DPSS ePolicy

• To convert existing policy to the new webpage - No content changes
• To release a new policy

Effective April 1, 2022, the Medi-Cal (MC) postpartum period was extended to provide an additional ten months of coverage following the current 60-day postpartum period, for a total of 12 months (365-day postpartum period).  The Postpartum Care Extension (PCE) period will begin on the last day of the pregnancy and will end on the last day of the month in which the 365th day occurs.

Individuals eligible for pregnancy or postpartum care services under MC are eligible to the PCE.  PCE will be granted automatically to these individuals when the pregnancy is reported.  Under the Continuous Eligibility for Pregnancy (CEP) program, pregnant individuals eligible under MC will maintain coverage through their pregnancy and postpartum period regardless of income changes.  These protections are limited to increases in income.  With the implementation of PCE, these individuals are further protected as MC coverage for these individuals must be maintained through their pregnancy and 365-day postpartum period, regardless of income changes, citizenship, or immigration status.  This will ensure that PCE individuals receive all medically necessary services during the pregnancy and postpartum periods.

Additionally, individuals eligible for pregnancy or postpartum care services under the Medi-Cal Access Program (MCAP) will also be entitled to the extended 365-day postpartum period.  MCAP is managed by MAXIMUS INC. (MAXIMUS) through a partnership with the California Department of Health Care Services (DHCS).  

California Code of Regulations (CCR), Title 22 Section 50260, states that a pregnant individual who was eligible for and received MC during the last month of pregnancy shall continue to be eligible for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy.

CCR, Title 10 Section 2699.209, states that a pregnant individual who was eligible for and received coverage under the MCAP during the last month of pregnancy shall continue to be eligible for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy.

Under the provisions of H.R. 1319, the American Rescue Plan Act of the 117th Congress 2021-2022 (ARPA) (Pub. Law 117-2), effective April 1, 2022, California’s DHCS opted to broaden the scope of coverage for currently eligible and newly eligible pregnant individuals, to provide all medically necessary services during both the pregnancy and postpartum periods, and extend the postpartum period to provide an additional ten months of coverage following the current 60-day postpartum period, for a total of 12 months.

Under the Health Services Initiative (HSI) in State Plan Amendment (SPA) 21-0032, the postpartum coverage period for individuals eligible for pregnancy or postpartum care services under MCAP was also extended to 12 months, and it will end on the last day of the month in which the 365th day occurs.

Self-Attestation

Under MC, pregnant individuals can self-attest to the pregnancy.  Verification of pregnancy is not required.

Effective April 1, 2022, MC eligible individuals who are pregnant or in their postpartum period must remain in their full-scope or pregnancy aid code for the duration of the pregnancy and 365-day postpartum period.  If an individual is not on a full-scope or pregnancy aid code, then aid code 76 must be granted to run concurrently with their current aid code.  If an individual is losing their full-scope or pregnancy coverage, aid code 76 must be granted to protect these individuals.  Aid code 76 will provide all medically necessary services during the pregnancy and postpartum periods.

Retroactive Eligibility

Individuals applying for MC in the month of April 2022 can request retroactive coverage for the previous three months (January, February, and March 2022).  If they are found to be eligible for retroactive coverage, they will also be eligible to the 365-day postpartum period if the pregnancy ended in any of these three months.  The 365-day postpartum period will be calculated from the first of the month following the pregnancy end date.

Individuals applying for MC in the month of April 2022 who do not request retroactive coverage will not be eligible to the 365-day postpartum period since there was no MC eligibility in the pregnancy end month.

Allowable Discontinuance Reasons

Individuals are protected from being discontinued from MC before the end of their 365-day postpartum period, except when the individual is deceased, moves out of state, requests termination, or begins receiving MC benefits through other programs, such as California Work Opportunity and Responsibility to Kids (CalWORKs) or Supplemental Security Income (SSI).

Annual Renewals (REs)

Annual REs due during the 365-day postpartum period shall not affect the PCE individual’s eligibility.  If the household fails to complete the RE process, MC benefits must not be discontinued for the PCE individual.  These individuals are protected from being discontinued prior to the end of the 365-day postpartum period.  MC benefits can be discontinued for other household members if they fail to complete the RE process.

Furthermore, if an individual reports during the annual RE process that they were pregnant within the previous 365 days, they are eligible to the remaining days of the 365-day postpartum period, even if the pregnancy was not previously reported.  The remaining days left in the 365-day postpartum period will be calculated from the end of the pregnancy.

Redetermine MC Eligibility at the End of PCE

An eligibility redetermination must be completed for PCE individuals nearing the end of their 365-day postpartum period to evaluate for all MC programs, including Non-MAGI.

• If the end of the 365-day postpartum period aligns with the individual’s annual RE, the RE process must be followed to determine ongoing MC eligibility for the PCE individual.
• If the end of the 365-day postpartum period does not align with the individual’s annual RE, the end of the postpartum period will be considered a CIC, and ongoing MC eligibility must be determined.

Medical Support Enforcement (MSE)

PCE individuals are exempt from the MSE compliance requirements until the end of their 365-day postpartum period.

MSE referrals must not be completed for PCE eligible individuals during the 365-day postpartum period, even if there are children in the household with other absent parents.

N/A

N/A