Comparison of Postpartum Health Care Use and Spending Among Individuals with Medicaid-Paid Births Enrolled in Continuous Medicaid vs Commercial Insurance

Abstract

IMPORTANCEPostpartum Medicaid eligibility extensions are likely to shift enrollees from commercial to Medicaid coverage in the postpartum year; however, the potential implications for health care use and spending are unknown. OBJECTIVE To compare health care use and spending among individuals with a Medicaid-paid birth who had continuous Medicaid vs continuous commercial insurance during months 3 to 12 post partum. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study using linked all-payer claims, birth records, and income data for Medicaid-paid births in the Colorado All Payer Claims Database from 2014 to 2019 to estimate the association between continuous Medicaid vs commercial insurance and health care use and spending during months 3 to 12 post partum. EXPOSURE Continuous enrollment in Medicaid vs commercial insurance during months 3 to 12 post partum. MAIN OUTCOMES AND MEASURES Primary outcomes were the rate and number of primary care and outpatient visits, and total out-of-pocket spending during months 3 to 12 post partum. Secondary outcomes were the rate and number of emergency department visits and hospitalizations during months 3 to 12 post partum. RESULTS The 44 471 individuals in the sample had a mean (SD) age of 26.8 (5.50) years. Selfreported race and ethnicity included 1279 (2.9%) Asian individuals, 4028 (9.1%) Black individuals, 33 534 (75.4%) White individuals, as well as 5630 (12.7%) individuals of other race and ethnicity (American Indian or Alaskan Native; Other Pacific Islander; and unspecified). Of these, 19 337 (43.5%) self-identified as Hispanic individuals. The sample included 42 989 individuals continuously enrolled in Medicaid and 1482 individuals continuously enrolled in commercial insurance during months 3 to 12 post partum. Compared with those continuously enrolled in Medicaid, commercially insuredenrollees were older (32.2% of commercial enrollees were between the ages of 30-39 vs 27.5% of Medicaid enrollees, P < .001), less likely to be Hispanic (38.9% in commercial vs 43.7% in Medicaid, P < .001) or born in the US (15.6% in commercial vs 19.6% in Medicaid, P < .001), and more likely to be married (62.8% in commercial vs 54.8% in Medicaid, P < .001), have completed college (32.9% in commercial vs 16.5% in Medicaid, P < .001), and initiated early prenatal care (79.7% in commercial vs 72.5% in Medicaid, P < .001). In multivariable models, individuals with commercial insurance were 2.46 percentage points (95% CI, 2.12-2.79 percentage points; P < .001) more likely to attend a primary care visit and had 0.81 (95% CI, 0.70-0.92; P < .001) additional primary care visits total during months 3 to 12 post partum. Individuals enrolled in commercial insurance were 7.92 percentage points (95% CI, −8.44 to −7.40 percentage points; P = .006) less likely to visit an emergency department compared with those enrolled in Medicaid. Total adjusted per person (continued) Key Points Question How do health care use and spending compare in the postpartum year for individuals with Medicaid vs commercial i...

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