FROM: KIM EVANS, DIRECTOR
SUBJECT: MO HEALTHNET (MHN) POLICY CHANGES TO EXTEND POSTPARTUM COVERAGE TO 12 MONTHS
FORM REVISION #
IM-32MAGI
DISCUSSION:
Senate Bills 45 and 106, signed by Governor Parson on July 7, 2023 extend postpartum coverage to 12 months for women who have active Medicaid (including prior quarter) or Children’s Health Insurance Programs (CHIP) coverage when their pregnancy ends. The manual sections listed above are updated to reflect these changes. The changes included in this memorandum were effective July 7, 2023. Missouri’s State Plan Amendment (SPA) to implement these changes was approved by the Centers for Medicare and Medicaid Services (CMS) on November 14, 2023.
Note: This change to postpartum coverage does not apply to state funded programs such as Blind Pension (BP), Emergency MHN for Ineligible Aliens (EMCIA), Show-Me Healthy Babies (SMHB) individuals denied MO HealthNet for Pregnant Women (MPW) coverage due to an ineligible immigration status, and Uninsured Women’s Health Services (UWHS).
The following Family MO HealthNet (MAGI) manual sections are now obsolete:
- 1850.040.30 Coverage When Application Is Made After the Birth
- 1805.040.40 Extended Women’s Health Services
- 1850.040.40.10 Eligibility for Other MO HealthNet Programs
- 1850.040.40.30 Notification of Ineligibility for Extension Due to Insurance
The following sections have been added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual:
Appendix I and the IM-32MAGI have been updated to reflect a 12 month postpartum period.
Non-Pregnancy Levels of Care
Individuals receiving coverage under a non-pregnancy MHN level of care will not be moved to a pregnancy level of care unless they request that Family Support Division (FSD) do so.
Postpartum coverage for these individuals is granted within the MHN program they were on the date their pregnancy ended.
- Non-MAGI Spend Down and Ticket to Work Health Assurance (TWHA) – A pregnant individual under these programs will have continuous coverage from the first day they meet their Spend Down or pay their premium while pregnant through the end of the 12 month postpartum period.
- CHIP children – If it is not reported that a CHIP child is pregnant until after the pregnancy ends, the child will continue to be covered on the CHIP level of care they had on the date the pregnancy ended through their 12 month postpartum period. Pregnant and postpartum CHIP individuals are not required to pay a premium. However, if it is reported that a CHIP child is pregnant, they will be transitioned to MPW or SMHB for the remainder of their pregnancy through the end of the 12 month postpartum period.
NOTE: CHIP/SMHB individuals in their postpartum period who request to be moved to Title XIX level of coverage will not be able to regain eligibility under postpartum.
Prior Quarter
Individuals who apply for coverage after their pregnancy ends and are found eligible for prior quarter coverage, including the date the pregnancy ended, will be eligible for 12 months of postpartum coverage.
Extended Women’s Health Services (EWHS)
The EWHS program is discontinued with the implementation of 12 month postpartum. The UWHS program remains in place.
Annual Renewals
Annual renewals are not to be completed until the end of the 12 month postpartum period. An ex parte renewal will be attempted prior to sending a pre-populated renewal form to the participant.
System Updates
Updates are in progress in both eligibility systems to systematically grant 12 months of postpartum coverage. Review MEDES Resources, key word “Mitigation” for the manual process to follow on MAGI levels of care. The Non-MAGI manual process will be released in an email memorandum.
NECESSARY ACTION:
- Review MEDES Resources, key word “Mitigation” for the MAGI manual process to follow until system updates can be completed.
- Review this memorandum with appropriate staff.
KE/rc
