and quality of care in the postpartum period, and to work with health plans, providers and other stakeholders to improve maternal health care. Drawing on the experiences of states in several learning collaboratives (discussed below), CMS has developed a number of tools and strategies that states can employ and can provide technical assistance to states to support these quality measurement and improvement activities.

Care during the postpartum period involves not just a single visit but a series of encounters and a range of services tailored to the needs of the beneficiary. The American College of Obstetricians and Gynecologists (ACOG) recommends that all postpartum individuals have contact with their health care providers within the first three weeks after delivery followed by individualized ongoing care as needed.14 Coverage during an extended postpartum period gives providers opportunities to assess beneficiaries’ physical recovery from pregnancy and childbirth, and, critically, to screen for and provide care to address conditions that can lead to morbidity and mortality in the later postpartum period. High quality, comprehensive postpartum care should address chronic health conditions (e.g., diabetes or hypertension), mental health and psychological well-being (e.g., postpartum depression, interpersonal violence), and family planning (e.g., contraceptive counseling). Postpartum visits are also a time for providers to counsel individuals on nutrition, breastfeeding, tobacco and other drug use, and other preventive health issues that affect both the postpartum individual’s longer-term health and that of their infant, and to help individuals retain coverage under Medicaid or CHIP or successfully transition to other coverage at the end of the postpartum period, including enrollment in a qualified health plan available through the Health Insurance Marketplace.

States may also consider building on person-centered models of perinatal care to support individuals in the prenatal, delivery, and postpartum periods, such as doula services and home visiting. Doula support, which can be delivered in a home setting, is associated with improved health outcomes including decreased likelihood of postpartum depression and near-universal breastfeeding among low-income individuals.15 Coverage of doula services may be effectuated

14 Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obset Gynecol 2018; 131:e 140-50. https://www.acog.org/clinical/clinical-guidance/committee- opinion/articles/2018/05/optimizing-postpartum-care 15 https://www.medicaid.gov/medicaid/quality-of-care/downloads/mih-expert-workgroup-recommendations.pdf

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.