Medicaid postpartum care is extended in NC. What to know about the change.
Eligible North Carolina mothers on Medicaid can now receive 12 months of postpartum care, up from the previous limit of just 60 days.
For a full year after giving birth, eligible beneficiaries will be able to access full Medicaid benefits from doctors, OB/GYNs, health departments and rural health clinics for a variety of services, including mental and behavioral health care, dental services, vision and hearing services and more.
The extension went into effect April 1, with women who are pregnant or give birth on or after that date becoming eligible for the benefits. Women who were pregnant or gave birth between Feb. 1 and March 31 of this year are also eligible.
In a release about the changes, the N.C. Department of Health and Human Services said the American Rescue Plan Act of 2021 “gave states the option to increase postpartum coverage to 12 months.” In North Carolina, the extension was included in the state budget, which was approved in November 2021.
“This extended coverage is an important component to help improve the health of families in our state,” Deputy Secretary for NC Medicaid Dave Richard said in the DHHS release. “I hope we can build on this important step by expanding Medicaid in North Carolina to further support maternal health and reduce infant mortality by improving health before the pregnancy.”
Who is eligible for the extended coverage? What services does the extended coverage include? And how long will extended coverage be available in North Carolina?
Here are some answers to those questions and more.
Who is eligible for extended Medicaid postpartum care?
Information from NC Medicaid says you can get 12 months of postpartum Medicaid care if:
▪ You are in a Medicaid program that covers the birth of a child. This includes Medicaid for Pregnant Women, also known as the Baby Love program in North Carolina, which provides pregnancy-specific services to Medicaid-eligible women during and after pregnancy.
▪ You become pregnant on or after April 1, 2022.
▪ Your pregnancy ended 60 days before April 1, 2022 (Feb. 1 through March 31, 2022).
If you are in the Medicaid for Pregnant Women program, but do not currently receive full Medicaid benefits, you also will receive full Medicaid benefits as part of the postpartum care extension, effective April 1.
▪ You can get full Medicaid benefits even if you experience some life changes, such as a change in income or a change in household (for example, you get married or divorced).
▪ Some life changes could change your eligibility status and make you not qualify for the continued Medicaid coverage provided under the extension. These changes include if someone in your household dies, if you move to a new state and if you ask to leave the Medicaid program.
Note: If you are not already enrolled in a Medicaid program, you can see if you qualify for Medicaid in North Carolina at benefits.gov/benefit/1390. Eligibility depends on household size, income and other factors. You can also contact your local Department of Social Services, which you can locate at ncdhhs.gov/divisions/social-services/local-dss-directory, to work with a caseworker and determine your eligibility.
What postpartum care services are covered under the law?
The full Medicaid benefits available through the postpartum care extension include services at doctors offices, OB/GYNs, health departments and rural health clinics, beyond services just related to pregnancy, including:
▪ Laboratory and radiology services
▪ Hospitals, anesthesia and ambulatory surgical centers
▪ Outpatient specialized therapy
▪ Prescriptions (except prescriptions for Medicare beneficiaries)
▪ Vision and hearing services
▪ Dental services
▪ Podiatry
▪ Nursing home care
▪ Personal care and other home health services
▪ Medical equipment, such as wheelchairs
▪ Orthotics and prosthetics
▪ Mental and behavioral health care
▪ Transition from facilities to home- and community-based care
Postpartum care begins when your pregnancy ends. You will be eligible to receive postpartum care and associated benefits for a full 12 months after the end of your pregnancy, with the postpartum care period ending on the last day of the 12th month.
How to sign up for extended postpartum care under the law
To receive 12 months of postpartum care benefits, you must contact your local Department of Social Services (DSS) and work with a caseworker to enroll.
You can find your local DSS office at ncdhhs.gov/divisions/social-services/local-dss-directory.
You should contact your local DSS caseworker at the following points in your pregnancy:
▪ When you become pregnant
▪ If your due date changes
▪ When your pregnancy ends
Based on these factors, your DSS caseworker will set the dates for your 12-month postpartum care period and make changes as needed.
If you are already receiving Medicaid for Pregnant Women or are enrolled in another Medicaid program that qualifies you for extended postpartum coverage, you should receive a letter about postpartum benefits and how to enroll.
▪ If you do not get a letter, call the NC Medicaid Contact Center at 888-245-0179. The line is open Monday through Friday, 8 a.m. to 5 p.m.
Note: Remember to keep your contact information up-to-date throughout your pregnancy and your 12-month postpartum care period. If you or someone in your family changes their address or phone number, make sure to tell your local DSS caseworker. Your address will be used to send important documents and information throughout your care period.
When does the law end?
In its current state, the provisions of the law allowing the extended coverage will be in effect until March 31, 2027.
Additional resources and information
You can find additional information about extended postpartum Medicaid coverage in North Carolina at medicaid.ncdhhs.gov/postpartum-coverage-extension.
You can also contact the NC Medicaid Contact Center at 888-245-0179. The line is open Monday through Friday, 8 a.m. to 5 p.m.
This story was originally published April 4, 2022 at 2:30 PM.
