9. Pregnant or Entitled to Postpartum Coverage

Section 1902(xx)(9)(A)(ii)(IX) of the Act establishes an exclusion for pregnant and postpartum women who are entitled to medical assistance under section 1902(e)(5) or (16) of the Act. While pregnant women are generally not eligible for the adult group under § 435.119, and so most often would not be subject to community engagement, we also recognize that individuals enrolled in the adult group can become pregnant and remain in the adult group. [ 83 ] Also, it is possible that a section 1115(a)(2) demonstration population determined to include applicable individuals may have pregnant women enrolled in it. Therefore, it is important to specify that a pregnant woman is a specified excluded individual.

Section 1902(e)(5) of the Act, implemented at § 435.170, establishes mandatory State plan continuous eligibility during pregnancy and through the end of the month in which the 60-day postpartum period following the end of pregnancy concludes, regardless of a change in income. Section 1902(e)(16) of the Act provides the State option, effective beginning April 1, 2022, for continuous and extended coverage for women during pregnancy and for 12 months after the end of the pregnancy. [ 84 ] As of May 2026, 48 States, the District of Columbia, and U.S. Virgin Islands have elected the option to provide 12-month extended postpartum coverage in Medicaid (and CHIP). This State plan option means that a pregnant woman enrolled in Medicaid is continuously eligible for 12 months after the end of pregnancy, ( printed page 33379) regardless of the eligibility group in which she is enrolled. As a result, any woman who is receiving Medicaid under either the mandatory postpartum period (§ 435.170) or the 12-month postpartum extension while in the State plan adult group or a relevant section 1115(a)(2) demonstration population is a specified excluded individual during the relevant postpartum period. We implement this definition at the new § 435.554(c)(10).