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 effective through March 31, 2027.
- All pregnant Medicaid beneficiaries who have coverage that covers the birth of the child will be able to access full Medicaid benefits for the duration of the 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 (PA) related to pregnancy and pregnancy-related conditions or complications will be removed.
- Eligibility will be extended to the end of the 12-month postpartum period for beneficiaries currently in their 60-day postpartum eligibility on April 1.
- Coverage for the 12-month postpartum extension and full Medicaid benefits does not apply to those beneficiaries with Emergency Medicaid.
Some NCTracks claims and MPW prior authorization program restriction removals may not be in place as of April 1, 2022, and providers could receive claim or PA denials. Claims or PA requests denied on or after April 1, 2022, can be resubmitted or reprocessed once all changes are completed.
A fact sheet NC Medicaid’s New Extended Postpartum Coverage has been published for providers.
A future Medicaid provider bulletin and NCTracks email blast will be published once the 1E-5, Obstetrical Services Policy is finalized and posted.
Contact
NCTracks Call Center: 800-688-6696