Health Insurance Coverage and Postpartum Outcomes in the US

Abstract

ImportanceApproximately half of postpartum individuals in the US do not receive any routine postpartum health care. Currently, federal Medicaid coverage for pregnant individuals lapses after the last day of the month in which the 60th postpartum day occurs, which limits longer-term postpartum care.ObjectiveTo assess whether health insurance coverage extension or improvements in access to health care are associated with postpartum health care utilization and maternal outcomes within 1 year post partum.Evidence ReviewMedline, Embase, CENTRAL, CINAHL, and ClinicalTrials.gov were searched for US-based studies from inception to November 16, 2022. The reference lists of relevant systematic reviews were scanned for potentially eligible studies. Risk of bias was assessed using questions from the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Strength of evidence (SoE) was assessed using the Agency for Healthcare Research and Quality Methods Guide.FindingsA total of 25 973 citations were screened and 28 mostly moderate-risk-of-bias nonrandomized studies were included (3 423 781 participants) that addressed insurance type (4 studies), policy changes that made insurance more comprehensive (13 studies), policy changes that made insurance less comprehensive (2 studies), and Medicaid expansion (9 studies). Findings with moderate SoE suggested that more comprehensive association was likely associated with greater attendance at postpartum visits. Findings with low SoE indicated a possible association between more comprehensive insurance and fewer preventable readmissions and emergency department visits.Conclusions and RelevanceThe findings of this systematic review suggest that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate SoE. Future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.

Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes

“…Despite documented gains in coverage, we did not identify significant associations between the FFCRA and postpartum visit attendance, contraception, breastfeeding, or depressive symptoms. Small or null effects on overall contraception and depressive symptoms were consistent with prior studies of Medicaid expansions . However, other studies have found increases in postpartum visit attendance and LARC use, which we did not identify .…”

“…Small or null effects on overall contraception and depressive symptoms were consistent with prior studies of Medicaid expansions . However, other studies have found increases in postpartum visit attendance and LARC use, which we did not identify . These null results could again reflect a lack of beneficiary awareness of continued coverage.…”

“…Finally, this analysis highlights how research on postpartum policy interventions is restricted by the limited data on postpartum outcomes, and the short-term follow-up period for these outcomes, in PRAMS and other available data sources . There is an urgent need for definitions of target postpartum outcomes and measurement of those outcomes in representative samples . Without better data, evaluating policies and programs aimed to improve postpartum health will be severely hindered, disrupting evidence-based policymaking, limiting opportunities to improve on policy implementation and potentially leading to false conclusions that interventions are not effective.…”

Use of Recommended Neurodiagnostic Evaluation Among Patients With Drug-Resistant Epilepsy

“…The discrepancy was particularly stark for use of video EEG, a resource-intensive inpatient test. Numerous studies have reported disparities in appropriate care for patients with Medicaid . Patients in the MDCD and CCAE cohorts had similar rates of nonemergency outpatient and inpatient visits and antiseizure medication trials, suggesting disparities may be more pronounced for expensive and logistically complex neurodiagnostic studies not routinely available outside specialized centers.…”

Promoting Health for Latino Immigrant Families—A Call for Improved Systems and Policies

“…The premise of this option is that fetal health is dependent on that of the mother. However, this assumption disappears once the infant is born; only 10 states and Washington, DC, cover 1 year of postpartum care for undocumented people despite the association of postpartum care with decreased readmissions, emergency department visits, and maternal mortality …”