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Legislative Milestones in Medicaid and CHIP Coverage of Pregnant Women


Year Statute
1984 Deficit Reduction Act of 1984 (P.L. 98-369) required states to provide Medicaid to:

  • a pregnant woman with no other dependent children who would be a single parent (or a parent with the other parent incapacitated) and eligible for Aid to Families with Dependent Children (AFDC) if the child were born; and
  • a pregnant women in a family with two able-bodied parents (one of whom must be unemployed), who would be eligible for AFDC if the child were born.
1986 Consolidated Omnibus Budget Reconciliation Act of 1985 (P.L. 99-272):

  • required states to cover pregnant women meeting state AFDC income and resource standards, regardless of employment or marital status;
  • required 60 days postpartum coverage for pregnant women; and
  • provided that pregnancy-related services available to covered women need not be available to other Medicaid enrollees.
1986 Omnibus Budget Reconciliation Act of 1986 (P.L. 99-509):

  • gave states the option to cover all pregnant women and children up to age five in families with incomes at or below 100 percent of the federal poverty level (FPL), regardless of their AFDC eligibility status or assets;
  • gave states the option to provide continuous coverage to a woman throughout her pregnancy and for 60 days following delivery regardless of changes in income or assets; and
  • permitted states to provide ambulatory prenatal care to women during a presumptive eligibility period of up to 45 days, if:
    • the woman has begun maternity care with a qualified provider,
    • the provider determines that the woman’s family income falls below the applicable Medicaid standard and notifies the state of the woman’s eligibility within five working days, and
    • the woman applies for such benefits within 14 days of being presumed eligible.
1987 Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203):

  • gave states the option to extend Medicaid coverage to pregnant women and infants up to 185 percent FPL.
1988 Medicare Catastrophic Coverage Act of 1988 (MCCA, P.L. 100-360):

  • required states to phase in Medicaid coverage for all pregnant women and infants in families with income up to 100 percent FPL. (Much of MCCA was repealed in 1989, but provisions related to pregnant women were retained.)
1989 Omnibus Budget Reconciliation Act of 1989 (P.L. 101-239):

  • required Medicaid coverage for all pregnant women (and children under age six) in families with incomes at or below 133 percent FPL.
1990 OBRA 1990, Omnibus Reconciliation Act of 1990 (P.L. 101-508).

  • Required states to provide continuous coverage for women throughout pregnancy and through the 60-day postpartum period regardless of changes in income or assets.
1996 Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193):

  • prohibited Medicaid coverage for non-emergency services to otherwise eligible legal non-citizens entering the United States on or after August 22, 1996 (including pregnant women), until they have resided in the United States for five years. Permitted coverage after the five-year ban at state option.
2009 Children’s Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3):

  • permitted states to cover lawfully residing pregnant women and children through Medicaid and CHIP without regard to the five-year residency requirement; and
  • allowed states to cover low-income pregnant women under CHIP through a state plan amendment.
2010 Patient Protection and Affordable Care Act of 2010 (P.L. 111-148, as amended):

  • added tobacco cessation programs for pregnant women and services provided at freestanding birth centers as mandatory benefits.
2021 American Rescue Plan Act of 2021 (P.L. 117-2) provided states an option to extend the postpartum coverage period for 12 months. States that adopt the option must provide pregnant and postpartum individuals full Medicaid benefits. A state selecting this option must also extend the postpartum coverage period for targeted low-income children and pregnant women in CHIP. This option is available for five years, beginning April 1, 2022.
2022 The Consolidated Appropriations Act, 2023 (P.L. 117-328) made the state option to
extend the postpartum coverage period for 12 months a permanent option.

Source: MACPAC analysis as of January 2023.