Implementation Guides

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CS27 – General Eligibility - Continuous Eligibility
Statute: 2107(e)(1)(J), 2107(e)(1)(K), and 1902(e)(16) of the SSA
Regulation: 42 CFR 457.342 and 435.926

INTRODUCTION

This state plan page (fillable PDF) applies to states with separate child health assistance
programs.
The state plan page CS27 captures two continuous eligibility policies for states’ separate CHIPs:
1) whether states provide continuous eligibility through a pregnant individual’s 12-month
postpartum period and 2) states’ assurance that it provides continuous eligibility coverage for
children.
This state plan page is required in the following scenarios:
1) When a state elects to provide continuous eligibility during an individual’s 12-month
extended postpartum period in Medicaid if it has an approved CS7 and/or CS8
2) Effective January 1, 2024, when a state has an approved CS7 and/or CS9 (i.e., the state
provides coverage to targeted low-income children), continuous eligibility coverage must
be provided for 12 months.
For states that elect to cover only the from-conception-to-end-of-pregnancy population
(otherwise known as the “unborn”) consistent with the CS9 through its separate CHIP, the 12Month Postpartum Continuous Eligibility section of this template is not applicable; however, the
Mandatory Continuous Eligibility for Children section is required.

BACKGROUND
12-Month Postpartum Period Continuous Eligibility
Section 2107(e)(1)(J) of the Social Security Act (the Act) requires that if states elect to provide
continuous eligibility through an individual’s 12-month postpartum period in Medicaid, the state
is also required to provide the same extended postpartum coverage in CHIP. Additionally,
separate CHIPs cannot offer the 12-month postpartum period if the state does not elect to provide
the same option in Medicaid.

Section 2107(e)(1)(J) applies section 1902(e)(16) equally to CHIP and allows individuals who
were eligible for and enrolled in CHIP while pregnant to remain eligible regardless of changes in
circumstance except for the following:
• The individual requests a voluntary disenrollment.
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CS27 – General Eligibility - Continuous Eligibility
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•

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The individual is no longer a resident of the state;
The Agency determines that eligibility was erroneously granted at the most recent
determination or renewal of eligibility because of agency error or fraud, abuse, or perjury
attributed to the individual; or
The individual dies.

Unlike with continuous eligibility for children, states providing an extended postpartum period
may not disenroll individuals during their pregnancy or 12-month postpartum period for
becoming eligible for Medicaid.
While eligibility for Medicaid is not an exception to continuous eligibility in CHIP during
pregnancy and the extended postpartum period under section 2107(e)(1)(J), it may be beneficial
for a pregnant or postpartum individual to request voluntary termination of CHIP eligibility to
enroll in Medicaid. As such, beneficiaries who become Medicaid eligible need to be informed
about the differences between the programs, including cost sharing, benefits, provider networks,
and their eligibility for extended postpartum coverage, so they can make an informed decision.
States implementing the extended postpartum period in CHIP are required to provide the same
scope of benefits provided to other targeted low-income children or targeted low-income
pregnant women under the CHIP state plan.
Mandatory Continuous Eligibility Period for Children
Section 2107(e)(1)(K) of the Act requires states to provide coverage to children for a 12-month
period, regardless of a change in family circumstances that might otherwise result in the
termination of eligibility.
Under 42 CFR 457.342(a), states must apply the same exceptions to continuous eligibility for
children in Medicaid consistent with §435.926. In addition, if a child becomes eligible for
Medicaid, the state must transfer them to Medicaid.
The continuous eligibility period must begin on the effective date of the child’s most recent
determination or renewal of eligibility and continue for a duration of 12-months, regardless of
any changes in family’s circumstances, unless:
•
•
•

The child attains age 19.
The child or child’s representative requests voluntary disenrollment.
The child is no longer a resident of the state.

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•
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The Agency determines that eligibility was erroneously granted at the most recent
determination or renewal of eligibility because of agency error or fraud, abuse, or perjury
attributed to the child or the child’s representative.
The child dies; or.
The child becomes eligible for Medicaid.

