Modified Adjusted Gross Income (MAGI) Post-Partum Coverage

Created on: 
Jun 30 2022

What is Modified Adjusted Gross Income (MAGI) Postpartum Coverage?

Postpartum coverage for MAGI medical recipients includes the following programs:

After-Pregnancy Coverage (N04) is postpartum coverage through the end of the 12th month after the pregnancy end date. To be eligible for this program, a client either: 

  • Received Pregnant Federal (N03) or Pregnancy State (N23) medical in the month their pregnancy ended, or
  • Received Categorically Needy (CN) or Medically Needy (MN) coverage at any time during their pregnancy and they currently meet eligibility requirements for coverage from a higher priority CN program.

Expanded After-Pregnancy Coverage (N07) is postpartum coverage through the end of the 12th month after the pregnancy end date. To be eligible for this program, a client:

  • Didn't receive CN or MN coverage at any time during their pregnancy, 
  • Met the non-financial eligibility requirements of the N03 or N23 program, and
  • Their income is less than or equal to the N03 or N23 income standard. 

State After-Pregnancy Coverage (N24) is state funded postpartum coverage through the end of the 12th month after the pregnancy end date. To be eligible for this program, a client either: 

  • Received medical on an N03 or N23 program in the month their pregnancy ended, or
  • Received CN or MN coverage at any time during their pregnancy and they don't currently meet eligibility requirements for coverage from a higher priority CN program. 

State Expanded After-Pregnancy Coverage (N27) is state funded postpartum coverage through the end of the 12th month after the pregnancy end date. To be eligible for this program, a client:

  • Didn't receive CN or MN coverage at any time during their pregnancy, 
  • Met the non-financial eligibility requirements of the N03 or N23 program, and
  • Their income is less than or equal to the N03 or N23 income standard.

For more information regarding After-Pregnancy Coverage programs, see the Apple Health eligibility manual - After-Pregnancy Coverage.

When does After-Pregnancy Coverage begin?

Individuals are eligible for postpartum coverage under the After-Pregnancy Coverage  program through the end of the 12th month after their pregnancy ends, and either of the following conditions are true:

  • They were active on Pregnant - Federal (N03) or Pregnancy - State (N23) at the time their pregnancy ended, or
  • They received Categorically Needy (CN) or Medically Needy (MN) coverage at any time during their pregnancy and they do not currently meet eligibility requirements for coverage from a higher priority CN program.

There are no income or resource limits for After-Pregnancy Coverage.

When does Expanded After-Pregnancy Coverage begin?

Individuals are eligible for postpartum coverage from the new Expanded After-Pregnancy program through the end of the 12th month after their pregnancy ends when all of the following conditions are true:

  • They had a pregnancy end within the last 12 months.
  • They did not receive Categorically Needy (CN) or Medically Needy (MN) coverage at any time during their pregnancy.
  • They meet the non-financial eligibility requirements of the N03 or N23 program (e.g., residency, citizenship). 
    • Having to have a current pregnancy is excluded from this condition.
  • At the time of the initial eligibility determination, their income is less than or equal to the N03 or N23 income standard.

Once an individual has have been determined eligible for postpartum coverage, the coverage is continuous through the end of the 12th month from the pregnancy end date as long as they continue to meet non-financial eligibility requirements. Income changes during the postpartum certification period don't affect eligibility.

What if the client reports a new pregnancy during the After-Pregnancy coverage period?

If an individual meets the eligibility requirements for coverage from a higher priority coverage group than the After-Pregnancy program, then that program will provide their postpartum coverage. If this eligibility ends, then they are eligible to receive coverage under the After-Pregnancy program for the remainder of their 12-month post-partum coverage period.