SB 923
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 923 (Senator Washington)
Finance Health and Government Operations
Maryland Medical Assistance Program - Eligibility
This bill requires Medicaid, subject to the limitations of the State budget, to extend
coverage for eligible pregnant women with family incomes up to 250% of the federal
poverty level (FPL) for one year immediately following the end of the woman’s pregnancy.
Coverage must include dental care (in addition to comprehensive medical and other health
care services under current law). The bill takes effect January 1, 2022.
Fiscal Summary
State Effect: As discussed below, Medicaid expenditures increase by $3.9 million
(61% federal funds, 39% general funds) in FY 2022 and $15.7 million annually thereafter
to extend coverage, including dental, for pregnant women through one year postpartum.
Federal fund revenues increase accordingly. This bill increases the cost of an entitlement
program beginning in FY 2022.
($ in millions) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
FF Revenue $2.4 $9.6 $9.6 $9.6 $9.6
GF Expenditure $1.5 $6.1 $6.1 $6.1 $6.1
FF Expenditure $2.4 $9.6 $9.6 $9.6 $9.6
Net Effect ($1.5) ($6.1) ($6.1) ($6.1) ($6.1)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: Minimal.
Analysis
Current Law: Medicaid covers individuals, including pregnant women, with incomes up
to 138% FPL. Pregnant women with incomes between 138% and 264% FPL may also
qualify for Medicaid based on their pregnancy under the “SOBRA” category. In Maryland,
as in most states, current law provides Medicaid coverage to pregnant women for 60 days
postpartum.
States can extend postpartum coverage beyond 60 days through the use of state-only funds
or through a federal § 1115 waiver. The federal American Rescue Plan Act (ARPA),
enacted March 11, 2021, establishes a new state option to increase postpartum coverage to
12 months through a State Plan Amendment (SPA). Postpartum coverage granted through
an SPA is valid for a five-year period beginning April 1, 2022.
A woman who loses Medicaid coverage postpartum qualifies for a special enrollment
period through Maryland Health Connection (the State’s health insurance exchange).
Cost-sharing reduction plans are available to consumers with incomes up to 250% FPL,
and advanced premium tax credits are available to consumers with incomes up to
400% FPL.
State Fiscal Effect: Under the bill, the Maryland Department of Health (MDH) must
extend Medicaid coverage for pregnant women from 2 months postpartum to 12 months
postpartum. To receive a federal match, MDH must apply and receive approval for a federal
§ 1115 waiver or an SPA. Application can be handled with existing budgeted resources.
MDH advises that, under the new federal ARPA provision, it will pursue an SPA for the
coverage extension under the bill.
Thus, Medicaid expenditures increase by $3.9 million (61% federal funds, 39% general
funds) in fiscal 2022, which reflects an April 1, 2022 effective date for the coverage
extension. Although the bill takes effect January 1, 2022, federal law specifies that
postpartum coverage granted through an SPA begins April 1, 2022. This estimate reflects
the cost of extending Medicaid coverage for pregnant women to 12 months postpartum.
The information and assumptions used in calculating the estimate are stated below:
Based on 2019 data, an estimated 26,572 pregnant women are covered by Medicaid
each year based on their pregnancy.
About 13.8% of these women (3,667) lose their Medicaid coverage 60 days
postpartum (the remainder remain eligible under other categories).
Under the bill, Medicaid must provide an additional 10 months of coverage to these
women at an estimated rate of $428.13 per month, including both medical and dental
benefits.
SB 923/ Page 2
The coverage extension begins April 1, 2022 (thus, at most, three additional months
of postpartum coverage are provided to pregnant women in fiscal 2022).
Federal matching funds are provided at a rate of 61%.
Future years reflect annualization and assume stable enrollment and no increase in the rate
paid.
Sufficient funding for this purpose is available for fiscal 2022 as the fiscal 2022 budget,
specifically in Supplemental Budget No. 5, includes $8.3 million ($5.1 million in
federal funds, $3.2 million in general funds) to extend Medicaid coverage, including
dental, for pregnant enrollees to 12 months postpartum. Although Maryland could have
extended this coverage under ARPA absent this bill, this analysis assumes the fiscal impact
is due to the bill.
Additional Comments: In August 2020, the President of the Senate appointed a Senate
workgroup to address environmental justice, health care disparities, and wealth and
economic opportunity for minority Marylanders. The workgroup issued a report in
January 2021, which includes a recommendation to extend Medicaid coverage for pregnant
women until 12 months postpartum and provide care coordination and health literacy
education for individuals as they transition from Medicaid coverage.
Additional Information
Prior Introductions: None.
Designated Cross File: None.
Information Source(s): Maryland Department of Health; Department of Human Services;
Department of Legislative Services
Fiscal Note History: First Reader - March 9, 2021
rh/ljm Third Reader - March 29, 2021
Revised - Amendment(s) - March 29, 2021
Revised - Updated Information - March 29, 2021
Revised - Budget Information - April 13, 2021
Analysis by: Jennifer B. Chasse Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 923/ Page 3
Statutes affected: Text - First - Maryland Medical Assistance Program - Eligibility and Disenrollment: 15-103 Health General, 15-103 Health General
Text - Third - Maryland Medical Assistance Program - Eligibility: 15-103 Health General, 15-103 Health General