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.

Extending Medicaid coverage from 60 days to one year postpartum is especially critical because of the Medicaid unwinding, which began in April 2023 and allowed states restart the process of disenrolling ineligible members from Medicaid. Soon, many people who had Medicaid coverage will no longer be eligible for that coverage and may become uninsured, making Medicaid extension even more critical.

Federal and State Advocacy

ACOG is the leading voice advocating for Congress and the administration to extend Medicaid coverage to at least one year postpartum. 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 and advocated for CMS to encourage states to pursue this policy and swiftly approve pending Section 1115 waiver and state plan amendment (SPA) requests to extend postpartum coverage from 60 days to 12 months without restriction.

Postpartum Medicaid coverage can be extended 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 SPA to CMS.

SPA 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: the SPA.

The Center for Medicaid and CHIP Services released guidance for state Medicaid Directors to implement the postpartum SPA in their state.

Frequently Asked Questions

Q: Does the American Rescue Plan Act automatically extend Medicaid postpartum coverage in every state?

  • Not currently—states still must act.

Q: How can states use SPAs to extend Medicaid coverage?

  • A SPA is a simpler option that 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 budget allocation.

Q: What does the American Rescue Plan Act 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, just as with a 1115 waiver.

Q: How does the American Rescue Plan Act apply to the Children’s Health Insurance Program??

  • Colorado, Missouri, New Jersey, Rhode Island, Virginia, and West Virginia also provide coverage to pregnant people under the Children’s Health Insurance Program in addition to Medicaid.
  • For states that implement the SPA, the one year of postpartum coverage will also apply to pregnant people enrolled in the Children’s Health Insurance Program.