The Medicaid program finances about 4 in 10 births in the U.S. Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days postpartum. After that period, some postpartum individuals may qualify for Medicaid through another pathway, but others may lose coverage, particularly in non-expansion states. To help improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act of 2021 gave states a new option to extend Medicaid postpartum coverage to 12 months via a state plan amendment (SPA).
This new option took effect on April 1, 2022 and was originally available for five years; however, the option was made permanent by the Consolidated Appropriations Act 2023. The Centers for Medicare and Medicaid Services (CMS) released guidance on December 7, 2021 on how states could implement this option.
States that sought to implement extended postpartum coverage prior to April 1, 2022 have done so through a section 1115 waiver or by using state funds. This page tracks state actions to implement extended Medicaid postpartum coverage, including states that have implemented a 12-month postpartum extension, states that are planning to implement a 12-month extension, states with pending legislation to seek federal approval through a SPA or 1115 waiver, and states that have proposed or received approval for a limited coverage extension.
Medicaid Postpartum Coverage Extensions: Approved and Pending State Action as of March 19, 2026
Medicaid Postpartum Coverage Extensions: Approved and Pending State Action as of March 19, 2026
| Location | Medicaid/CHIP Income Eligibility Limit for Pregnancy (% FPL) | ACA Medicaid Expansion Status | Status of State Action | Limits on Coverage Period, Eligible Population, and/or Benefits |
| Total: 50 states | N/A | Adopted: 40 | ||
| Alabama | 3.17 | Not Adopted |
12-month extension implemented
|
|
| Alaska | 2.3 | Adopted |
12-month extension implemented
|
|
| Arizona | 1.61 | Adopted |
12-month extension implemented
|
|
| California | 3.22 | Adopted |
12-month extension implemented
|
|
| Colorado | 2.65 | Adopted |
12-month extension implemented
|
|
| Connecticut | 2.63 | Adopted |
12-month extension implemented
|
|
| Delaware | 2.17 | Adopted |
12-month extension implemented
|
|
| District of Columbia | 3.24 | Adopted |
12-month extension implemented
|
|
| Florida | 1.96 | Not Adopted |
12-month extension implemented
|
|
| Georgia | 2.25 | Not Adopted |
12-month extension implemented
|
|
| Hawaii | 1.96 | Adopted |
12-month extension implemented
|
|
| Idaho | 1.38 | Adopted |
12-month extension implemented
|
|
| Illinois | 2.13 | Adopted |
12-month extension implemented
|
|
| Indiana | 2.13 | Adopted |
12-month extension implemented
|
|
| Iowa | 2.15 | Adopted |
12-month extension implemented
|
|
| Kansas | 1.71 | Not Adopted |
12-month extension implemented
|
|
| Kentucky | 2.18 | Adopted |
12-month extension implemented
|
|
| Louisiana | 2.14 | Adopted |
12-month extension implemented
|
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| Maine | 2.14 | Adopted |
12-month extension implemented
|
|
| Maryland | 2.64 | Adopted |
12-month extension implemented
|
|
| Massachusetts | 2.05 | Adopted |
12-month extension implemented
|
|
| Michigan | 2 | Adopted |
12-month extension implemented
|
|
| Minnesota | 2.83 | Adopted |
12-month extension implemented
|
|
| Mississippi | 1.99 | Not Adopted |
12-month extension implemented
|
|
| Missouri | 3.05 | Adopted |
12-month extension implemented
|
|
| Montana | 1.62 | Adopted |
12-month extension implemented
|
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| Nebraska | 2.02 | Adopted |
12-month extension implemented
|
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| Nevada | 1.9 | Adopted |
12-month extension implemented
|
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| New Hampshire | 2.01 | Adopted |
12-month extension implemented
|
|
| New Jersey | 2.05 | Adopted |
12-month extension implemented
|
|
| New Mexico | 2.55 | Adopted |
12-month extension implemented
|
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| New York | 2.23 | Adopted |
12-month extension implemented
|
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| North Carolina | 2.01 | Adopted |
12-month extension implemented
|
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| North Dakota | 1.75 | Adopted |
12-month extension implemented
|
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| Ohio | 2.05 | Adopted |
12-month extension implemented
|
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| Oklahoma | 2.1 | Adopted |
12-month extension implemented
|
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| Oregon | 1.9 | Adopted |
12-month extension implemented
|
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| Pennsylvania | 2.2 | Adopted |
12-month extension implemented
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| Rhode Island | 2.58 | Adopted |
12-month extension implemented
|
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| South Carolina | 1.99 | Not Adopted |
12-month extension implemented
|
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| South Dakota | 1.38 | Adopted |
12-month extension implemented
|
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| Tennessee | 2.55 | Not Adopted |
12-month extension implemented
|
|
| Texas | 2.07 | Not Adopted |
12-month extension implemented
|
|
| Utah | 1.44 | Adopted |
12-month extension implemented
|
|
| Vermont | 2.13 | Adopted |
12-month extension implemented
|
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| Virginia | 2.05 | Adopted |
12-month extension implemented
|
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| Washington | 2.15 | Adopted |
12-month extension implemented
|
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| West Virginia | 3.05 | Adopted |
12-month extension implemented
|
|
| Wisconsin | 3.06 | Not Adopted |
Planning to implement a 12-month extension
|
|
| Wyoming | 1.59 | Not Adopted |
12-month extension implemented
|
Notes
NOTES
Pending legislation includes legislation that has passed one or both chambers.
