Extending Medicaid Postpartum Coverage May Reduce Disenrollment

States that have extended their Medicaid postpartum coverage periods may be better positioned to protect residents from widespread coverage loss in the wake of the public health emergency’s termination, KFF researchers found.

“During the pandemic, people who obtained Medicaid coverage because they were pregnant were able to remain on the program even after the traditional 60-day postpartum coverage period ended,” the researchers explained.

“While the Medicaid continuous enrollment was in place, Congress took additional steps to improve postpartum coverage by giving states the option to extend that coverage from 60 days to 12 months starting in April 2022. Because this coverage option has not been uniformly adopted by states, some postpartum individuals may now be disenrolled after 60 days as states return to pre-pandemic enrollment and eligibility operations.”

Medicaid programs overall are expected to cover pregnant individuals with incomes between 138 and 380 percent of the poverty level. Under this requirement, each state must offer 60 days of coverage postpartum. But during the pandemic, CMS opened up pathways for states to extend the timeframe for postpartum coverage.

As of this study’s publication date, 34 states and Washington, DC had adopted a 12-month postpartum coverage extension.

Another four states planned to implement this solution but had not yet done so (Vermont, New York, Mississippi, and Wyoming). Four more states were awaiting federal approval for a 12-month extension through an 1115 Waiver or state plan amendment (Missouri, New Hampshire, Montana, and Alaska).

Three states were considering proposals for limited coverage extensions. These states were Texas, Wisconsin, and Utah.

In Texas, for example, policymakers are contemplating a proposal that would limit coverage to six months and allow for four extra months of coverage for individuals who involuntarily miscarry. Legislation passed in the state’s House and is now awaiting review in the state Senate to extend coverage for 12 months.

States without an extension or Medicaid expansion may see an uptick in coverage losses as the public health emergency comes to a close. But there are actions that these states can take to prevent the losses from escalating.

“The demands of caring for a newborn can exacerbate challenges in completing the renewal process, which is further complicated because infants born during the pandemic will need to transition to eligibility for children, another procedural hurdle for parents of young children,” the researchers concluded.

“State approaches to the unwinding process, particularly policies to streamline renewals and to follow up with enrollees who have not completed the renewal process, can facilitate the ability of eligible individuals to retain coverage.”

Many experts have voiced concerns about how the end of the public health emergency will affect Medicaid eligibility and enrollment as well as overall uninsurance rates. While the coverage loss estimates vary, the Robert Wood Johnson Foundation and Urban Institute projected that as many as 18 million Americans could lose Medicaid coverage in the 14 months after the end of the public health emergency.

In states like Texas—which has neither extended its timeframe for postpartum Medicaid coverage nor adopted Medicaid expansion—people who are in the postpartum period may find themselves without Medicaid coverage and stuck in a coverage gap. A previous KFF study found that Medicaid expansion could reduce coverage loss after states began redeterminations.