Recent legislation has enabled an unprecedented expansion of pregnancy-related Medicaid coverage to continuously cover the full 12-month postpartum period from the previously required 60 days. Given that Medicaid pays for more than 41 percent of births nationwide, Medicaid postpartum extensions mark significant progress toward improved access to maternal health care in the United States. However, these extensions currently ring hollow for millions of pregnant immigrants who are ineligible because of nuances in state pregnancy-related Medicaid policy. Immigrant exclusions are acutely relevant to current policy debates around Medicaid postpartum extensions, yet to date, they have received little attention. This article outlines historic Medicaid policies that shape variation in states’ immigrant eligibility rules for pregnancy-related Medicaid coverage, then considers whether 12-month postpartum extensions apply differentially across states to citizens versus different categories of noncitizens, including lawfully residing immigrants who are over the five-year bar (that is, the individual has been legally established as a US resident for more than five years), lawfully residing immigrants under the five-year bar, and undocumented immigrants.