Under current law, states must provide continuous coverage to Medicaid enrollees through the public health emergency (PHE) period to be eligible for enhanced federal matching funds under the Families First Coronavirus Response Act. States seeking to implement extended postpartum coverage after the end of the PHE but prior to April 1, 2022 must do so through a Section 1115 waiver or by using state funds.
CMS approved the U.S. Virgin Island's state plan amendment on June 23, 2023.
SOURCES
KFF analysis of approved and pending 1115 waivers, state legislation, and Medicaid state plan amendments. For links to key documents, click here.
DEFINITIONS
Medicaid/CHIP Income Eligibility Limit for Pregnancy: This column indicates the upper Medicaid/CHIP income eligibility limit for pregnant women, calculated as a percent of the Federal Poverty Level (FPL). See here for more information on Medicaid and CHIP income eligibility limits for pregnant women.
FOOTNOTES
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CMS approved Alabama's state plan amendment on January 13, 2023
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CMS approved Alaska's state plan amendment on February 23, 2024
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CMS approved Arizona's state plan amendment on April 6, 2023.
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CMS approved California's state plan amendment on May 25, 2022.
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CMS approved Colorado's state plan amendment on March 14, 2023
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CMS approved Connecticut's state plan amendment on July 26, 2022.
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CMS approved Delaware's state plan amendment on May 15, 2023.
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CMS approved the District of Columbia's state plan amendment on June 16, 2022.
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Florida has received approval for its postpartum extension through a Section 1115 waiver.
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CMS approved Georgia's state plan amendment on October 27, 2022.
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CMS approved Hawaii's state plan amendment on August 16, 2022.
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CMS approved Idaho's state plan amendment on January 17, 2025
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CMS approved Illinois' state plan amendment on October 20, 2022. Illinois also received approval for a CHIP state plan amendment to implement a health services initiative (HSI) to extend postpartum coverage from 60 days to 12 months under the CHIP unborn child option. This coverage applies to postpartum individuals who are not eligible for Medicaid due to immigration status.
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In June 2021, Indiana withdrew a pending 1115 waiver (Maternal Opioid Misuse Indiana Initiative) that would have extended postpartum coverage only to pregnant individuals with opioid use disorder. In a letter to CMS, the state announced its intention to pursue the broader postpartum coverage extension under the American Rescue Plan Act and CMS approved Indiana's state plan amendment on September 8, 2022.
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CMS approved Iowa's state plan amendment on January 6, 2025
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CMS approved Kansas' state plan amendment on July 26, 2022.
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CMS approved Kentucky's state plan amendment on May 25, 2022.
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CMS approved Louisiana's state plan amendment on April 1, 2022.
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CMS approved Maine's state plan amendment on June 16, 2022.
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CMS approved Maryland's state plan amendment on August 16, 2022.
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In February 2022, Massachusetts sent a letter to CMS stating its intent to withdraw its pending 1115 waiver amendment under the MassHealth waiver that would have extended postpartum coverage to 12 months and instead pursue the postpartum coverage extension under the American Rescue Plan Act. On July 26, CMS approved Massachusetts' SPA for a 12-month PPC extension for Medicaid.
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CMS approved Michigan's state plan amendment on April 14, 2022.
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CMS approved Minnesota's state plan amendment on June 16, 2022.
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CMS approved Mississippi's state plan ammendment on December 13, 2023
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CMS approved Missouri's state plan ammendment on November 14, 2023
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CMS approved Montana's state plan amendment on October 16, 2023
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CMS approved Nebraska's state plan amendment on December 8, 2023
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CMS approved Nevada's state plan amendment on May 3, 2024
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CMS approved New Hampshire's state plan amendment on November 3, 2023
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Proposed/ Implemented postpartum Medicaid extensions in these states include continuous eligibility during the postpartum coverage period. Continuous eligibility allows postpartum individuals to remain enrolled during the extended postpartum period by disregarding changes in income that would make them ineligible for coverage.
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New Jersey has implemented its postpartum extension through a Section 1115 waiver.
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CMS approved New Mexico's state plan amendment on June 16, 2022.
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CMS approved New York's state plan amendment on June 13, 2023.
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CMS approved North Carolina's state plan amendment on September 22, 2022
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CMS approved North Dakota's state plan amendment on January 12, 2023
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CMS approved Ohio's state plan amendment on August 16, 2022.
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CMS approved Oklahoma's state plan amendment on March 23, 2023.
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CMS approved Oregon's state plan amendment on May 25, 2022.
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CMS approved Pennsylvania's state plan amendment on October 27, 2022.
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CMS approved Rhode Island's state plan amendment on April 20, 2023.
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CMS approved South Carolina's state plan amendment on May 6, 2022.
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CMS approved South Dakota's state plan amendment on June 5, 2023.
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Tennessee's Section 1115 waiver approved in January 2021 gives the state authority to add coverage allowable under the state plan without CMS approval. Tennessee exercised this authority to extend postpartum coverage to 12 months beginning on April 1, 2022, which CMS acknowledged and added to the waiver terms on April 4, 2022.
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CMS approved Texas's state plan amendment on Janauary 17, 2024.
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CMS approved Utah's state plan amendment on March 8, 2024
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CMS approved Vermont's state plan amendment on August 11, 2023
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Virginia has implemented its postpartum extension through a Section 1115 waiver.
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CMS approved Washington's state plan amendment on June 30, 2022.
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CMS approved West Virginia's state plan amendment on September 8, 2022.
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Governor Evers has signed SB23 into law, which will extend postpartum coverage to 12 months. Wisconsin has previously passed a 90 day extension and submitted a waiver application to CMS.
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CMS approved Wyoming's state plan amendment on September 14, 2023
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