The American Rescue Plan Act of 2021 (ARPA) created a new option that allows states to submit state plan amendments (SPAs) to extend postpartum Medicaid coverage from 60 days to 12 months of continuous coverage. Under this option, states can receive their traditional federal medical assistance percentage (FMAP) rate to extend Medicaid coverage to new parents. States that pursue this option must provide full Medicaid benefits to all who are eligible for a continuous 12 months postpartum.ii ARPA has streamlined the process for state Medicaid agencies to request approval from the federal Centers for Medicare & Medicaid Services (CMS).iii The extension option in health insurance coverage goes into effect on April 1, 2022 and is available to states for 5 years before the option sunsets.15
States can also extend coverage through a Section 1115 waiver request that allows states to set requirements that fall outside of the standard SPA requirements, which several states had taken advantage of prior to the passage of ARPA. Some states are using these waivers to expand coverage for a briefer period (e.g., 6 months postpartum in Georgia and Texas) or specified services (e.g., Missouri provides support for substance use disorder and mental health services for individuals diagnosed with a substance use disorder). Indiana considered extending coverage only to pregnant women with opioid use disorder, but has since pursued broader coverage.16
In addition to the SPA and Section 1115 pathways, states can also extend Medicaid coverage using state, rather than federal funds. California extended Medicaid coverage to postpartum people with a mental health condition using state funds in 2020. However, California passed legislation in 2021 and will request approval from CMS to provide continuous Medicaid coverage to all eligible postpartum people for 12 months.17
State Actions to Extend the Pregnancy-related Medicaid Coverage Past 60 Days Postpartum
As of January 2022, 25 states,iv both Medicaid expansion and non-expansion states, have acted to extend the postpartum coverage period past 60 days, through either the new provision in ARPA or a Section 1115 waiver request, and/or with state funds.18 According to KFF, as of January 2022, 15 states (California, Colorado, Connecticut, the District of Columbia, Maine, Maryland, Minnesota, North Carolina, Ohio, South Carolina, Tennessee, Texas, Washington, West Virginia, and Wisconsin)v have passed legislation that directs the state Medicaid office to submit a SPA or Section 1115 waiver to extend postpartum coverage and allocates state funding to finance the coverage extension. As of January 2022, five states (Florida, Indiana, Massachusetts, Michigan, and Pennsylvania) have proposed or pending Section 1115 waivers to CMS or plan to submit a SPA or Section 1115 waiver.19
Currently, five states (Georgia, Illinois, Missouri, New Jersey, and Virginia) have received federal approval from CMS on Section 1115 waiver requests to extend postpartum coverage. Each of these states submitted Section 1115 waiver requests that varied in duration and benefits. Illinois, for example, received approval to provide 12 months of Medicaid coverage to all eligible pregnant people following childbirth, effective through December 2025.20
Beyond the varied ways states can approach Medicaid extension, states are also pursuing unique aspects of their program. A snapshot is below:
- Connecticut passed H.B. 6687, which appropriated state funding to extend postpartum Medicaid coverage to 12 months for those who do not qualify for Medicaid due to immigration status.21
- Missouri received a Section 1115 waiver in April 2021 to extend postpartum Medicaid for substance use disorder and mental health services for individuals diagnosed with substance use disorder.22
- South Carolina enacted legislation to request federal approval to extend Medicaid to 12 months postpartum. The state’s Department of Health and Human Services and the Maternal Mortality and Morbidity Review Committee will conduct an evaluation of how to best evaluate the policy after implementation.23
- If states extend Medicaid to postpartum women, they must do so for the Children’s Health Insurance Program (CHIP) as well if those states were previously providing coverage for low-income pregnant women through CHIP. Prenatal-to-3 Policy Impact Center. (2021). How Will the American Rescue Plan Strengthen the Prenatal-to-3 System of Care? A Summary of the 2021 Act’s Benefits for Infants and Toddlers (B.005.0321). Child and Family Research Partnership, Lyndon B. Johnson School of Public Affairs, University of Texas at Austin. https://pn3policy.org/resources/how-will-the-american-rescueplan-strengthen-the-prenatal-to-3-system-of-care
- CMS recently released guidance to state health officials to help them pursue this new option. See Tsai, D. (2021, December 7). RE: Improving Maternal Health and Extending Postpartum Coverage in Medicaid and the Children’s Health Insurance Program (CHIP) (SHO# 21-007). Centers for Medicare and Medicaid Services, US Department of Health and Human Services.
- State counts include the District of Columbia.
- Maine coverage limited to 6 months initially and will extend to 12 months by July 1, 2023; Texas Medicaid coverage limited to 6 months postpartum.