ModifiedUtah MedicaidPolicy UT-25-0024

Extended Postpartum Coverage State Plan Provisions

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This amendment removes Utah’s election of the extended postpartum coverage option from the Medicaid state plan and transitions authority for extended postpartum coverage to Utah’s Medicaid Reform 1115 Demonstration.

Policy Summary

PayerUtah Medicaid

PolicyExtended Postpartum Coverage State Plan Provisions

Policy CodePolicy UT-25-0024

Change TypeModified

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionApply continuous eligibility through the end of the month in which the applicable 60-day or 12-month postpartum period ends.

SourceLink

POLICY UPDATE CHANGES

Utah removes its state plan election of the extended postpartum coverage option under section 1902(e)(16) of the Social Security Act.

Adds optional continuous Medicaid eligibility through the end of the month in which a 12-month postpartum period ends.

Provides mandatory continuous eligibility through the end of the month in which the 60-day postpartum period ends, without regard to income changes that would otherwise cause ineligibility.

60 daysMandatory postpartum eligibility

12 monthsOptional postpartum eligibility

ExcludedPresumptive eligibility-only individuals

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ModifiedUtah MedicaidPolicy UT-25-0024

Extended Postpartum Coverage State Plan Provisions

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Policy Summary

PayerUtah Medicaid

PolicyExtended Postpartum Coverage State Plan Provisions

Policy CodePolicy UT-25-0024

Change TypeModified

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionApply continuous eligibility through the end of the month in which the applicable 60-day or 12-month postpartum period ends.

SourceLink

POLICY UPDATE CHANGES

Utah removes its state plan election of the extended postpartum coverage option under section 1902(e)(16) of the Social Security Act.

Adds optional continuous Medicaid eligibility through the end of the month in which a 12-month postpartum period ends.

Provides mandatory continuous eligibility through the end of the month in which the 60-day postpartum period ends, without regard to income changes that would otherwise cause ineligibility.

60 daysMandatory postpartum eligibility

12 monthsOptional postpartum eligibility

ExcludedPresumptive eligibility-only individuals

Postpartum Continuous Eligibility

State Plan Treatment and Transition of Authority

Effective January 1, 2026, Utah removed its election of the extended postpartum coverage option under Social Security Act §1902(e)(16) from the state plan. Authority for extended postpartum Medicaid coverage transitioned to the Utah Medicaid Reform 1115 Demonstration (project number 11-W-00145/8), approved as an amendment on November 13, 2025, and implemented in alignment with the SPA effective date.

Extended postpartum coverage treatment

Utah's state plan no longer elects the extended postpartum coverage option described in Social Security Act §1902(e)(16), effective January 1, 2026.
Extended postpartum coverage authority is provided through the Utah Medicaid Reform 1115 Demonstration (project number 11-W-00145/8).

Mandatory 60-Day Postpartum Continuous Eligibility

Mandatory continuous eligibility applies to pregnant individuals who were eligible and enrolled under the state plan.

ALL of the following

The individual was eligible and enrolled under the state plan while pregnant.
The individual is within the 60-day postpartum period beginning on the last day of the pregnancy, through the last day of the month in which that period ends.60-day postpartum period
Eligibility continues without regard to changes in income that would otherwise result in ineligibility.
The individual was not eligible only during a period of presumptive eligibility.
The mandatory continuous eligibility extension does not apply to pregnant individuals eligible only during presumptive eligibility.

Optional 12-Month Postpartum Continuous Eligibility

Optional 12-month postpartum continuous eligibility applies to pregnant individuals who were eligible and enrolled under the state plan while pregnant, including during a period of retroactive eligibility.

ALL of the following

The individual was eligible and enrolled under the state plan while pregnant, including during a period of retroactive eligibility.
The individual remains covered through the last day of the month in which the 12-month postpartum period, beginning on the last day of the pregnancy, ends.12-month postpartum period

Eligibility Periods

Mandatory postpartum continuous eligibility

Coverage typeMandatory continuous eligibility for pregnant individuals

Coverage endpointThrough the last day of the month in which the 60-day postpartum period ends

Postpartum period beginsOn the last day of the pregnancy

ExclusionDoes not apply to pregnant individuals eligible only during a period of presumptive eligibility

Optional extended postpartum continuous eligibility

Coverage typeOptional 12-month postpartum continuous eligibility for pregnant individuals

Coverage endpoint

Eligibility and Postpartum Terms

Mandatory continuous eligibility

DefinitionContinuous eligibility for pregnant individuals who were eligible and enrolled under the state plan

Income changesContinues without regard to income changes that otherwise would result in ineligibility

Coverage periodContinues through the applicable 60-day postpartum period

ExclusionDoes not apply to individuals eligible only during a period of presumptive eligibility

Optional 12-month postpartum continuous eligibility

DefinitionContinuous eligibility for pregnant individuals who were eligible and enrolled under the state plan while pregnant