i. Pregnant or Eligible for Postpartum Coverage

Section 1902(xx)(9)(A)(ii)(IX) of the Act establishes an exclusion for pregnant and postpartum women who are entitled to medical assistance under section 1902(e)(5) or (16) of the Act. Consistent with existing requirements under § 435.956(e), the State must accept an attestation of pregnancy or entitlement to postpartum medical assistance unless the State has information that is not reasonably compatible with such attestation. Individuals may report pregnancy at application, post-enrollment as a change in circumstance (including in connection with a verification of compliance with the community engagement requirement more frequently than at renewal, if elected by the State), or at renewal. States should use this information from their eligibility system or the individual's case record, including their application forms, to verify qualification as a specified excluded individual on this basis. In addition, when checking data sources to determine whether a beneficiary who was previously identified as an applicable individual is now newly excluded during a more frequent verification or at renewal. States may identify pregnancy or postpartum status based on claims data, encounter data, health records, or other reliable information available to the State. Consistent with the requirement at section 1902(xx)(5) of the Act to use reliable information available to the State to verify an individual's specified excluded status, the State must use such information to determine whether an individual qualifies as a specified excluded individual on the basis of pregnancy or eligibility for postpartum coverage without requiring information from the individual.