Extending Postpartum Medicaid Beyond 60 Days Improves Care Access and Uncovers Unmet Needs in a Texas Medicaid Health Maintenance Organization

Abstract

Under longstanding federal law, pregnancy-related Medicaid coverage is only guaranteed through 60-days postpartum, at which point many women become uninsured. Barriers to care, including lack of insurance, contribute to maternal mortality and morbidity. Leveraging the Families First Coronavirus Response Act, a federal law requiring that states provide continuous coverage to Medicaid enrollees during the COVID-19 pandemic as a condition of receiving enhanced federal financial support, we examine whether postpartum women seek additional care, and what types of care they use, with extended coverage. We analyze claims from the Parkland Community Health Plan (a Texas Medicaid Health Maintenance Organization) before and after implementation of the pandemic-related Medicaid extension. We find that after implementation of the coverage extension, women used twice as many postpartum services, 2 × to 10 × as many preventive, contraceptive, and mental/behavioral health services, and 37% fewer services related to short interval pregnancies within the first-year postpartum. Our findings provide timely insights for state legislators, Medicaid agencies, and members of Congress working to improve maternal health outcomes. We add empirical evidence to support broad extension of Medicaid coverage throughout the first-year postpartum.

Access to Reproductive Healthcare and Maternal Mental Health

“…• Mental health (MH) and substance use disorder (SUD) services were utilized three times more than before FFCRA. 42 The Importance of Healthcare Coverage It's important to note that healthcare coverage is foundational in family planning and for access to a range of reproductive health services. Coverage is provided in a variety of manners in the U.S., including through employers, the health benefit exchange, and public programs like Medicaid.…”

Sidebar: The Fourth Trimester: Promising Possibilities through Postpartum Medicaid Coverage Expansion

“…Medicaid expansion-both full expansion through the ACA and postpartum extension-improves access to care. Prior studies demonstrate decreased uninsurance rates and insurance churn postpartum, reduced maternal and infant mortality, and improved chronic disease management when Medicaid is offered to more and extended 12 months postpartum [5,8,[13][14][15][16][17][18][19][20]. Importantly, those at highest risk of adverse outcomes may have the greatest benefits.…”

“…Perinatal mood disorders confer short-and long-term health risk for women and their children, and suicide is a leading cause of maternal death in the United States [6,11,21,22]. ACA Medicaid expansion was associated with increased utilization of mental health resources and a reduction in postpartum depressive symptoms [5,17,19]. Extensions in postpartum Medicaid also led to increased availability of substance use disorder resources [5,16,19].…”

“…ACA Medicaid expansion was associated with increased utilization of mental health resources and a reduction in postpartum depressive symptoms [5,17,19]. Extensions in postpartum Medicaid also led to increased availability of substance use disorder resources [5,16,19]. Postpartum Medicaid extension improves access to contraceptive services, translating into decreased rates of unintended pregnancy and short interpregnancy intervals, which has important implications for maternal interpregnancy health optimization and preterm birth prevention [19,[23][24][25][26].…”

“…Extensions in postpartum Medicaid also led to increased availability of substance use disorder resources [5,16,19]. Postpartum Medicaid extension improves access to contraceptive services, translating into decreased rates of unintended pregnancy and short interpregnancy intervals, which has important implications for maternal interpregnancy health optimization and preterm birth prevention [19,[23][24][25][26]. Logistically, continuous insurance coverage postpartum enables patients to utilize contraceptive methods-such as intrauterine devices and implants-that often require more than one visit.…”