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Tell Congress to Protect Maternal Health Provisions in the Build Back Better Act! Write them now!

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The Issue

Individuals with pregnancy-related Medicaid coverage typically lose their benefits 60 days after the end of pregnancy. Our nation’s rate of maternal mortality is rising, and a growing body of evidence shows that many of these deaths, particularly from preventable causes such as overdose and suicide, occur after pregnancy-related Medicaid coverage ends.

Federal & State Advocacy

ACOG is the leading voice advocating to Congress and the Administration to extend Medicaid coverage to at least one year postpartum. In Congress, ACOG has worked to enact bipartisan legislation in the U.S. House of Representatives and U.S. Senate to support state efforts to extend postpartum coverage. With the Administration, ACOG advocates to the Centers for Medicare and Medicaid Services (CMS) to encourage states to pursue this policy and to swiftly approve pending Section 1115 waiver requests to extend postpartum coverage.

ACOG continues to work with the White House and Congress to include provisions in the Build Back Better Act that permanently extends, and requires, Medicaid coverage continuously for 12 months postpartum.

Currently, extending postpartum Medicaid coverage can be achieved through various pathways. States can extend coverage with legislative action through a bill, executive action in a governor’s budget, or regulatory action by submitting a Section 1115 waiver request or a state plan amendment (SPA) to CMS.

State Plan Amendment to Extend Postpartum Medicaid under the American Rescue Plan Act

The American Rescue Plan Act, signed into law on March 11, 2021, makes available an additional pathway that allows states to extend Medicaid coverage for pregnant people from 60 days to one year postpartum. This pathway—known as a state plan amendment (SPA)—will become effective next year (April 1, 2022).

On December 7, 2021, the Center for Medicaid and CHIP Services released guidance for state Medicaid Directors to implement the postpartum SPA in their state. CMS also released frequently asked questions for state health officials seeking to implement this policy.

FAQs:

Does the new federal law automatically extend Medicaid postpartum coverage in every state?

  • Not currently—states still must act. The Build Back Better Act includes language to make Medicaid postpartum coverage mandatory and permanent, but it has not yet passed the Senate.

What’s new for states?

  • Congress has made available to states an additional and simpler pathway for five years in which to extend Medicaid coverage for pregnant people from 60 days to one year postpartum.
  • This vehicle, called a State Plan Amendment (SPA), is an option which some states may find preferable to the burdensome and time-consuming Section 1115 waiver process.
  • The process to initiate a SPA varies by state—some states may require legislative action. All states will still require a budget allocation.

What is the timeline?

  • The new SPA vehicle goes into effect next year, on April 1, 2022.
  • This delay is intentional to give states time to put into motion any necessary laws, regulations, and financing.
  • It is also important to remember that a federal law passed last year prohibits states from ending coverage for Medicaid enrollees for the duration of the COVID-19 public health emergency declaration.
  • Once it goes into effect in 2022, the SPA vehicle will be available to states for only five years. Without additional action by Congress to extend the life of the SPA or make it permanent, any implemented coverage extension will expire.

What does this mean for state budgetary decisions and their financial commitment?

  • The federal financial commitment is the same, whether a state uses a SPA or an 1115 waiver.
  • The federal match for a coverage extension under the SPA is the regular, per-capita based federal medical assistance percentage (FMAP), just like with an 1115 waiver.

How does this apply to CHIP?

  • Some states (CO, MO, NJ, RI, VA, and WV) also provide coverage to pregnant people under the Children’s Health Insurance Program (CHIP) in addition to Medicaid.
  • For states that implement the SPA, the one-year postpartum coverage will also apply to CHIP-enrolled pregnant people.

Status of State Actions to Extend Postpartum Medicaid Coverage

 

Advocacy Tools

Obstetrician–gynecologist advocates may need to explain to allies, legislators, and other stakeholders to not wait for the passage of Build Back Better to extend Medicaid postpartum coverage. 

It is critical that as many states as possible ready to implement the SPA on April 1, 2022. To help advance this policy across states, ACOG has developed several advocacy tools.

 

ACOG Advocacy in Action

COVID-19 Advocacy