Continuous Medicaid Enrollment Linked To Less Postpartum Coverage Loss, Study Finds

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Dive Brief:

• Continuous Medicaid eligibility during the COVID-19 pandemic was linked to a large decrease in the number of people who lost coverage shortly after giving birth, according to a new study published in JAMA Health Forum. 
• A 100% federal poverty level increase in postpartum Medicaid eligibility during the pandemic was associated with an 8% jump in Medicaid coverage and a 40% decrease in uninsurance among people who had a Medicaid-covered birth. 
• Forty-five states have now expanded Medicaid coverage for a year after pregnancy. Those policies could result in similar reductions in uninsured postpartum people, researchers wrote. 

Dive Insight:

States are required to provide Medicaid coverage to low-income people through 60 days after giving birth. 

After that period, beneficiaries likely need to meet more restrictive income requirements to stay covered under the safety-net program, particularly in states that haven’t expanded Medicaid under the Affordable Care Act. They could become uninsured if they make too much to qualify for Medicaid as a parent. 

In 2021, the American Rescue Plan Act offered states the option to use federal matching funds to expand continuous Medicaid eligibility from 60 days to up to a year postpartum, which some researchers suggest could improve maternal health and prevent deaths. 

Last week, Utah became the 45th state to broaden Medicaid coverage up to a year after giving birth. Now, 691,000 Americans across 45 states, Washington, D.C., and the U.S. Virgin Islands have access to expanded postpartum coverage, according to the CMS.

The JAMA study provides insights into possible outcomes from expanded Medicaid policy, researchers said, using data from more than 47,000 people with a Medicaid-paid birth during the pandemic.

The research found postpartum uninsurance declined from 16.7% before the continuous enrollment policy was enacted to 9.6% at the height of the pandemic in 2020 and 2021. 

Researchers noted large decreases in Black and White people who had births covered by Medicaid, though no change for Hispanic respondents, possibly related to immigration status.

And though the study found significant coverage increases, they didn’t find associations between continuous enrollment and postpartum visit attendance, contraceptive use, breastfeeding or depressive symptoms.

Beneficiaries might not be aware of continued coverage, or they could have avoided medical appointments due to the risk of COVID-19, researchers wrote. They may have also missed patients receiving postpartum care or contraceptive counseling because of the study’s short follow-up period. 

“[…] Translation of coverage to improved postpartum health care and health outcomes should not be assumed, and will likely require concerted efforts to improve health care access and delivery in the postpartum period, which is broadly recognized as deficient,” researchers wrote.