Extending Postpartum Medicaid: State and Federal Policy Options during and after COVID-19

Daw, Jamie R.; Eckert, Emily; Allen, Heidi; Underhill, Kristen

doi:10.1215/03616878-8893585

Cited by 16 publications

(13 citation statements)

References 8 publications

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“…Over the past year, multiple states have introduced or passed legislation to extend pregnancy-related Medicaid to 1 year postpartum, and several states have Medicaid 1115 waivers pending to do so. 11 In March 2021, Congress passed the American Rescue Plan (ARP), which included an option for states to extend postpartum Medicaid for 1 year with federal matching funds. 12 This legislation allows states to bypass the 1115 waiver process and implement an extension through a state plan amendment.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Postpartum Uninsurance Among Medicaid-Paid Births

Daw¹,

Kozhimannil

Admon

2021

JAMA Health Forum

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IMPORTANCE To reduce postpartum uninsurance and improve postpartum health, the American Rescue Plan included an option for states to extend pregnancy-related Medicaid from 60 days to 1 year after childbirth. Recent estimates of postpartum uninsurance among Medicaid-paid births would provide information on who would benefit from state adoption of this extension. OBJECTIVETo estimate rates of postpartum uninsurance among individuals with Medicaidpaid births. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used survey data from the 2015 to 2018 Pregnancy Risk Assessment Monitoring System (PRAMS), a representative sample of births in 43 states and New York City, New York, and included PRAMS participants for whom Medicaid was the primary payer for childbirth. The mean weighted PRAMS response rate was 60.9% for the sites and years included in this study. The data were analyzed from December 2020 to January 2021. INTERVENTIONS OR EXPOSURES Self-reported postpartum uninsurance measured at the time of the PRAMS survey (mean [interquartile range], 4.2 (3.0-5.0) months after birth). MAIN OUTCOMES AND MEASURES Survey-weighted rates of postpartum uninsurance and 95% CIs overall, by state, by state Medicaid expansion status, and by maternal sociodemographic characteristics. Adjusted odds ratios of the association between maternal characteristics and postpartum uninsurance. RESULTS We identified 63 370 respondents with a Medicaid-paid birth. Of these, 22 016 (41.1%) were non-Hispanic White individuals, 17 442 (22.0%) non-Hispanic Black individuals, 6808 (13.3%) Spanish-speaking Hispanic individuals, 7000 (13.7%) English-speaking Hispanic individuals, 2410 (4.0%) Asian/Pacific Islander individuals, and 3894 (1.3%) Indigenous individuals. Of these, 41.7%were no longer insured by Medicaid postpartum and 22.0% were uninsured postpartum. The postpartum uninsurance rate was 3 times higher in Medicaid nonexpansion states (36.8%) compared with expansion states (12.8%). Postpartum uninsurance varied significantly across states, ranging from 1.7% in Massachusetts to 56.7% in Texas. There were substantial racial and ethnic disparities in postpartum uninsurance: 54.9% of Hispanic, Spanish-speaking individuals (adjusted odds ratio[aOR], 6.2; 95% CI, 5.5-7.0) and 42.8% of Indigenous respondents reported postpartum uninsurance (aOR, 4.3; 95% CI, 3.8-4.9) compared with 15.2% of non-Hispanic White respondents. The odds of postpartum uninsurance was higher among unmarried people (aOR, 1.3 compared with married people; 95% CI, 1.2-1.4), those 35 years and older (aOR, 1.5 compared with those younger than 20 years; 95% CI, 1.2-1.9) and those with lower levels of education (aOR, 0.8 for more than high school compared with less than high school; 95% CI, 0.7-0.9). CONCLUSIONS AND RELEVANCEIn this cross-sectional survey study of 43 states, a high proportion of people with Medicaid-paid births were uninsured in the postpartum period, (continued) Key Points Question What factors are associated with postpartum uninsurance among Medicaid-paid ...

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Section: Introductionmentioning

confidence: 99%

Factors Associated With Postpartum Uninsurance Among Medicaid-Paid Births

Daw¹,

Kozhimannil

Admon

2021

JAMA Health Forum

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“…These findings are timely, as multiple state legislatures and Medicaid programs consider the necessity for and parameters of extending postpartum coverage beyond 60 days ( 10 ). The ongoing debate largely centers on the optimal duration of coverage (e.g., 6- vs. 12-months) and the breadth of services (e.g., full scope vs. limited to certain conditions) that should be provided ( 15 ).…”

Section: Discussionmentioning

confidence: 98%

“…A provision in the Families First Coronavirus Response Act (FFCRA) of 2020 provides a unique opportunity to study the potential impact of extending the Medicaid postpartum coverage period. By requiring that state Medicaid programs provide continuous coverage to enrollees through the end of the COVID-19 public health emergency (PHE), the FFCRA functionally extends coverage for pregnant women beyond 60 days postpartum ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Pengetnze

Eckert

et al. 2022

Front. Public Health

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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.

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“…Coverage before, during, and beyond pregnancy can anchor and finance health care system transformations (Bellerose, Collin & Daw;Daw, Eckert, Allen, & Underhill, 2021;Haley & Johnston, 2021;Johnston, McMorrow, Thomas, & Kenney, 2020). The need for transformation of primary care for women is well-documented.…”

Section: Support For Health Care System Transformationmentioning

confidence: 99%