Medicaid for Pregnant Beneficiaries Extended to 12 Months After Birth New Legislation Extends Medicaid for Pregnant Beneficiaries from 60 Days to 12 Months After Birth Effective April 1, 2022

Effective April 1, 2022, NC Medicaid coverage for pregnant beneficiaries will extend to the last day of the month in which the 12-month postpartum period ends. The change is made pursuant to NC Senate Bill 105 Session Law 2021-180 Section 9D.13 and the American Rescue Plan Act of 2021. These laws are in effect through March 31, 2027.

• All Medicaid beneficiaries who are pregnant and have benefits in a program that covers the birth of the child will be able to access full coverage Medicaid benefits for the duration of pregnancy and the extended 12-month postpartum period. For example, Medicaid for Pregnant Women (MPW) will now cover dental services for the full 12-month postpartum period after the day of delivery. 
• Prior Authorization guidelines currently in place to limit services related to pregnancy and to other conditions that may complicate pregnancy will be removed.

Beneficiaries who are in their current 60-day postpartum period on April 1, 2022, will be extended for the remainder of the 12-month period following the date the pregnancy ends.

Coverage for the 12-month postpartum extension does not apply for those beneficiaries with Emergency Medicaid. 

A future Medicaid provider bulletin will be published once the 1E-5, Obstetrical Services Policy is finalized and posted.

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NCTracks Contact Center: 800-688-6696