With the end of the Medicaid continued enrollment provision implemented during the pandemic health emergency, states are resuming Medicaid cancellations. Many people who originally qualified for Medicaid through pregnancy eligibility may be at risk of losing coverage. During the pandemic, people who got Medicaid coverage because they were pregnant were able to stay in the program even after the traditional 60-day postpartum coverage period ended. CMS data shows that from February 2020 to July 2022, there was a 75% increase in enrollment in the pregnancy fitness group. States could have moved people into other eligibility groups, but many didn’t.
While continued Medicaid 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 beginning in April 2022. Because this coverage option is not Having been adopted uniformly by states, some postpartum people can now be deferred after 60 days as states revert to pre-pandemic enrollment and eligibility operations.
State policies on postpartum coverage
Medicaid offers coverage to pregnant women and others with state-set income eligibility levels ranging from 138% to 380% of poverty (approximately $34,000 to $94,000 annually for a family of 3) and, to as a result, it covers four out of ten births nationwide. States must cover pregnant people up to 60 days after giving birth and now have the option to extend that coverage to 12 months. In addition to declaring the choices to implement the postpartum extensionstates policies on Medicaid comprehensive expansion affect coverage in the postpartum period. Before the pandemic, in booming states, most women and people eligible for postpartum coverage with incomes up to 138% FPL were able to stay in the program, and many with higher incomes were eligible for subsidized coverage through Affordable Care Act (ACA) Marketplace . However, in states that had not adopted Medicaid expansion, eligibility levels for parents are much lower than for pregnancy, so many people would lose coverage after 60 days because their incomes exceed the lower income thresholds for the parents. Those with incomes below poverty, which is the minimum income required to qualify for ACA benefits, have been caught in the Medicaid coverage gap in non-expansion states.
It is well accepted that the postpartum period extends beyond 60 days. Many common pregnancy-related complications, such as cardiovascular conditions, high blood pressure, and postpartum depression, require long-term care. Providing coverage for a longer period after pregnancy also promotes continuity of care and access to preventive services such as contraception and intrapartum care. Since the start of the pandemic, there has been a sea change in postpartum coverage as 37 states and DC have adopted the 12-month extension and 4 other states have legislation to adopt the pending extension (Figure 1).
In the coming months, in states that have not adopted the 12-month postpartum extension, people who qualified for Medicaid through the pregnancy pathway are at risk of losing Medicaid coverage before the end of their postpartum year because related income levels at pregnancy are higher than those for the parents. However, the risk is higher in some non-expansion states. Texas, for example, has not expanded Medicaid under the ACA and does not have an approved postpartum extension (state lawmakers are considering a bill). A single mother with a newborn in Texas can lose Medicaid coverage two months after giving birth if she has an annual income above $4,000 (~16% of the poverty level). Additionally, you may be in the coverage gap if your income is below the poverty line ($24,860), the minimum eligibility for assistance through the ACA market.
Considerations for unrolling
As states resume Medicaid cancellations, many who qualified for Medicaid through the pregnancy pathway during the pandemic are at risk of losing their Medicaid coverage. Some will qualify for subsidized ACA Marketplace plans. Some parents, particularly in non-booming states, are likely to become uninsured, but their children will remain eligible for Medicaid or CHIP.
Some people after giving birth may even lose coverage while remaining eligible because they encounter obstacles to completing the renewal process. Not receiving or understanding renewal notices or not knowing how to respond to state requests for information are some of the reasons people may not complete the renewal process.
Monitoring how Medicaid settlement is progressing in states can help ensure continuity of coverage for eligible individuals postpartum by identifying potential enrollment issues early in the process. States are required to report monthly on the number of individuals with pregnancy-related coverage who are terminated and whether it is for procedural reasons; however, data collection, quality and timing can be a challenge.
The demands of caring for a newborn can exacerbate the difficulties completing the renewal process, which is further complicated because babies born during the pandemic will need to transition into child eligibility, another procedural hurdle for parents of young children. State approaches to the winding-up process, especially policies to simplify renewals and to follow enrollees who have not completed the renewal process, can facilitate the ability of eligible individuals to maintain coverage.
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