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 * Medicaid Postpartum Coverage Extension Tracker


MEDICAID POSTPARTUM COVERAGE EXTENSION TRACKER


Published: May 18, 2023

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The Medicaid program finances about 4 in 10 births in the U.S. Federal law
requires states to provide pregnancy-related Medicaid coverage through 60 days
postpartum. After that period, some postpartum individuals may qualify for
Medicaid through another pathway, but others may lose coverage, particularly in
non-expansion states. To help improve maternal health and coverage stability and
to help address racial disparities in maternal health, a provision in
the American Rescue Plan Act of 2021 gives states a new option to extend
Medicaid postpartum coverage to 12 months via a state plan amendment (SPA). This
new option took effect on April 1, 2022 and is available to states for five
years. The Centers for Medicare and Medicaid Services (CMS) released guidance on
December 7, 2021 on how states can implement this new option.

During the COVID-19 public health emergency (PHE), states must provide
continuous coverage to Medicaid enrollees to be eligible for enhanced federal
matching funds under the Families First Coronavirus Response Act. As a result,
postpartum coverage has been continuous since the start of the coronavirus
pandemic.

States that sought to implement extended postpartum coverage prior to April 1,
2022 have done so through a section 1115 waiver or by using state funds. This
page tracks recent state actions to implement extended Medicaid postpartum
coverage, including states that have implemented a 12-month postpartum
extension, states that are planning to implement a 12-month extension, states
with pending legislation to seek federal approval through a SPA or 1115 waiver,
and states that have proposed or received approval for a limited coverage
extension.





MEDICAID POSTPARTUM COVERAGE EXTENSIONS: APPROVED AND PENDING STATE ACTION AS OF
MAY 18, 2023




MEDICAID POSTPARTUM COVERAGE EXTENSIONS: APPROVED AND PENDING STATE ACTION AS OF
MAY 18, 2023

View Full TableExport CSV
Location

Medicaid/CHIP Income Eligibility Limit for Pregnancy (% FPL)
ACA Medicaid Expansion Status
Status of State Action
Limits on Coverage Period, Eligible Population, and/or Benefits



Total: 45 states
Alabama
Alaska
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Illinois
Indiana
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Montana
New Hampshire
Missouri
New Jersey 25
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah 25
Vermont
Virginia 25
Washington
West Virginia
Wisconsin 25
Wyoming

N/A
Adopted: 35; Not adopted: 10
12-month extension implemented: 34; Planning to implement a 12-month extension:
4 Limited coverage extension proposed: 3; Pending legislation to seek federal
approval through SPA or 1115 Waiver: 4
No limits: 41 states; Limits: 4 states
146%
Not Adopted
12-month extension implemented 1

205%
Adopted
Pending legislation to seek federal approval through SPA or 1115 Waiver 2

161%
Adopted
12-month extension implemented 3

213%
Adopted
12-month extension implemented 4

265%
Adopted
12-month extension implemented 5

263%
Adopted
12-month extension implemented 6

217%
Adopted
12-month extension implemented 7

324%
Adopted
12-month extension implemented 8

196%
Not Adopted
12-month extension implemented 9

225%
Not Adopted
12-month extension implemented 10

196%
Adopted
12-month extension implemented 11

213%
Adopted
12-month extension implemented 12

213%
Adopted
12-month extension implemented 13

171%
Not Adopted
12-month extension implemented 14

200%
Adopted
12-month extension implemented 15

138%
Adopted
12-month extension implemented 16

214%
Adopted
12-month extension implemented 17

264%
Adopted
12-month extension implemented 18

205%
Adopted
12-month extension implemented 19

200%
Adopted
12-month extension implemented 20

283%
Adopted
12-month extension implemented 21

199%
Not Adopted
Planning to implement a 12-month extension

162%
Adopted
Pending legislation to seek federal approval through SPA or 1115 Waiver 23

201%
Adopted
Pending legislation to seek federal approval through SPA or 1115 Waiver 24

305%
Adopted
Pending legislation to seek federal approval through SPA or 1115 Waiver 22
Coverage is extended to women when her child enrolls in a MO HealthNet plan or
CHIP program, or when a physician or managed care plan notifies MO HealthNet
that the pregnancy ended involuntary or necessarily to save the life of the
mother
205%
Adopted
12-month extension implemented 26

255%
Adopted
12-month extension implemented 27

223%
Adopted
Planning to implement a 12-month extension

201%
Adopted (but not implemented)
12-month extension implemented 28

162%
Adopted
12-month extension implemented 29

205%
Adopted
12-month extension implemented 30

138%
Adopted
12-month extension implemented 31

190%
Adopted
12-month extension implemented 32

220%
Adopted
12-month extension implemented 33

258%
Adopted
12-month extension implemented 34

199%
Not Adopted
12-month extension implemented 35

200%
Not Adopted
12-month extension implemented 36

203%
Not Adopted
Limited coverage extension proposed 37
Coverage period limited to 6 months; eligibility for the four months of extended
coverage limited to individuals who "deliver or experience an involuntary
miscarriage"
144%
Adopted
Limited coverage extension proposed
Coverage extended to women whose pregnancy ends in birth, miscarriage,
stillbirth, or abortion due to rape, incest, or life endangerment.
213%
Adopted
Planning to implement a 12-month extension

205%
Adopted
12-month extension implemented 38

198%
Adopted
12-month extension implemented 39

305%
Adopted
12-month extension implemented 40

306%
Not Adopted
Limited coverage extension proposed
Coverage period limited to 90 days
159%
Not Adopted
Planning to implement a 12-month extension








Notes

FOOTNOTES

 1.  CMS approved Alabama's state plan amendment on January 13, 2023

 2.  On April 19, 2023, Alaska's Senate passed legislation that would extend
     postpartum coverage to 12 months; the legislation is now pending in the
     House.

