In a Jan. 29 FAQ document, the Centers for Medicare & Medicaid Services clarified the definition of full benefits for states extending Medicaid and Children’s Health Insurance Program coverage for 12 months postpartum.
The FAQ support a December 2021 letter to state health officials introducing the option for extended postpartum coverage.
During the extended postpartum period, from the end of the mandatory 60-day postpartum period through the end of the month that occurs 12 months postpartum, full benefits include all items and services covered under the state plan or waiver of the state plan for which the beneficiary is eligible. This may include benefits for categorically needy adults, benefits under an Alternative Benefit Plan, or Early and Periodic Screening, Diagnostic, and Treatment benefits if the beneficiary is younger than 21.
The FAQ also define enhanced pregnancy-related services and the mandatory tobacco cessation benefit for pregnant individuals, though neither are required as a benefit during for the extended postpartum period. To provide these services during the extended postpartum period, a state only must submit a state plan amendment if their state plan limits these services to the 60-day postpartum period.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.