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ARPA Post-Partum Care Extension (PPCE)
Postpartum Care Extension to 365 Days
Prior to April 1, 2022, a pregnant individual eligible for Medi-Cal during the last month of pregnancy continued eligibility for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy. Access to these services ended on the last day of the month in which the 60-day period ends. Under the provisions of the American Rescue Plan Act (ARPA), beginning April 1, 2022, California opted to extend the Medi-Cal postpartum period to a 365-day period (12 months). The 12 month period will begin on the on the last day of pregnancy and end on the last day of the month in which the 365th day occurs. The new provisions also expand full scope coverage to individuals in restricted or limited scope Medi-Cal programs. Due to Continuous Eligibility for Pregnancy (CEP) rules, pregnant individuals will maintain coverage through their pregnancy and an extended postpartum coverage regardless of income changes, or the outcome of the pregnancy and without requiring a mental health diagnosis which was previously required to extend postpartum coverage beyond 60 days.
MEDS alerts 9561 and 9562 will generate when PPCE is ending or overdue and eligibility needs to be redetermined. The end of the PPCE period will be treated as a change in circumstance (CIC) and the PPCE individual must have their eligibility redetermined. Annual redeterminations (REs) which are due during the PPCE period must not negatively affect PPCE eligibility.
Note: MCAP individuals (aid code 0E) will have their PPCE administered by MAXIMUS. If an EW receives the MC 61 PPCE for an individual in aid code 0E, they shall send the scanned copy to MAXIMUS by secure email at SPELiaisons@maximus.com.
Aid Codes
Beginning April 1, 2022, a pregnant individual will be granted a 365 day postpartum period and will remain in a full-scope aid code for the duration of the pregnancy and 365 postpartum period. If an individual is not in a pregnancy aid code, does not have full-scope, or is losing their coverage in a full-scope aid code, or the aid code does not provide the full breadth of medically necessary services the individual should also be aided under aid code 76 as a means to protect the pregnancy and postpartum eligibility. Aid code 76 is not required when the beneficiary has full scope coverage or is active on M0 or M8.
Retroactive Eligibility
Individuals applying for Medi-Cal in April 2022 can request retroactive coverage for any of the three previous months in 2022 (January, February, March). If found eligible for retroactive Medi-Cal and their pregnancy ended in any of the three previous months, the individual must have their 365 day postpartum period established from last day of their pregnancy.
Medi-Cal Redetermination After April 2022
If the individual later informs the county through the annual Medi-Cal Redetermination process and the individual did not have their 365 day postpartum period previously established, the individual must have their 365 day postpartum period established from the last day of their pregnancy
Allowable Reasons to Discontinue During the 365 Day Postpartum Period
There are only five allowable reasons to discontinue during the 365 day continuous eligibility period for the postpartum individual.
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Deceased
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Loss of California Residency
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Client Request
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Receipt of Social Security Supplemental income (SSI)
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Eligible for CalWORKS
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