 3.  CMS approved Arizona's state plan amendment on April 6, 2023.

 4.  Since August 2020, California has been using state funds to provide up to
     12 months of Medicaid coverage for postpartum individuals diagnosed with a
     maternal mental health condition, known as the Provisional Postpartum Care
     Extension (PPCE) program. Subsequently, CMS approved California's state
     plan amendment on May 25, 2022, which now applies to all who were
     previously covered through the state-funded extension.

 5.  CMS approved Colorado's state plan amendment on March 14, 2023

 6.  CMS approved Connecticut's state plan amendment on July 26, 2022.

 7.  CMS approved Delaware's state plan amendment on May 15, 2023.

 8.  CMS approved the District of Columbia's state plan amendment on June 16,
     2022.

 9.  Florida has received approval for its postpartum extension through a
     Section 1115 waiver.

 10. CMS approved Georgia's state plan amendment on October 27, 2022.

 11. CMS approved Hawaii's state plan amendment on August 16, 2022.

 12. CMS approved Illinois' state plan amendment on October 20, 2022. Illinois
     also received approval for a CHIP state plan amendment to implement a
     health services initiative (HSI) to extend postpartum coverage from 60 days
     to 12 months under the CHIP unborn child option. This coverage applies to
     postpartum individuals who are not eligible for Medicaid due to immigration
     status.

 13. In June 2021, Indiana withdrew a pending 1115 waiver (Maternal Opioid
     Misuse Indiana Initiative) that would have extended postpartum coverage
     only to pregnant individuals with opioid use disorder. In a letter to CMS,
     the state announced its intention to pursue the broader postpartum coverage
     extension under the American Rescue Plan Act and CMS approved Indiana's
     state plan amendment on September 8, 2022.

 14. CMS approved Kansas' state plan amendment on July 26, 2022.

 15. CMS approved Kentucky's state plan amendment on May 25, 2022.

 16. CMS approved Louisiana's state plan amendment on April 1, 2022.

 17. CMS approved Maine's state plan amendment on June 16, 2022.

 18. CMS approved Maryland's state plan amendment on August 16, 2022.

 19. In February 2022, Massachusetts sent a letter to CMS stating its intent to
     withdraw its pending 1115 waiver amendment under the MassHealth waiver that
     would have extended postpartum coverage to 12 months and instead pursue the
     postpartum coverage extension under the American Rescue Plan Act. On July
     26, CMS approved Massachusetts' SPA for a 12-month PPC extension for
     Medicaid.

 20. CMS approved Michigan's state plan amendment on April 14, 2022.

 21. CMS approved Minnesota's state plan amendment on June 16, 2022.

 22. On March 2, 2023, Missouri's Senate passed legislation that would extend
     postpartum coverage to 12 months; the legislation is now pending in the
     House.

 23. Both chambers of the MT legislature have passed HB 917, which states that
     the appropriations in HB 2 for the health and resources division include
     funds to extend postpartum Medicaid coverage to 12 months. HB 2, a general
     appropriations act, has passed the state House but not the Senate.

 24. On April 6, 2023, New Hampshire's House passed legislation that would
     extend postpartum coverage to 12 months; the legislation is now pending in
     the Senate.

 25. Proposed/ Implemented postpartum Medicaid extensions in these states
     include continuous eligibility during the postpartum coverage period.
     Continuous eligibility allows postpartum individuals to remain enrolled
     during the extended postpartum period by disregarding changes in income
     that would make them ineligible for coverage.

 26. New Jersey has implemented its postpartum extension through a Section 1115
     waiver.

 27. CMS approved New Mexico's state plan amendment on June 16, 2022.

 28. CMS approved North Carolina's state plan amendment on September 22, 2022

 29. CMS approved North Dakota's state plan amendment on September 12, 2022

 30. CMS approved Ohio's state plan amendment on August 16, 2022.

 31. CMS approved Oklahoma's state plan amendment on March 23, 2023.

 32. CMS approved Oregon's state plan amendment on May 25, 2022.

 33. CMS approved Pennsylvania's state plan amendment on October 27, 2022.

 34. CMS approved Rhode Island's state plan amendment on April 20, 2023.

 35. CMS approved South Carolina's state plan amendment on May 6, 2022.

 36. Tennessee's Section 1115 waiver approved in January 2021 gives the state
     authority to add coverage allowable under the state plan without CMS
     approval. Tennessee exercised this authority to extend postpartum coverage
     to 12 months beginning on April 1, 2022, which CMS acknowledged and added
     to the waiver terms on April 4, 2022.

 37. In addition to this legislation since September 2020 Texas has been using
     state funds to provide postpartum individuals in the Healthy Texas Women
     program a limited package of postpartum services. In December 2020, Texas
     submitted an 1115 request to draw down federal funds for this program.
     Additionally, in May 2022, Texas submitted a Section 1115 waiver request to
     extend postpartum coverage to six months with continuous eligibility. In
     April 2023, Texas' House passed legislation that would extend postpartum
     coverage to 12 months; the legislation is now pending in the Senate.

 38. Virginia has implemented its postpartum extension through a Section 1115
     waiver.

 39. CMS approved Washington's state plan amendment on June 30, 2022.

 40. CMS approved West Virginia's state plan amendment on September 8, 2022.

TOPICS

 * Medicaid
 * Women's Health Policy

TAGS

 * Pregnancy
 * Maternal and Child Health
 * Waivers
 * Coverage


ALSO OF INTEREST

 * Postpartum Coverage Extension in the American Rescue Plan Act of 2021
 * Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
 * Expanding Postpartum Medicaid Coverage

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