TECHNICAL GUIDANCE
PREREQUISITES:
None
This state plan page is broken down into the following sections:
12-Month Postpartum Continuous Eligibility
• Policy statement
• Selection of 12-Month Postpartum Continuous Eligibility
• Eligible Individuals
• Exceptions to Continuous Eligibility
• Benefits During the 12-Month Postpartum Period
Mandatory Continuous Eligibility Period for Children
• Policy Statement
• Assurance of Continuous Eligibility and Exceptions
• Selection of From-Conception-to-End-of-Pregnancy Optional Coverage Group
• Assurance of Continuous Eligibility for From-Conception-to-End-of-Pregnancy Optional
Coverage Group
12-Month Postpartum Continuous Eligibility
Policy Statement
This section begins with a policy statement that providing continuous eligibility through a
pregnant individual’s 12-month postpartum period is required in CHIP if the state elects to
provide the same option for pregnant individuals in the Medicaid state plan.
Selection of Continuous Eligibility Option
In this section, the state indicates whether it provides continuous eligibility during an
individual’s 12-month postpartum period in Medicaid.
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Review Criteria
If the state does not elect to provide continuous eligibility during an individual’s 12-month
postpartum period in Medicaid, the state cannot provide the option under the CHIP state plan.
If the state has an approved CS7 or CS8, and the answer is yes, the state must complete the
remainder of the Postpartum Section of the state plan page.
Eligible Individuals
This section provides a description of individuals who are eligible for continuous eligibility
throughout their pregnancy and 12-month postpartum period. In addition to all pregnant
applicants and all pregnant or postpartum enrollees in CHIP, states have the option to re-enroll
individuals who were terminated from CHIP prior to the state implementing the extended
postpartum option who would have otherwise been eligible for the extended postpartum period.
These individuals who are re-enrolled are eligible for continuous eligibility through the
remainder of their 12-month postpartum period.
Review Criteria
The state must check off the first assurance that the state will implement the extended
postpartum period consistent with section 2107(e)(1)(J) of the Act, and the second assurance
describing the required eligible individuals. If the state does not check off the assurances, this
state plan page cannot be approved.

Exceptions to Continuous Eligibility
The first assurance in this section lists the permissible exceptions to continuous eligibility
throughout an individual’s pregnancy and 12-month postpartum period. All of these exceptions
are mandatory and are prechecked.
The second assurance specifies that states electing the extended postpartum option continue to
provide continuous eligibility regardless of exceptions otherwise permitted in CHIP under
§457.342(b). This includes becoming eligible for Medicaid.

Review Criteria
The state must check off both assurances in this section, otherwise the state plan pages cannot
be approved.
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Benefits
This section describes the benefit package states are required to provide individuals during their
12-month postpartum period.
Review Criteria
The state must check off the assurance in this section, otherwise the state plan pages cannot
be approved.
If states want to provide additional benefits to individuals only during the 12-month
postpartum period, the state should make the appropriate updates in Section 6 of the paper
CHIP state plan.
Mandatory Continuous Eligibility Period for Children
Policy Statement
This section of the CS27 begins with a policy statement that “The CHIP Agency must provide
that children who have been determined eligible under the state plan shall remain eligible,
regardless of any changes in the family’s circumstances, for a 12-month continuous eligibility
period.”
Assurance of Continuous Eligibility and Exceptions
In this section, the state assures that it provides continuous eligibility to its targeted low-income
children for a duration of 12 months, regardless of any changes in circumstances. The CHIP
regulations at §457.342 cross reference Medicaid regulations at §435.926(d) and permit the same
Federal exceptions to the continuous eligibility process as Medicaid.
The assurance in this section lists the permissible exceptions to continuous eligibility. The
mandatory exceptions are pre-checked.
Review Criteria
The state must check off the assurance in this section if the state has an approved CS7 and
offers coverage to targeted low-income children, otherwise the state plan pages cannot be
approved.

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Selection of From-Conception-to-End-of-Pregnancy Optional Coverage Group
In this section, the state selects whether or not is has elected to provide coverage to the fromconception-to-end-of-pregnancy population (otherwise known as “unborn”). States that have
elected to provide this coverage option must provide continuous eligibility to this population as
well.
Review Criteria
The state must answer yes in this section if the state has an approved CS9 and offers coverage
to the from-conception-to-end-of-pregnancy population, otherwise the state plan pages cannot
be approved.
If the answer is yes, the state must complete the remainder of this section of the state plan
page.
If the state does not have an approved CS9 and does not offer coverage to the fromconception-to-end of pregnancy population, the state must answer no and it does not need to
complete the remainder of this section. The review is complete.
Assurance of Continuous Eligibility for the From-Conception-to-End-of-Pregnancy
Optional Coverage Group
In this section, the state assures continuous eligibility for the from-conception-to-end-ofpregnancy group (otherwise known as “unborn”) is provided in the same manner as continuous
eligibility for other targeted low-income children, except for the duration of the continuous
eligibility period.
Unlike other targeted low-income children, the duration of the continuous eligibility period for
the unborn will depend on how a state pays for labor and delivery services. The state may refer
to the Continuous Eligibility for Children SHO #23-004 for more detailed information on
payment information.
Following the initial assurance in this section, the state will answer the following “Yes/No”
questions: 1) the state screens the child for potential eligibility for Medicaid upon birth, and 2)
the state deems the newborn eligible for Medicaid and ends the continuous eligibility period in
CHIP at birth.
Review Criteria
If the state offers coverage under the from-conception-to-end-of-pregnancy population, the
state must select the assurance or this state plan page cannot be approved.
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The state must select yes or no to screening the child for potential eligibility for Medicaid upon
birth or this state plan page cannot be approved.
The state must select yes or no to deeming newborns eligible for Medicaid or this state plan
page cannot be approved.

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