SCDHHS Extends Medicaid Coverage to 12 Months Postpartum
Columbia, SC –The South Carolina Department of Health and Human Services (SCDHHS) today announced Medicaid coverage will be extended from 60 days to 12 months postpartum for new and expecting mothers. SCDHHS has pursued this policy goal since 2019. In June 2021, the agency supported a proviso amendment introduced by Rep. Bill Herbkersman that supported extending Medicaid coverage to 12 months postpartum.
“Establishing continuous health care coverage during a new mother’s first year postpartum is critical to supporting strong family foundations,” said SCDHHS Director Robby Kerr. “In South Carolina, 14% of pregnancy-related deaths occur between six weeks and one-year postpartum. This policy change will enable necessary health monitoring and care coordination as providers factor in the extension to their care plans. As the health care coverage payor for 60% of the births in South Carolina, SCDHHS is well-positioned to use this targeted investment in the traditional Medicaid population to help improve the state’s maternal mortality rate and support the healthiest possible start to life for South Carolina’s youngest citizens.”
According to the South Carolina Maternal Morbidity and Mortality Review Committee, 80% of pregnancy-related deaths occur between the mother giving birth and one-year postpartum with 14% occurring between 43 days and one-year postpartum. The coverage extension to 12 months will include full Medicaid benefits for women who qualify for Medicaid because they are pregnant.
To comply with the provisions of the Families First Coronavirus Response Act, SCDHHS has not performed eligibility reviews during the federal public health emergency (PHE). As such, Medicaid coverage has continued for anyone who was enrolled in the Healthy Connections Medicaid program as of March 2020. The Secretary of the U.S. Department of Health and Human Services recently announced the federal PHE will remain in effect until at least April 16, 2022.
Healthy Connections Medicaid members should direct any questions related to this bulletin to the Member Contact Center at (888) 549-0820. The Member Contact Center’s hours of operation are from 8 a.m.-6 p.m. Monday-Friday. Providers with questions about the policy change announced above can read the Medicaid bulletin issued on this policy change or call the Provider Service Center at (888) 289-0709. The Provider Service Center’s hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.
SCDHHS pursued extending full-benefit Medicaid coverage for new mothers who qualified for Medicaid because they were pregnant or postpartum from 60 days to 12 months postpartum in 2019 through its Healthy Connections Community Engagement Initiative.
Non-disabled adults typically qualify for Medicaid if they have dependent children in the home and have an income of less than 67% of the federal poverty level (FPL). Women who are pregnant or up to 60 days postpartum are eligible for Medicaid coverage if they have an income less than 199% of the FPL. Currently, those who qualify for Medicaid because they are pregnant or postpartum and have an income above 67% of the FPL often lose full Medicaid coverage on their 61st day postpartum.
In applying for the Healthy Connections Community Engagement Initiative in 2019, SCDHHS sought to extend coverage for those who qualified for Medicaid because they were pregnant or postpartum from 60 days postpartum to 12 months postpartum for Healthy Connections Medicaid members with an income up to 199% of FPL. The Centers for Medicare & Medicaid Services approved a narrower version of this request on Dec. 12, 2019, that would provide coverage to new mothers who have been diagnosed with substance use disorder or a serious mental illness and whose income was below 199% of FPL and pledged to work with South Carolina to authorize extended postpartum coverage for the broader requested population.
About the South Carolina Department of Health and Human Services
The South Carolina Department of Health and Human Services provides health care benefits to more than 1.2 million South Carolinians. Its mission is to purchase the most health for our citizens in need at the least possible cost to the taxpayer.