Urge CMS to Approve Medicaid Extensions for Postpartum Women Act Now!


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. In West Virginia, for example, 62 percent of all maternal deaths from 2007-2013 occurred more than 60 days postpartum.

Extending Medicaid Coverage Can Help Eradicate Preventable Maternal Deaths

The United States is experiencing a maternal mortality crisis.

As the largest single payer of maternity care in the U.S., covering over 42 percent of births, Medicaid has a critical role to play in ensuring healthy moms and babies. One in three women experience a disruption in insurance coverage before, during, or after pregnancy, and nearly 60% of these perinatal insurance disruptions include a period of uninsurance. ACOG is taking action at the state and federal levels to ensure all individuals whose pregnancies are covered by Medicaid can keep their Medicaid coverage for at least one year postpartum, including coverage for such services as case management and outreach, substance use disorder treatment, and mental health screening and treatment.

Maternal Health Experts Agree

In addition to being endorsed by over 275 national and state-based organizations, extending Medicaid coverage beyond 60 days postpartum is a leading recommendation of state maternal mortality review committees (MMRCs) and state departments of health. Maternal health experts in Alabama, Arizona, Colorado, Connecticut, Delaware, Georgia, Idaho, Illinois, Iowa, Maryland, Massachusetts, Mississippi, Missouri, New Mexico, North Carolina, Oklahoma, Philadelphia, Tennessee, Texas, Utah, and Washington have each highlighted this policy as one solution among many to ending preventable maternal deaths.

Federal Advocacy

ACOG is a leading voice advocating to Congress and the Administration to extend Medicaid coverage to at least one year postpartum. In Congress, ACOG’s work has focused on enacting 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.

State Advocacy

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. More information on the new SPA option is available below.

New State Plan Option to Extend Postpartum Medicaid under the American Rescue Plan Act

The American Rescue Plan Act, signed into law on March 11, 2021, makes available a new pathway states can use 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), but there is work to be done now. Below is a summary of the option to extend postpartum Medicaid under the American Rescue Plan Act.

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

  • No—states still must act. Congress did not make this mandatory.

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

Importantly, obstetrician–gynecologist advocates may find themselves needing to explain to allies, legislators, and other stakeholders that the new law does not automatically extend Medicaid postpartum coverage. Instead, it makes available to states an additional and simpler pathway to achieve this coverage. In other words, there is still work to be done to achieve postpartum extension in your state!

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


ACOG Advocacy in Action

COVID-19 Advocacy