New mothers covered by Medicaid and CHIP in New Jersey will now be able to stay enrolled for one year after the end of pregnancy under a Medicaid Section 1115 waiver approved by the Centers for Medicare and Medicaid.
The state will extend postpartum coverage for individuals from the state’s current pregnancy coverage cutoff at 60 day postpartum period to the end of the 12th month following the end of the pregnancy. The state estimates that about 8,700 postpartum people will be eligible for the year of coverage, and they will remain eligible regardless of changes in circumstances, including income fluctuations, during this time.
The decision makes New Jersey the fourth state to receive CMS approval via 1115 waiver to receive federal matching funds for an extended postpartum Medicaid coverage period, and the second state, along with Illinois, to extend postpartum coverage for the full year after the end of pregnancy. At least half the states have taken action to extend postpartum coverage through the American Rescue Plan state plan amendment option, and Congress is currently considering a plan to make 12 months of postpartum coverage mandatory for all states.
New Jersey initially sought CMS approval for an amendment to its FamilyCare 1115 demonstration to extend coverage for six months postpartum coverage back in March 2020. However, the state legislature appropriated money in the state’s 2022 budget to cover 12 months of postpartum coverage, so the state expanded its request to CMS accordingly. The FamilyCare demonstration is currently set to expire on June 30, 2022; the state is seeking to extend this demonstration and recently conducted the state comment process for its extension application.
The waiver approval also ensures that the state can receive the enhanced 90% Medicaid expansion match for services provided to postpartum people covered for one year who, because their income is below 138% FPL, would otherwise qualify for the Medicaid expansion adult group. Claims for postpartum people who would not otherwise be eligible for the Medicaid expansion will be matched at the state’s regular matching rate. The state is developing a payment methodology to be approved by CMS to differentiate the claims eligible for the different matching rates.
New Jersey’s application responds to devastating data from the state’s maternal mortality review committee showing alarming racial disparities in maternal outcomes in the state. In New Jersey, Black women are seven times more likely to die of a pregnancy-related cause than White women. Extending Medicaid for one year postpartum was one of the recommendations from the state’s Nurture NJ strategic plan to address maternal mortality and reduce racial disparities in the state.
New Jersey’s approval is the latest step in a national march towards setting a new standard in Medicaid and CHIP coverage for one year postpartum, a policy change that will have benefits for new mothers and infants and support growing families.
On the same day as New Jersey’s waiver approval, the House Rule Committee unveiled a compromise reconciliation bill that requires all states to provide 12 months of postpartum coverage for all pregnant people covered in Medicaid and CHIP, and makes significant investments to reduce racial disparities in maternal health and make pregnancy, birth and the postpartum period safer for mothers and babies of color. The bill also creates a state plan option for a maternal health home that would provide high-quality team-based care for pregnant and postpartum people. In addition, the bill creates a coverage gap solution for the millions of uninsured adults in non-expansion states and includes several coverage changes that benefit children as well.
Taken together, these administrative and legislative proposals will help move the nation closer to health equity for mothers and babies and help every family get a healthy start.